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Hospice, LTC, Rehab, Home Health

Content by FLArn

  1. FLArn

    Charting when you are no longer able to obtain vitals.

    I missed hourly too. We do vitals only once per shift or visit except for temperature or respiratory rate to chart effectiveness of an intervention.
  2. FLArn

    Charting when you are no longer able to obtain vitals.

    First, if you are unable to obtain a value for the particular VS state just that "unable to obtain BP" and then proceed with the rest of the values you are able to obtain. For example, VS BP UTO, P 98, R 20, T 99.4 F Ax. Second, in my experience, O2 Sats are by MD order only and are rarely if ever ordered (generally only for peds cases). We treat respiratory issues by assessing the symptoms and patient reporting. For example, use of accessory muscles, cyanosis, restlessness, increased respiratory effort to name a few. The best way to chart is to record what your patient says and what you observe. The best way to know what to include in general is to chart to support the plan of care and document the progression of the terminal diagnosis.
  3. FLArn

    What's With the "Poop"?

    Perhaps in the past when they lived together in the same home, either hers or the family home, dear old Dad used the bathroom just before dinner (or maybe she just has a bowel fixation). Either way, I would have the CNA take him to the BR on the way to the dining room since daughter is there an hour before that should take care of the problem. If he doesn't want to "try" before dinner, have the CNA remind him that this way he'll get to eat a hot meal.
  4. FLArn

    Moral of the story: Never give IM injections?

    @nightowl If I am reading the original post correctly the OP took 2 other staff with her to restrain the agitated patient so that she (the patient) would not move unexpectedly causing the OP to accidentally stab someone else. No one got an accidental stick.
  5. FLArn

    rescue meds...or not.

    I am so sorry you had that experience and kudos to you for attempting to advocate for your patient. The thing to always remember is that "we" hospice are guests in the SNF and must play by their rules. Sometimes trying to educate staff that what they are seeing are the signs of the very end of life and the patient is in extreme distress may get them to try and get an order to use from the E kit. Remember that use of the Ekit in SNFs is not as simple as opening the kit and signing out the meds. It may involve a hard copy signed script from the MD to the pharmacy if not an actual phone call to the pharmacist from the MD. Also most states prohibit or strongly discourage the use of psychotropics for ANY reason so the SNFs simply do not stock them in the Ekit. (Sorry, Dr X that's not in the Ekit. What would you like to order instead?) Unfortunately the presence of hospice patients and their special needs are simply not addressed in the regulations that determine care in the SNFs.
  6. FLArn

    morphine pumps

    When possible it is good to have a PICC or Port if the patient has a longer prognosis (weeks to months as opposed to hours to days) so as to minimize the number of venipunctures needed. But it is entirely possible to infuse Morphine via PCA in a peripheral line, it is even possible to get effective relief from a subqu site. I've seen all of the above used effectively.
  7. FLArn

    Medication Adm in FL

    I never found that it took that much extra time. Also the one time I tried to "save" time by mixing the meds, they congealed into a horrible thick glob in the plastic cup so I had to discard the whole mess and repour the meds; then I had to order replacement doses for all of them. So much for time saved. I don't remember what the meds were since this was very early in my career.
  8. FLArn

    Medication Adm in FL

    And when the state surveyor is following your med pass. (Actually I always gave each Gtube med separately and never gave meds - e.g. Tums, cough syrup - without an order because your patients' or families will rat you out in a heartbeat and never know they've done it) " What do you mean I can't have a Tums? You gave me one yesterday!":facepalm:
  9. FLArn

    PRN and e-kits

    Based solely on the information contained in the question; I would say no as you state that there are no refills. So technically you have no order for the prn medication. I would say you need to call the MD get a new order including the order to use from the ekit until pharmacy fills the order. The procedure for actually removing the med from the kit would depend on your facility policy.
  10. FLArn

    Can nurses have artifical nails?

    It is possible to have your nails professionally manicured and buffed to have a kind of a sheen without having artificial nails. I am terrible at shaping my nails so they are more or less uniform so I see the manicurist just for trimming and filling. I treat myself to a pedicure with polish in place of my acrylics!
  11. FLArn

    Revoking and Hospitalization

    However, if the patient has not revoked hospice, the hospital may not be able to bill Medicare for their treatment of the patient's exacerbation of the terminal diagnosis as Medicare will not pay for both aggressive and hospice care for the same diagnosis. Somebody isn't getting paid, and if it ends up being the hospital they may bill the patient/family. The hospice will inform the hospital that the hospice is not responsible financially since the treatment being provided by the hospital is outside the hospice plan of care. At least that is my understanding of how the hospice election reads.
  12. FLArn

    Should we teach unlicensed caregiver . . . . .

