My mistake?

[makes needs known]

Recently a pt of mine started to severely desat (40's-50's) on 4L o2, and I notified my SV, she assessed the pt, who happened to be on hospice. She contacted the MD for orders and got an order to send to the hospital for eval. She discussed the fact that the patient was on hospice. Pt did not want to go initially (anxious and confused) but did agree when we reassured her they would be able to determine what would make her feel better. She was admitted with pneumonia. She was started on antibiotics and began to feel better. The SV did not inform the family that she had been sent to the hospital, they were mad and pt was sent back to us the next day with orders not to continue antibiotics. SV was new and did not call the family. She did the paperwork and on it there is a section asking which family member was contacted. I feel like a fool. I'm in trouble, for sending a hospice pt to the hospital and not letting the family know.

[klone, MSN, RN]

Why didn't the hospice case manager let the family know? Yes, you probably should have contacted the family, but generally, the hospice case manager is the family's first line of comunication and they should have been in communication with the family as well.

[FutureRN_NP]

If you work in LTC, before or after sending pt to hospital you suppose to notify MD, his/her family member whoever name on file and hospice case manager. Hospice case manager may and should notify the family but it's not their sole responsibility. Ultimately you are the one have the pt.

[Esme12, ASN, BSN, RN]

I am curious why I keep seeing these kind of posts. What is your position? Are you a nurse? If it is your patient why didn't you call the family that their loved one going to the ED? Would you be upset if your loved one was sent to another facility with you knowing where they went?

The hospital is responsible for not ordering the antibiotics but call the PCP....surely he knows the patient went to the hospital and what antibiotics were ordered. Now that the family is upset of course they are going to pick everything apart. Who is usually responsible for calling the families? Just because she did the paperwork doesn't absolve you from your responsibilitiy in calling the familiy.

I just don't understand why the families aren't being called.

[classicdame, MSN, EdD]

Please be sure you understand the laws in your state about this type situation. Advanced directives and state laws will take precedence over facility policy and family preferences. Also, being on hospice does not mean we cannot administer therapies. Again, depends on many factors. Maybe the Case Managers can educate the staff on these issues. I am glad that your first instinct was to make the patient more comfortable.

[nurseprnRN, BSN, RN]

so... lessee now, a dying patient was bounced from a snf hospice bed to a hospital for some treatment she didn't want, and back again in a day to resume her comfort care because of lack of communication?

the first person to call if a dying hospice patient is experiencing uncomfortable symptoms is not the physician. i don't know what "sv" stands for, but if she is the one responsible for making calls, she should be educated to call the hospice people first. if you are a nurse, you should have called the hospice people, not the physician.

dollars to doughnuts that the hospice nurse would have been right over, made some suggestions for comfort measures, and the patient would not have had to suffer the transport, the family would not have been livid (i certainly would have been, if my loved one was promised hospice comfort care and then got bounced around like that), and her comfort care could have continued as planned.

if i had to guess, i would guess that the sv, whatever that means, is uncomfortable or uneducated or both on the role of hospice. i can assure you that the hospice liaison nurse would be quite willing to offer a staff inservice on this so no patient or family -- or staff-- needs to suffer the result of being uninformed again.

[ebear, BSN, RN]

Grn Tea, I'm thinking SV = supervisor

[Anna Flaxis, BSN, RN]

Calling the family whenever you send a patient to the hospital is a no-brainer, and I think you both bear responsibility. I think there should have been communication between the two of you about who would call the family.

I'm also very confused about why a hospice patient would be sent to the ED for eval. I thought they were on hospice for a reason? That there was a careplan in place? If the person is on hospice, then the hospice service would the the first one you'd call for a change in condition, not the facility's on-call physician, right?

[Old.Timer]

so... lessee now, a dying patient was bounced from a snf hospice bed to a hospital for some treatment she didn't want, and back again in a day to resume her comfort care because of lack of communication?

the first person to call if a dying hospice patient is experiencing uncomfortable symptoms is not the physician. i don't know what "sv" stands for, but if she is the one responsible for making calls, she should be educated to call the hospice people first. if you are a nurse, you should have called the hospice people, not the physician.

dollars to doughnuts that the hospice nurse would have been right over, made some suggestions for comfort measures, and the patient would not have had to suffer the transport, the family would not have been livid (i certainly would have been, if my loved one was promised hospice comfort care and then got bounced around like that), and her comfort care could have continued as planned.

if i had to guess, i would guess that the sv, whatever that means, is uncomfortable or uneducated or both on the role of hospice. i can assure you that the hospice liaison nurse would be quite willing to offer a staff inservice on this so no patient or family -- or staff-- needs to suffer the result of being uninformed again.

thank you !!!!!

[makes needs known]

I goofed up, but I did not realize it until after. I never sent a hospice patient to the hospital. I have been punished and educated. Thank you for your comments.

[Esme12, ASN, BSN, RN]

It's ok to goof up but the supervisor also screwed up as well. Take this and learn form it and it will make you a better nurse.

[merlee]

Comfort care DOES NOT EQUAL no acute care. This patient was suddenly having a change that may or may not have been consistent with end-of-life issues. If the pt fell and broke a hip would she have just been put back to bed???

The hospice nurse should have been notified, and she would have helped decide the best course of action. Yes, sometimes hospice patients get antibiotics for acute problems, such as a UTI or pneumonia.

And, no matter who made the decision, the family should have been notified before the pt left the facility.

It is not 'comfortable' to have pneumonia. It can be very painful - -been there, done that, and received the IV antibiotics!!!

Sorry you learned this the hard way, but somebody needed to call the family.