NTS

The pt called and is who I spoke to on return call. Lives alone and independent. Does call regularly to make sure to get narcotic meds refilled. Did give report to IDG on morning call and agreed pt usually calls to inform of problems with meds. Slow decline, no major recent changes. Cm was planning visit as first pt for her that day. trying to be generic in details and not give too many details.

I am an on-call Hospice nurse who works 7 on, 7 off. I get all after hours and weekend calls, triage, after hours admits, visits, deaths, emergencies and anything else that comes up. I do have a backup Nurse who case manages during the day. I got a message At 4:45 am from the answering service that pt was having difficulty speaking. When I returned the call the pt was speaking clearly, no slurred words or word finding noted. Pt stated just couldn’t get words to come out right. Pt was alert and oriented and answered my questions appropriately. Pt denied pain, dizziness, weakness, shortness of breath or stroke symptoms. Pt stated couldn’t get medicine until the next day. This pt was known to drink alcohol and use illicit drugs, frequently intoxicated or high during nurse visits. Also insistent on getting pain pills on time. The call was about difficulty speaking which was clearly not a problem at that time. The pt was advised I would speak to the case manager and see about the medications. The pt agreed and hung up. later in the morning the pt was found dead. based on the info at the time I didn’t feel a visit was warranted. Now I’m questioned why a visit wasn’t made when called. I called nursing judgement. I admitted the pt and knew the background. And knew how things were going. My manager says he agrees with me. what would you have done?