    I have taught many skills to FAMILY caregivers who are willing to learn, however, I would never attempt to teach nursing skills to unlicensed paid caregivers. That is an entirely different matter legally. Family members may learn whatever skills are needed to provide care but HHAs, CNAs etc are limited by state practice acts as to what care they are allowed to provide. If you are uncomfortable or unsure what can or can not be taught to paid caregivers, contact your education department or risk management.
  13. FLArn

    Hospice Resources

    Check with your supervisor or the education department to see if your company offers ELNEC training. Also find out if they offer any sort of computer based education. Also if you are in a position to join HPNA (Hospice Palliative Nurses Association) they provide access to many educational online opportunities.
  14. FLArn

    Hospice nurses required to take marketing territory?

    I have been a hospice nurse for 10 years and have never heard of anything so outrageous. This was never a part of ANY clinical position I have held in ANY setting. (LTC, Home Health or Hospice)
  15. FLArn

    Facebook: Should I Just Give in and Join?

    I love my facebook for the free games! It is a great free stress buster! Posting anything private or work related...not so much!
  16. FLArn

    Comic relief...

    OP, On going back and rereading your post and your follow up comment, I will say that if your intent in the post was to highlight your immediate reaction to the way you were set up by your co-workers, I can see where looking back on your initial statement would be humorous. That said, I still feel your co-workers showed a decided lack of good judgement in this whole episode.
  17. FLArn

    Comic relief...

    I hate to be "Debbie Downer" but I find it very disturbing that a) your co-workers found this so amusing that they thought it deserved an audience, b) that your co-workers care so little about his privacy and dignity as to make him an object of amusement to others, c) that you felt this to be amusing enough to post under the title you chose. Finally I find it amazing that you all have so much free time to indulge in this foolishness. If I had been your charge nurse, all involved would have received a verbal warning. Rant over.
  18. FLArn

    Is providing continuous home care required?

    Continuous care is a level of care which may be provided in either of 2 ways: 1) in an inpatient setting such as an IPU or 2) in the patients home. In an IPU coverage is guaranteed as there is always licensed staff in the unit; in the patient's home all shifts are attempted to be covered but there may be uncovered shifts if needs exceed available staff. The continuous care label can also be misleading as it is maintained only for short periods and must be justified by the presence of uncontrolled symptoms and ends when the symptoms are controlled. Therefore, some agencies have replaced the term Continuous care with the more appropriate term crisis care.
  19. FLArn

    How to deal with bad odors

    Try some perfume on the inside of a mask. Also a strong mint or cough drop may be helpful. Also there are special odor control dressings that the wound care nurse could consider using.
  20. CP - Just for clarification, it is correct that you do not need a physicians order for an information visit; however, admission to hospice care DOES require an order. So it is very important to be sure that your Dad's doctor is on board to give a hospice referral. If not, you may need to find another physician to evaluate your dad's condition and give the referral. (((((((Hugs for you and yours))))))
  21. FLArn

    Burnt out and struggling emotionally

    If it is available get a company cell for patient calls and turn it off when you are off duty. If no company cell is available, look at getting a cheap cell (like Net10 for example) for work calls. This may even be tax deductible as a work expense. Your peace of mind will be well worth the investment!
  22. FLArn

    Today's Hospice: It's Not What You Think

    The attending physician may elect to maintain full medical management and allow the Hospice MD only to weigh in on the recertification process so the family may not have any meaningful interaction with the hospice MD. Sometimes this works out well, but sometimes not. It depends on how well educated the PCP is on comfort care and how open he/she is to the suggestions offered by the hospice nurses.
  23. FLArn

    Bending and Breaking the Rules in Nursing

    The only reason the hamburger was "forbidden" was because she was in a LTC facility. Had she been at home with hospice or in a hospice residential unit she could have had a hamburger or any other food item she desired.So sad that is not the case with all hospice patients regardless of setting.
  24. FLArn

    PEG tube replacement

    Back in the day we replaced them all the time using catheters if we didn't have replacement feeding tubes. No xrays just obtaining residual to check placement. Then a few years ago we were told we had to send patients to ER for feeding tube replacement.
  25. All our beds have only half length rails at the head of bed. No rails of any kind at the foot of the bed. 2 half rails at the top is considered a mobility aid not a restraint. Older beds with full rail x2 = restraint.