river19

Try to be sensitive in communicating changes the family needs to be aware of, such as change in respirations or mottling. Many times these signs mean death is closer, but not always. Our hospice uses a well written booklet, "Gone from my sight" to explain symptoms seen at the time of death. Remember kindness is the most important thing. Good luck to you! River1951

Where I used to work we started having ATC staff on regular salary instead of the case managers doing it. So far I hear it has worked fabulously. You could easily work all night as well as work all day if it was your day to be on call before the change. That is a larger not for profit with a census in the 110s. Our little hospice here in the wilds of Oregon, we take turns one week on-call three off. Our census is about 6-8 usually. This works ok for here.

The ABHR suppository has haldol in it. It had no effect, even at doubled dose.

Been a Hospice nurse for a while. Had a patient die last week. She had vocalizations at end of each respiration, which were originally responsive to increased O2 and oral morphine. The vocalizations came back the next day, they were not responsive to lorazepam and morphine (patient was on huge doses of fentanyl and MSO4 anyway for rectal Ca with a stent in bowel. Next day we tried ABHR suppository. No good there either. Third day went out with oral phenobarbital- we are on the frontier, literally here- no other formulation available and she died right after I gave it to her. Do any of you have guidelines to help know when to jump to barbiturates? I am so sad for this little gal and her family.