doodlemom

Why would the Chaplain or a SW be any different than a nurse as far as liability? Any member of our staff is allowed to pick up medications and deliver to the patient - even office staff. We even have volunteers deliver medications. As long as they have a medication sheet for the patient to sign, what would be the problem?

ditto

I take that back...it doesn't list oxyfast in the approved or unapproved column List of Approved Narcotics Drug Products: Morphine Sulfate Tablets and Solutions Drug NDC #* NDA# Manufacturer Morphine Sulfate Tablets 15 & 30 mg 00054 22207 Roxane Morphine Sulfate Oral Solutions 10mg/5 ml & 20mg/5ml 00054 00054 22195 Roxane Morphine Sulfate Extended Release Tablets 00406 76412 Mallinckrodt Morphine Sulfate Tablets Extended Release 60951 75295 Endo/Skyepharma Hydromorphone Immediate Release Tablets Drug NDC #* NDA# Manufacturer Hydromorphone immediate release tablets - 2, 4, AND 8 mg 00074 00406 19892 78273 Abbott Mallinckrodt Oxycodone Drug NDC #* NDA# Manufacturer Oxycodone immediate release tablets - 5, 10, 15, and 30 mg 00406 76758 Mallinckrodt Oxycodone immediate release tablets, 5, 15, and 30 mg 00254 77-712 Vintage Oxycodone Extended Release Tablets, 10 mg 59011 20-553 75923 Purdue Endo Oxycodone Extended Release Tablets, 15 mg 59011 20553 Purdue Oxycodone Extended Release Tablets, 20 and 40 mg 59011 20553 Purdue * 5-digit Labeler Code of the NDC number List of Unapproved Narcotics Drug Products Subject to Warning Letters Firms Products Mallinckrodt Inc. Pharmaceuticals Group Morphine Sulfate Concentrate Oral Solution 20mg/ml Boehringer Ingelheim Roxane Inc. Roxanol Oral Solution, 20 mg/ml; Roxicodone Tablets, 5 mg Roxane Laboratories, Inc. Hydromorphone Hydrochloride Tablets, 2 mg & 4 mg Glenmark Generics Inc. Morphine Sulfate Tablets, 15 mg & 30 mg; Morphine Sulfate Solution Immediate Release Concentrate, 20 mg/ml; Morphine Sulfate Solution Immediate Release Oral Solution, 20mg/5ml Lannett Company, Inc. Morphine Sulfate Solution Immediate Release 20mg/ml; Hydromorphone HCl Tablets, 2mg and 4mg Lehigh Valley Technologies Inc. Morphine Sulfate Tablets, 15 mg & 30 mg; Morphine Sulfate Solution Concentrate, 20 mg/ml Physicians Total Care, Inc. Morphine Sulfate Immediate Release Tablets, 30 mg; Hydromorphone Tablets, 2 mg; Hydromorphone Hydrochloride Tablets 4 mg Xanodyne Pharmaceuticals Inc. Roxanol Oral Solution, 20 mg/ml; Roxicodone Tablets, 5 mg Cody Laboratories, Inc. Morphine Sulfate Solution Immediate Release 20mg/ml * 5-digit Labeler Code of the NDC number

MSIR and oxyfast are being pulled, as well.

Also MSIR, Oxyfast.... Please notify your administrators. Get in touch with your legislators and start a campaign. If this happens, this will have a huge impact on our patients care. The only way to obtain the strength needed for our pt's will be to compound. If anyone has contact at NHPCO, contact them. http://www.medpagetoday.com/ProductAlert/Prescriptions/13526

Actually anything that is related to comfort is covered under the hospice benefit so if the patient ends up being treated for their symptoms the hospice is require to cover it. It is discouraged because of this. We have a few patients that go to the hospital and are admitted and we follow them as a acute inpatient stay (we have contracts with all of the local hospitals.)

The medicare rates have not been cut yet.

We have a ton of so's that include meds for just about every symptom imaginable. I can't imagine being able to manage care very well without them and it sure does make the doctors happy to not have to be called for everything. pain - ibuprofen, tylenol, roxanol, hydrocodone nausea - compazine dyspnea - roxanol hiccups - thorazine, baclofen thrush- diflucan agitation/anxiety - ativan I can't remember all of them, they literally take up a whole page

It would be good to have about a year of experience in the hospital so that you will feel more confident with you nursing skills out in the field. As a case manager, your major responsibilities are to make sure the patients symptoms are managed - pt is comfortable and they have all of the meds they need. You will be teaching pt and family on what to expect as time passes and pt declines. There is a lot of education involved. Many families need education on bedside care, safety precautions. You will use the rest of your team for psychosocial and spiritual support - your aides will be there for bathing, personal care. You can look back at other posts on pay. Depending where you live, your salary could be less or more. More competition creates higher salaries. Stress can be high in any job - depending on how you handle it. If you have good boundaries and get help from other team members, you should be OK. As in any job, you need to take care of yourself and really take your time off away from the work. On call can be a draining part of hospice nursing. Some hospices are large enought ot have a dedicated on-call staff, but there are usually some requirements of most staff. That is always a good question to ask aboutwhen going for interviews.

