Latest Comments by RN4ustat

RN4ustat 2,485 Views

Joined: Apr 26, '02; Posts: 161 (1% Liked) ; Likes: 1

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    Wow!! Thanks for the links.......looks like some really good info!! I was very fascinated by the dementia prognostication info, specifically the mention of the Mortality Risk Index as the company I work for has recently started to use it in determining eligibility. Thanks again for the info!!

    This could lead to serious problems for your agency if you're not using the tools the same (which means at least one of you is using it wrong!) And I'm assuming these instruments are being used as part of the continuing certification as well as to document decline from a clinical stand point.

    I'm attaching "Fast Fact #150, Prognostication of Dementia" it should help with your documentation. I found it pretty easy just by putting into Google "Dementia Prognostication FAST score" it was the first hit. I guess I've just gotten good at doing searches.

    But you should also know about the "Fast Facts" in general -- there's even a downloadable version for a PDA! You can find them here:
    And there's even a search function now.

    The PPS is discussed in FF #125

    Also, Growth House has a link to various tools here:

    Good luck. I hope these documents help

    Concept 150 Dementia Formatted.pdf

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    Actually, you don't want to initiate atropine eye gtts too early...if the patient is actively dying then it is appropriate to use to manage congestion and secretions. However, if it is started too early, it can actually cause pyschosis.

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    I do 20-22 visits per week and I try to always give myself a day in the office for recerts and other paperwork. I usually see about 5 pts per day but that depends on how much windshield time is required to see them all. I have several patients that are only located within a 2-3 mile radius of each other, so I can easily see 6 on that day and I have several that all live in one facility so that makes it easy to see 6-7. My schedule is in an uproar at the moment however because I'm currently trying to transition my patients to other case managers so that I can move to another position.

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    paulh61 likes this.

    I currently have 15 and have had as many as 25 but my company utilizes LPNs to assist with the visits. We set our frequencies of course to meet our pt needs and we only have to see our pts q 14 days to do the supervisory visit, but most of us try to see all our pts at least once a week. They want the RN's to do 20-22 visits a week and the LPN's to do 28-30. This is really a fairly decent caseload....I even have one full day that I can dedicate to recerts and updating charts, etc and my team director will either let us come into the office on our "paper day" or work from home!! I've never had so much flexibility!! Its awesome!! We have a full-time after hours team and a full-time admit team but we do take backup call approximately one night a month and are back up for admits about once a month. Our service area is pretty large and there are days when we have 5 or 6 admits. It really isn't too often that we have to do a backup admit however. And if we do an admit voluntarily after hours or on a weekend, we are compensated VERY well for it!!

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    No, not all hospices are like the one you're working for. I worked for a large, nationally known hospice last year and can truly feel your pain because it sounds like a carbon copy of the scenario I experienced!! Our Executive director and Patient Care Manager were ignorant to our problems/concerns!! We begged desperately for more help and were promised multiple times that help was on the way but it never really was. The PCM promised to come out into the field to help ease our load but never did!! After nearly a year, I couldn't take it anymore and I went to work for a hospice 9 miles down the road. At first I was afraid that it would be the same situation but I've been with this company nearly 9 months and I've given up waiting for the other shoe to fall because I truly don't think it will!! I am truly amazed by the teamwork with this company. Everyone pitches in to help when there is a crisis and our team director is so supportive!! Hang in there!! Oh by the way, none of the nurses I worked with at the other company are still there..........imagine that!! I think the burnout rate is about 3 months........Sad isn't it?!

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    I recently attended a teleconference regarding terminal restlessness/agitation and was a little surprised to learn that often times, ativan is to blame for increased restlessness/agitation. The physicians that were giving this seminar recommended haldol or even risperdal which doesn't cause as much euphoria. I'll have to find the documentation from that seminar and post the specifics. It was VERY interesting actually!!

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    Quote from Suesquatch
    Next time stick your fingers in your ears and sing, "LA LA LA LA I CAN'T HEAR YOU!"

