nurselearner

I just received a generous supply of samples and I am trialing them. They are expensive, but maybe?????? in the long run cost effective.

Interesting topic - because it can just stop a conversation. I have been working on an "elevator" speech - an introduction to what I do rather than what I am. It starts out "I am Registered Nurse with specialized training in evaluating and caring for the terminally ill patient and assisting their families" Would love other feedback.

My preparation was to take the test that goes along with the core curriculum multiple times as well as the online test. First it showed me the areas where I needed to study more, but just as important was how to read the questions. Pay close attention to the words "first" "last" "best" etc. It can make the difference when deciding between 2 good answers. I just took it and I PASSED!

I agree. The only difference is that you are not driving. But patients may be on different units. And You must also document on the facility chart. You may be done and thena family member comes. You are speaking to manny more people and checking the MAR to se if the patient is taking their meds. All in all takes as long as a home visit.

one hint - after applying the ace - it should be snug but able to get your fingers under it - aplly tape length wise. It keeps it from raveling down. we used this in ortho for kids with success. Is the dressing staying dry? For my patient before putting the kerlix on we used sanitary napkins ..then the kerlix - they absorbed all the excess fluid and kept her dry.

Ok - if no body has standing orders for wound care-then how do you do it? Write the orders and get them signed with every change? Please help.

We have standing orders for symptom management and are thinking of adding standing orders for wound care- stage 1, 2 and 3. Does anybody have standing orders for wound care and how was it done? protocols? supplies? Thanks for any input.

Do you have a palliative care team at your facility? Our hospital does and any one can order a palliative care consult - it is not just for "hospice" but also for symptom management and decision making. Are her family inviolved? If so- they may be able to talk with Dr with her permission. It's a difficult situation. Frequently DR's don't want to open these doors and have a frank discussion.

Even if medicare will not pay for an air cushion they are usually less than $25 and can be purchased in some drug or medical supply stores. Shifting weight side to side (rolling hips up) helps relieve pressure. Barrier spray and paste work well when dressings don't. Tell the family that despite these measures the patient is at risk for further breakdown and document it all!

How are you treating it? What dressings do you find are most effective in this area - in terms of staying in place, not letting incontinece get into the wound, and being effective for absorbing etc. Would really appreciate your experience. Are you debriding? Autolytic with dressings? Using enzymes?Bedside or surgical? I am interested for home care as well as long term care. We are seeing more and more and trying to develop some effective guidelines for our hospice that consider pain, family ability to do the dressing,cost, quality of life. Thanks

When I had a patient with that kind of weeping in her legs we used poise pads (for urinary incontinence) instead of abds and ace wraps- wicked away the moisture - the "sticky" backing held the aces in place and they kept the aces stayed dry - were less expensive than sterile abd's. initially they were changed twice a day - eventually with elevation etc became once a day. Good luck.

We have an end stage patient on hospice with a necrotic sacral wound. Pain is well managed and the family does not want aggressive treatment for the wound. She is in LTC and the staff is c/o odor from the wound. Recommendations for dressings, or anything we can use in the wound to neutralize the odor. We already know about charcoal or cat litter under the bed. Anything more direct for the wound? Thanks for your help.

Not all hospices are run the way yours is. Look for another employer - or work the inpatient suite. Your employer keeps taking patients without the staffing because they get paid a daily rate for each patient even if they don't get the care they need. Not fair to the patient, not fair to you. You can not possibly keep up with your case load -look for something else and give your notice before you fall apart. It sounds like your employer won't make changes unless forced to and they are putting the responcsibility for making it all work on your shoulders while they collect the money.

tissue viability, What distance learning do you have them complete???

Does anyone use this service? How does it work? Do you evaluate the wound and tell them what you need ? How is the cost and what product line do they uuse - thanks for any info.

Is there a way to "unstickey" this topic ?

Thanks. I am currently working on an algorithm for our hospice on palliative wound care............while trying to be cost effective. If anyone has developed anything to this effect I would love to hear from them.

But I only want to know how hospice nurses are documenting........... others such as home health are reimbursed based on their documentation. Hospice isn't.so my question is how much documentation do we need to do? We are currently reviewing documentation at our hospice. Our staff will be computerized in the future but for now it is paper. How do you document wounds - do you use a separate wound care form, check sheet or in your notes. Are there any specific requirements for documenting wounds and their care in hospice. Currently we have a form where we have to write everything in - length, width, depth, location, drainage, etc, etc, etc................. I found a check sheet form but I wonder what is "required" to be documented about hospice patients with

doesn't anyone document wound care????????????????? Help!

stick to nursing info in your notes. The social worker will add the psychosocial

We are currently reviewing documentation at our hospice. Our staff will be computerized in the future but for now it is paper. How do you document wounds - do you use a separate wound care form, check sheet or in your notes. Are there any specific requirements for documenting wounds and their care in hospice. Currently we have a form where we have to write everything in - length, width, depth, location, drainage, etc, etc, etc................. I found a check sheet form but I wonder what is "required" to be documented about hospice patients with wounds. Thanks!

How do you change your treatment plan for patients who are end of life. I know if they are actively dying it is all about comfort but what about patients who are not in the last few days of life, who may have months to live, who have infected wounds or stage 3 wounds - or chronic wounds................. the goal is not necessarily cure but.... Do you change your treatment plan- what about cost containment when it is paid through the hospice benefit rather than insurance. what are you using, doing etc

For patients who are not in the last few days of life, who may have months to live, who have infected wounds or stage 3 wounds - or chronic wounds................. what are you using, doing etc

What would you recommend for a good resource book, course, or company providing info on wound care -to help set up treatment plans

I am new to hospice - looking for info I have a question about the emergency kits that are placed in the home. Do you place it there on admisssion with instructions to "leave it alone" unless instructed by the nurse to open it. OR do you review the medications in the kit at the time of admission - explaining what they are for etc with the instruction to put the kit aside and open if instructed by the nurse. We have to document instruction but it seems overwhelming to the family.I would like to see what the various policies are. All the medications in our kit are labeled with the usage information and the pharmacy med sheets are in there, but do you put any other "simplified" instructions or information about the medication itself. I have found that some people have no idea what a suppository is and you put it WHERE??? So if not instruucted before hand - it might mean a visit by the oncall nurse at 2 am. For the meds that the patient is already on - do you provide a medication schedule for the home. How do you instruct patients when talking to them about prn meds. So many say - just tell me when to give them and I will but I don't want to have to fuigure it out. This is mostly for roxanol and ativan usage but could be other prn meds as well. If any one has developed or knows of resourses for educating the family in an effective way please share. We use communication books in the home to write instructions but maybe because it is a notebook it just doesn't seem official. Thanks for feedback