Or she should be calling the administrator if she can't

My recommendation is to start small; pick one person (preferably one of the nurses) to get to know more and more with each visit. It is hard on the first one or two visits, but after you go 2-3 times, you will more than likely feel more welcomed. The nurses may indeed not have anything new to tell you about your patients. Dementia patients can go for weeks and months without anything new. We have gotten so accustomed to crisis care in our line of work that when there is no crisis, we tend to think there is something wrong. Another thing about nursing facilities; a lot of the time the nurses are taking care of a whole hall of residents and don't notice a whole lot unless there is a major change.

Our role in facilities can be very different than in the home. These patients probably need us equally if not more than those being cared for by their families in their homes. With our care, we can advocate for what they need. We can update and support their families, which is very beneficial to them. We can also support the facility staff. Some of these staff people have taken care of the patients for years and have become like family. Establishing and maintaining good relationships with facilities is mostly seen as a PR thing and may not seem part of patient care, but when we have good relationships with facilities - the patients benefit from our presence and the facility will usually pay more attention to our patients if they like and respect us.

Accessing federal and state money = rules and regs. If you are running completely as a charitable organization and not billing insurance (Medicare/Medicaid) you do not have to follow Medicare regs. There are a great deal of hospices all over the country that offer all kinds of alternative healing.

We don't make it a frequent thing, but we will deliver medications if there is no way a family member can pick up. We contract with a pharmacy that delivers but not in the middle of the night.

YOU SHOULD NOT PUT YOUR PATIENTS BEFORE YOURSELF...PERIOD. End of story! Patients will be dying all of the time. If it is your time off, you should not come in to take care of a dying patient - let someone else take care of it. Remember your boundaries. Those other nurses will burn out and their managers should reprimand them for coming in on their days off to take care of their patients.

Everyone else has said it: boundaries. Use the other members of your team and don't try to do it all. I think that is probably one of the biggest mistakes I see nurses do - they don't call the SW and CH for help when they should and end up being everything to everybody.

Yes - it is a not-for-profit. Our only policy is that there has to be a safe place for the staff to be. Otherwise, the patient's "home" is anywhere they live - so that might be in a tent or under a bridge. For safety sake, we will send 2 members of the team together. It is not unusual for many of these patients end up back in the hospital over and over again. Many die in the hospital.

we are in a growth spurt right now.

We do hire new grads at our IPF and there is a lot of support.

Some hospices have hired right out of nursing school or soon after - but this is not the norm or recommended. Hospice nursing takes a great deal of autonomy. You are out there with only phone support, so you have to know what you are doing. It would be recommended that you get a year of hospital experience before applying for a hospice job. Good luck - we need nurses in this field!

I have seen some hospices that have similar ethical/questionable admission practices. Some of the large chains can get away with this most of the time because they can afford to pay a huge fine (one of the national chains had to pay a 14 milllion dollar fine in 2006 and it did not stop these practices.) Your patient is obviously dying from cancer and your hospice would be required to pay for pleuryx drainage if you took him as a patient. Any physician that is willing to state the patient is dying from dementia would be putting his/her license on the line. If your hospice practices this way, I would look for another job. Anyone can give a referral for hospice, so it is perfectly legal for the facility to give a marketing person a referral without a doctors order. Hopefully the facility is talking with the families before the referral is given and the administrator is not just randomly going through charts to give name and numbers of pts/families (that would probably not be legal.) I have heard of marketing people going through facility charts to identify patients they think might be eligible - that is not legal.

I do not post where I am for privacy reasons. I know there are hospices that have similar missions all over the US. I am very fortunate to work for an agency that has the needs of the community at mind in all that we do. Thanks

We follow our patients wherever they are - so yes, if they are on the streets, we will arrange a time to meet with them under a bridge or wherever they are. We see some in the homeless shelter. Some are in housing units...sometimes they are in the hospital. But we will follow them wherever they are. We use compounds for some different meds and if our medical director feels it absolutely necessary, we will have something compounded - otherwise - it is way too expensive. We have chosen to put our resources into other work to be able to take care of more people that have no insurance (an increasing problem that is probably not going to get any better.) With all of the competition and medicare trying to decrease our rate of reimbursement....

I would have to ask why the patient is requiring pleuryx kits. Why does he have fluid in his lungs? Does he have lung or liver mets? If you can find a reason that is directly unrelated, then you would not have to pay for this. I can't imagine that there are too many people out there who require pleural drainage and it is not related to their terminal diagnosis.

We have seen a recent (in the last 2 years) influx of HIV patients that are no longer responding to the newest drugs available...but the majority of our HIV patients are those who have been out on the street and have not been on treatment or their treatment is very inconsistent. We pay for any of their preventative medications and on occasion will pay for their antiretrovirals on a case by case basis. Because the majority of our HIV population have come from the street and/or have a drug problem, this can be challenging. Many get back on their antiretrovirals and get better for a while - go off of hospice and then go back to not taking care of themselves and then bend up back on our service (this can sometimes result in multiple admissions for the same patient.) With all of these patients, we see a plethora of opportunistic infections, neurological symptoms, dementia - you name it - so each patient's hospice needs are so individualized. You are probably seeing a lot of the same symptoms that we see here but I think the hardest one to treat is the diarrhea. I've gotta run off to work now, but will check in later.