Order sets?

[spainton]

I'm a new nurse working on a hospice/palliative care unit on a CLC floor of a hospital. (Confusing right?) I was just wondering if it was standard practice or not to have order sets in place for things like bleed outs, imminent death, acute respiratory distress, terminal delirium. We don't, so the hospice docs tailor it to each pt but I work nights and our on call docs are geri docs, not hospice. They don't like to order meds much for the hospice guys. So we, the nurses, are left with kind of a mess, pts in pain and dying in a complete panic or swinging at us, screaming and causing the other pts to become agitated in the middle of the night. (We do have a behavioral code team but the hospital doesn't like us calling these codes on the hospice guys.) I know I try every non-pharmacholigical means available to calm my pts down but when you have 3 or 4 actively dying pts on a ward of 22-24 pts with only 5 staff (more likely 4, only 2 of which are licensed) it gets rough. So anyway order sets are they a thing or am I just having pipe dreams?

[Race Mom, ASN, RN]

I work in home hospice. We have standing orders that are signed by our medical director (some pts keep their PCP but our medical director signs these so we can implement). We also have a crisis kit order signed by her as well. This kit is delivered to the home upon admission so that it is there for any emergent needs.

[sclpn]

Our medical director will not sign for pts comfort kit (crisis meds) anymore. Said she must have a "pt relationship"to write for c2 meds. She will do it in the occasional emergency but then she must make a face to face visit to establish that relationship. Can make for a difficult admit on an actively dying pt

[spainton]

Thanks guys for your input! Our hospice docs see our pts before anyone else to see if they meet criteria for hospice, so they already have knowledge of the pts. But she has started doing an order sets of sorts. She will explain exactly what she wants for each pt in a note and will view alert the on call docs so they are all on the same page and if we have a situation the on-call they will now order whatever she said to. (within reason of course) not the quickest way but better at stabbing in the dark.