    She might stop from sheer astnishment.
    LOL!!! That just might work.......but may get me fired!! I have tried telling her that I can't discuss any other patients with her........she knows that. I think she just wants to test her boundaries. But its very frustrating. Like I said, I've never encountered a pt or family member that was SO nosy!! I hide my care when I go to the neighbors homes so that she can't see I'm there otherwise she'll call them on the phone during my visit!! She's amazing!! Loves to gossip and claims to be a really disgusts me. And her poor husband can't get a word in edgewise (he's the one I'm there to see). Nothing else has worked so far so I'm going to continue to try diversion and if that doesn't work then I'm going to start changing the subject when she starts to ask. Thanks for the great ideas and if anyone has anything else they'd like to share, please feel free!! You guys are a great sounding board!!

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    That's exactly what I say but she persists. Any other ideas??

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    Bear with me while I try to explain this.....never encountered anything like this before and not sure how to deal with it. My hospice covers several very small rural towns that are all about 8 - 10 miles apart. In these little towns, everyone knows everyone and probably knows folks from the surrounding towns as well. I have 1 patient in particular that makes me insane. Well it isn't really the pt but rather his wife. She is very nosy!! I call her "neighborhood watch". The neighbors on either side of these people are on service as well as their daughter and the daughter's mother-in-law. When I arrive the wife always asks if I've been to the neighbors or if I'm going to the daughters etc. I've explained until I'm blue in the face that I can't discuss it with her. She just looks at me like I'm being mean or lying and continues to ask. Tuesday one of my co-workers had a very serious car accident on her way home from work. Yesterday, I had to call this patient and the wife was asking me about my co-worker's accident (not sure how she found out about it unless it was from the front page of the local news paper......they showed a lovely picture of the accident with my friend being cut out of the car!!) I told her I wasn't able to discuss it with her and she continued to gossip about it. I am to the point that I hate going to this home!! What would you/should I do?? Any ideas on how to handle this would be great!! Thanks!!

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    Yes, we tend to order things like O2 concentrators/portable tanks, nebulizers, etc if there is a potential that the patient will need it. Its better to have it on hand and not use it than need it in a crisis and not have it available.

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    I just resigned from a hospice that informed me I was not "organized" because I never got finished on time. On a daily basis, I would have 5 or 6 patients with at least 30 mintues drive time in between each one. The boss never took windshield time into consideration when making assignments and advised me that I could do it in 8 hours because my colleague could do it in 8 hours (all her patients lived in the same town which was also conveniently her home town.) Being salaried, I got tired of donating my time to the company.

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    I feel the exact same way!! I concentrated on studying the core curriculum/study guide as well as a couple of symptom management books that I have and I felt very ill-prepared. i took the exam with my PCM and of course we compared answers afterward (I know you shouldn't) which made me second guess myself and feel very stupid!!

    Quote from SCgirl1962
    Took the exam in Columbia, SC on 9/16/06. Have been in Hospice for a total of about 5 years. Nothing in the core curriculum or study guide prepared me for this test. I studied for 2 months and used 3 or 4 different textbooks - the test was awful!! I memorized the drug conversion charts and didn't even have to use them. Instead, it seemed to focus more on the Medicare benefit and criteria. I didn't memorize the LMPR criteria at all. I went into the exam room feeling pretty good ( had only missed 25 or so questions of the 255 in the Study Guide ) but came out feeling like I didn't know anything. I wouldn't know how to study differently the next time because I studied and knew the material in the books - just none of it was on the test.

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    I have been taught that the admission must be done by an RN, but the RN only has to see the patient every 14 days. My hospice uses LPN's and it allows me to have a higher case load than the other case managers (not necessarily a good thing) but it can be very advantagous for all parties if the RN/LPN are a good working team.

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    Have you found any online resources?? If so, where did you find them?? I have the core curriculum and study guide but I am struggling with the core curriculum as I find it very dry. I am very nervous about the test this weekend.........hope I will do well and good luck to you!!