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Hospice   (4,943 Views | 31 Replies)

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BuckyBadgerRN has 4 years experience as a ASN, RN and specializes in HH, Peds, Rehab, Clinical.

3,520 Posts; 38,169 Profile Views

I'm confused from the get go. I was under the impression that a G-tube would be considered a "heroic" measure meant to prolong life?

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BuckyBadgerRN has 4 years experience as a ASN, RN and specializes in HH, Peds, Rehab, Clinical.

3,520 Posts; 38,169 Profile Views

Is there an impartial interpreter? Quite frankly, based on what I've read here so far, it sounds as though these may be his DAUGHTER'S decisions, not his =*(

To the last two responders, this man speaks only Viatnamese, he lives in his daughters home and she works at the hospital in the pharmacy, which I personally believe is the reason the decision was made for the tube. He has nasalpharalengal cancer with mets to the lungs. He was skin and bones and is asleep or in pain, with additional pain now, due to the tube insertion. The family never brought in the advanced directives; I tried to find them somewhere on a previous hospital visit and couldn't find them. It was the weekend and he got admitted over the phone and the admitting physician didn't see him until the following afternoon. The on call doc wasn't going to change a code status on someone else's patient. The admitting orders did not include pain meds; it was change of shift but I called and got the pain meds ordered. The man normally takes one Vicodin for pain, plus oral morphine drops. The doc spoke to the NOC RN and gave IV morphine 1-3Q 4. I wanted him to have his normal meds; I pondered calling the doc from home and getting the Vicoden added. When I came in the next day, he was in pain; I called and got the Vicodin added and an increase on the morphine 1-4. I kicked myself for not making the call from home that night; the doc could have just ordered it on our EMR. I just knew this whole thing was going to be a debacle from when I got report and tried to avoid all this unnecessary nonsense for this man. He should not have been admitted.

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Jensmom7 has 36 years experience as a BSN, RN and specializes in Hospice.

1,907 Posts; 11,429 Profile Views

I'm confused from the get go. I was under the impression that a G-tube would be considered a "heroic" measure meant to prolong life?

It is, and that's why a Hospice patient (or their POA) who wishes to have one must come off of Hospice until the procedure is done and they go back home.

It is definitely not part of anyone's Hospice Plan of Care. We never tell patients or families that they can't have something done. We explain why it isn't part of our POC and will not be approved. The choice is theirs to make.

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1,166 Posts; 15,770 Profile Views

To the last two responders, this man speaks only Viatnamese, he lives in his daughters home and she works at the hospital in the pharmacy, which I personally believe is the reason the decision was made for the tube. He has nasalpharalengal cancer with mets to the lungs. He was skin and bones and is asleep or in pain, with additional pain now, due to the tube insertion. The family never brought in the advanced directives; I tried to find them somewhere on a previous hospital visit and couldn't find them. It was the weekend and he got admitted over the phone and the admitting physician didn't see him until the following afternoon. The on call doc wasn't going to change a code status on someone else's patient. The admitting orders did not include pain meds; it was change of shift but I called and got the pain meds ordered. The man normally takes one Vicodin for pain, plus oral morphine drops. The doc spoke to the NOC RN and gave IV morphine 1-3Q 4. I wanted him to have his normal meds; I pondered calling the doc from home and getting the Vicoden added. When I came in the next day, he was in pain; I called and got the Vicodin added and an increase on the morphine 1-4. I kicked myself for not making the call from home that night; the doc could have just ordered it on our EMR. I just knew this whole thing was going to be a debacle from when I got report and tried to avoid all this unnecessary nonsense for this man. He should not have been admitted.

I think you've given far too much info on this patient. Please edit for HIPAA reasons

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28 Posts; 1,262 Profile Views

I think this mans admission cost him at least 24 hours of pain, discomfort and emotional distress and was not in his best interest, nor in the spirit of hospice. I did my best to be a "hospice nurse" but it was not at that level; it was the wrong environment and I didn't have the tools I needed to give him the care he deserved. That sucked, for me and the patient.

Edited by LadybirdRN

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28 Posts; 1,262 Profile Views

There's no identifying information, except his diagnosis and primary language. And gender. And who knows what his gender or primary language REALLY is, except me? There's no HIPPA issue. Unless you're a moderater, I'm not editing anything.

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SassyTachyRN has 4 years experience and specializes in Peds, Oncology.

408 Posts; 6,524 Profile Views

It is, and that's why a Hospice patient (or their POA) who wishes to have one must come off of Hospice until the procedure is done and they go back home.

It is definitely not part of anyone's Hospice Plan of Care. We never tell patients or families that they can't have something done. We explain why it isn't part of our POC and will not be approved. The choice is theirs to make.

So.. Question. They go off hospice and into the hospital to have a gtube placed. They come out of the hospital and want to go back on hospice. But the tube is placed and obviously going to be used for feeds. How does that work with insurance covering feeds and hospice?

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1,166 Posts; 15,770 Profile Views

There's no identifying information, except his diagnosis and primary language. And gender. And who knows what his gender or primary language REALLY is, except me? There's no HIPPA issue. Unless you're a moderater, I'm not editing anything.

I guess I would have said he's non/English speaking and lives with a family member who works at our hospital in a healthcare role

No skin off my nose if you do or don't edit. Just trying to save you from possibly violating your work's social media policy.

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28 Posts; 1,262 Profile Views

If anyone could ever figure out who this this patient is based on the information supplied I'll eat my shoe.

I was trying to give enough relevant information to nurses experienced with this type of care in order to paint an accurate and complete picture of the entire situation in order to help me, and other posters and readers, give the best care possible to hospice patients. Why someone feels the need to order me to change my post is ridiculous. This is a friendly thread with some good information being exchanged, meaningful questions being answered and insight given from experienced hospice nurses, all with the intent of helping give the best care possible to some of the most vulnerable patients at the most intense part of their lives.

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1,166 Posts; 15,770 Profile Views

If anyone could ever figure out who this this patient is based on the information supplied I'll eat my shoe.

I was trying to give enough relevant information to nurses experienced with this type of care in order to paint an accurate and complete picture of the entire situation in order to help me, and other posters and readers, give the best care possible to hospice patients. Why someone feels the need to order me to change my post is ridiculous. This is a friendly thread with some good information being exchanged, meaningful questions being answered and insight given from experienced hospice nurses, all with the intent of helping give the best care possible to some of the most vulnerable patients at the most intense part of their lives.

I re-read my initial post. I didn't mean to make it sound like an order. I meant " you might want to consider editing your post" Sorry didn't mean it it to come across that way. You're right no one would probably be able to figure it out. I'm probably over paranoid. Again I'm sorry.

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3 Articles; 2,815 Posts; 30,782 Profile Views

I think this mans admission cost him at least 24 hours of pain, discomfort and emotional distress and was not in his best interest, nor in the spirit of hospice. I did my best to be a "hospice nurse" but it was not at that level; it was the wrong environment and I didn't have the tools I needed to give him the care he deserved. That sucked, for me and the patient.

You think. Do you know what the patient thinks?

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3 Articles; 2,815 Posts; 30,782 Profile Views

Um, no, it was BECAUSE he was admitted that his pain med regimen was jacked up in the first place.

Hospice can manage some really severe pain right at home.

Comfort is more than just pain meds. Maybe these people don't really care so much about insurance approvals and pain med regimens, but have a different frame of reference that they're working from.

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