Opoid crisis and providing hospice care

TjackRN · Feb 9, 2019

I have been in hospice off and on since 2002. In the earlier days obtaining narcotics for patients was a breeze. I worked at a local hospice and we had good relationships with all the local pharmacies. We called ordered whatever the patient needed and mailed the hard copies. This included pca pumps.

The opioid crisis was just starting then. Drug diversion was a rarity.

Now we have patients that have been addicts .. pain is harder to control and a lot of patients are labeled as drug seekers who are just in pain. All harcopies have to be carefully calculated and submitted so patients dint run out of medication. If your hospice uses a mail order pharmacy it is an even bigger nightmare. Non of our local pharmacies compound for PCA pumps anymore which I really miss.

I feel like it has impacted the attitudes of the nurses as well. They are more skeptical about asking for med increases. Patients, family and staff all seem to feel like they are under a microscope. Ekits have helped with availability if your hospice uses them.

Kaisu · Feb 9, 2019

I have no problems obtaining whatever narcotics my patients need. It is so easy that I have had the thought that at some point, things are going to get tougher. I can't imagine the regulatory agency will not look at the amount we go through and start to tighten things up. I hope not. Our patients are dying and deserve all the comfort measures they want and need.

anashenwrath, ASN, RN · Feb 11, 2019

I'm on Cape Cod (ie, that place where HBO did a documentary about the opioid crisis) and find overall it's not too bad. Like anywhere, different prescribers prescribe differently, but it's not necessarily about the opioid crisis... it can just be ignorance about dying or symptom management in general. Same old same old.

I think it's actually become easier with families because I can be very upfront about checking meds. "Sorry I have to count your pills every visit; it's just the way things are done these days." People who may have taken it personally back in the day totally understand it's just the climate of our times.

I have had to manage comfort kits when there were active users in the house, which has challenges. We usually deal with it via lockboxes and trusted family members. I had one lockbox broken into. That really upset me. I'm pretty sure I know which family member did it, but couldn't prove it. We ended up double-locking the next kit and only the hospice crew had the combination. THAT was annoying. I thought we would have to do continuous care, but the patient actually passed very quickly and peacefully.

Oh, but what really cheeses me is, at least in this state, nurses aren't allowed to destroy meds in the home (or take them, obviously). Usually, families are more than willing to destroy them right there in front of me, but sometimes I will get a family that will be like, "Ehh, thanks. We're just going to hold onto these." THAT concerns me. Even if they do dispose of them later, if they just chuck them in the garbage, someone might notice and pick them out! I feel like dumb protocol like that contributes to the ongoing crisis.

advicenurse1, ADN, BSN, RN · Feb 24, 2019

I did hospice for 8 years and left about 2 years ago for a office nursing job. I had no problem obtaining medication for my patients. The opiod crisis was awful when I left hospice. We had addicts taking care of their dying loved ones and some even stealing the patients narcotics. I have had all kinds of reasons why the morphine was gone before refill time( cat jumped on counter and knocked the bottle over and all pills went down drain-true story). My physician would refill in a reasonable timeframe but not too soon. I do believe that the pharmacy is bound by laws where they cannot refill narcotics if its too soon. A lot of this is out of the doctors hands.

pmabraham, BSN, RN · Mar 16, 2019

I'm currently a hospice nurse, and we don't have issues getting the necessary pain medications for our patients.