New to hospice and I have a question...

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Specializes in OB, MS, Education, Hospice.

Hi--

I recently accepted a part-time position at a newly opened hospice home, and we recently had our site visit for medicare certification. One of the site evaluators questioned our nutritional assessment and subsequent plan if care based upon those assessment findings. In short, she stated that we have to offer every patient the option of a PEG tube placement and tube feedings... Granted, I am new, and we have had less than a dozen patients so far, but is this true? None of the patients we have had so far have even remotely been candidates for this. Thanks in advance for any feedback you can give me...:confused:

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Hi--

I recently accepted a part-time position at a newly opened hospice home, and we recently had our site visit for medicare certification. One of the site evaluators questioned our nutritional assessment and subsequent plan if care based upon those assessment findings. In short, she stated that we have to offer every patient the option of a PEG tube placement and tube feedings... Granted, I am new, and we have had less than a dozen patients so far, but is this true? None of the patients we have had so far have even remotely been candidates for this. Thanks in advance for any feedback you can give me...:confused:

s/b reflected in the plan of care, re use of fdg tubes.

a declining nutritional status is to be expected and hospice is responsible for discussing any potential wish to be enterally fed.

leslie

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Specializes in OB, MS, Education, Hospice.

Thanks--

I agree with enteral feeding as part of the POC--I was really thrown off by the PEG tube placement...

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Specializes in HOSPICE,MED-SURG, ONCOLOGY,ORTHOPAEDICS.

Okay, I am making an attempt to be positive and agree with leslie regarding the need to care plan for the questions the patient or family may have regarding enteral feedings. As hospice professionals, we deal with this issue on an almost daily basis, the "she is dying because we aren't feeding her" issue. Sometimes, I think that we deal with it so frequently, we neglect to get it into writing as part of the care plan.

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Specializes in OB, MS, Education, Hospice.

Absolutely--and I agree with Leslie, as well. I would say that is our biggest family issue thus far. I guess I was just thrown off by the invasiveness of PEG tube placement in a medically fragile, almost-actively dying patient... I can certainly see offering an NG for feedings, but hopefully on a fairly limited basis.

Thanks!

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Specializes in psych, addictions, hospice, education.

I question how much the evaluator knows about Hospice. If you worked in Palliative Care, I can see the need for peg tubes and NG feedings, but hospice? People who are dying quit wanting or needing food. Invasive procedures just give extreme discomfort. Feedings while dying have many negative consequences!

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Specializes in OB, MS, Education, Hospice.

Whispera--

Thank you--my thoughts exactly. I have worked for so long in acute care--and have watched too many dying people drown in the excess fluid that we administer. Tube feeding someone whose system is shutting down is so wrong--and the consequences can be so horrible for the patient. I have made more attempts to clarify what this evaluator meant, and I actually think it may have been a paperwork issue. We need to document more clearly that these options were discussed (and ruled out) and then be sure that it transcends to the plan of care. We are a brand new facility and we are still crossing the t's and dotting the i's.

Elli

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