Just when you think you've seen/heard it all.........

leslie :-D · Jun 23, 2012

A pt the other weekend told me he wanted on hospice, because he "heard hospice gives out the good stuff, and I want the good stuff!" Also wanted to know if he got on hospice, if he could have as much "morphin" as he wanted.

if he has a serious illness that could warrant hospice, then i hope he gets every gtt of mso4 out there.

at eol, i am NOT going to worry about actual or potential for addiction.

that should be the least of everyone's worries. :twocents:

leslie

LockportRN · Jun 23, 2012

Cheryl, amazingly compassionate insight.

nerdtonurse?, BSN, RN · Jun 23, 2012

But....

We've had to discharge people from hospice for addiction. When you place narcotics in the home, that's still your license, the hospice facility's MD's license, etc. And we've had people who took the emergency kit and had a party with the neighbors -- they were terminated from hospice for that, despite a end stage diagnosis. I've seen a bottle of 200 Vicodin from the VA be "used up due to pain" in 3 days. Uh, no. We're here to treat the sick, not be the dealer for the neighborhood. I don't know if in home diversion of meds from the patient to the other family members has ever shut down a hospice, but there are a lot of people who absolutely HATE hospice -- we're starving people to death, giving them "that last shot" and killing them with morphine, when they should be "fighting." You get the wrong DA or sheriff with a thimbleful of power, and you could lose the ability to help a lot of people because of a junkie. When we've had that situation, we go by the house and give only 1 day's meds, or put in a pain pump (that somehow always breaks because he "dropped it", and you can see the screwdriver marks where they were trying to get to the cassette to get the dilaudid). Push come to shove, we put them in a facility to monitor their pain control. We'll take them, but it's a huge liability and risk. You can't fix a life at it's end, but I wouldn't risk losing the ability to help a 100 people for the sake of 1.

Altra, BSN, RN · Jun 23, 2012

nerdtonurse, I have to say that I did not consider a home setting when reading or responding to this thread, particularly since the OP stated that the patient in question was instead referred to her ECF - another inpatient setting.

leslie :-D · Jun 23, 2012

nerd, excellent points.

and i was talking from an inpt hospice setting...

but definitely agree with the caveats re risks involved at home.

definitely.

thanks for the other (but equally as notable) perspective.

lesie

netglow, ASN, RN · Jun 23, 2012

Eh, well. Depends on who put him on service to begin with. I'd be willing to bet especially if it was one of the gazillion pop up hospice companies as of late, they just used his dx to put him on. Anything to get an admit $$$. He was good with the decision and so were they - win/win.

However, if this is not the case and he is in trouble, you just might not have decent case managers, and you have some creepy staff trying to pin seeking on a dead man. This could also be the case. Not all hospice CMs know what they are doing. Actually lots don't, and think this whole deal is about them, and not the patient.

So greatly dependent on a lot of factors, hospice can be really "you know what'd up".

BlueDevil,DNP, DNP, RN · Jun 24, 2012

I saw a patient last week with CC "demonic possession." the only thing that reportedly kept the demon under control was lorazepam. I suggested lithium and a priest, lol.

I win.

bratmobile · Jun 24, 2012

@bluedevil,,, yes you do,,hands down,,every time ,,lol

tothepointeLVN, LVN · Jun 24, 2012

I saw a patient last week with CC "demonic possession." the only thing that reportedly kept the demon under control was lorazepam. I suggested lithium and a priest, lol.
I win.

So jealous. So generic lorazepam worked and not brand name Ativan only?

BlueDevil,DNP, DNP, RN · Jun 24, 2012

low rent demon I guess.

Paging Zenman, I have a referral for you!