Palliative Care on Med Surg Floor

[Tgeagle83]

Hey all,

I work in an incredibly understaffed hospital with administrators constantly trying to cut cost. Currently my unit (post-op/orthopedic/medsurg/telemetry) is accepting palliative care patients too so that the hospital won't have to consult hospice. Last night along with the rest of my team and NO aid I took care of this actively dying apneic patient and was in there every hour or more. This morning I got word that our DON wants us to use PCA pumps for these patients and the nurse can come in and hit the button or just do a continuous rate to help with the acuity and us being stretched thin. The doctor was writing the order after I finished handing off report. IS THIS EVEN LEGAL?!?!?

[Pepper The Cat, BSN, RN]

We use pain pumps on Palliative all the time. And nurses will definitely push the bolus button before turning the pt or providing care.

What's the worst thing that's going to happen? They are already dying.

[nutella, MSN, RN]

The method of symptom control needs to be appropriate and proportional to the symptom severity. What that means is that some patients achieve acceptable symptom control by receiving medication intermittently. Some patients are ok with "prn" medications but some need scheduled medication to ensure symptom control. There are patients who are best served by continues infusion of medication, which is usually the case when the burden of an "up and down" is too much and causes undue distress or when the medication has to be administered so often that the nurses in acute care cannot keep up.

On regular med/surg floors we recommend a drip when the medication has to be given every 2 hours or more often for symptom control or when the patient has such severe symptoms that controlling them via continues infusion is the best way. Just because somebody is CMO or dying does not automatically mean that a pump is needed. This should be a case by case decision.

The options are to give it continues via regular pump as a drip with ordered doses for breakthrough symptoms. Or a pump like PCA or CADD - but if the clinician is administering the bolus, the MD order has to specify that "clinician bolus is permitted". Using a pump when symptom severity is best managed this way is all about patient comfort although it will also most likely help with time management. No nurse on a regular med/surg floor is able to get in a room in time when meds are needed q 2 hours and more often especially when those are multiple meds.