need some advice

This person may just not want to suffer any longer. I have ALS pts who choose not to be vented even though that could prolong their life. Maybe this person does not want to live life less than whole in their eyes. If the docs won't increase pump, do you have a med director who can order increases? I think, as hospice nurses, we have a duty to provide comfort for those entrusted in our care and the biggest thing is pain management. You need to advocate for this poor soul.

This person may just not want to suffer any longer. I have ALS pts who choose not to be vented even though that could prolong their life. Maybe this person does not want to live life less than whole in their eyes. If the docs won't increase pump, do you have a med director who can order increases? I think, as hospice nurses, we have a duty to provide comfort for those entrusted in our care and the biggest thing is pain management. You need to advocate for this poor soul.

totally agree....and I am advocating to the extreme. I did get our Medical director involved.....we are holding a family meeting next week with all the docs b/c I am done playing games. they will hear the patient say this one last time and then I am getting orders from someone. I guess the arguement I see coming from the docs is that she is not hospice appropriate because she is not septic. I am going to run a couple LMRPs on her before then...again...I am sure I get at least get her in for failure to thrive if I cant for the PVD. If only we could get all docs on board with the hospice philosophy! Hospice 101 anyone? hehe

Some questions to ask are : would you be surprised if this person was dead in 6 months without curative treatment? If the answer is no, then this person is probably eligble for hospice benefit. Also what is the underlying reason she needs amputation? The main criteria for hospice eligble is the pt must have a prognosis of 6 months or less to live if the disease runs its normal course AND the pt/family wants hospice care vs curative care. Also if this person is having pain, I would not wait until a meeting next week. That would mean she would suffer that much longer. Can you place her on hospice inpatient or continuous level of care until her pain is managed? Also get IDT members involved, sometimes it takes a call from the hospice medical director to the PCP to get things moving. Remember pain is what the pt says it is and she is the one living and dying right now. I have a pt that takes methadone 145mg q6h and Roxanol 180mg q1h for breakthrough pain. This pt has been such as education for me for pain management and I have really had to advocate for his PCP to increase his pain meds.

I actually had a patient like that once. We took her because she would die if her leg wasn't amputated, but she was tired of the pain and her surgeon wouldn't medicate her correctly. Once we got her pain under cantrol, she was able to make different choices, she had her leg amputated and is still alive today (6 years later). Pain is so undertreated, it really can screw people up. Good for you, I will pray for you and your patient to have the needed result.

Thank you to those who replied to this thread. My lovely patient passed away peacefully and pain free last week.