hospicemom

Local Coverage Determinators

you need an order before any treatment can begin. Sometimes if its the weekend and I know that the MD will not be around to sign all the papers then I will page and get numerous medications started or at least given the order to go ahead and start if needed. But yes, an order before any meds are started.

Looking at switching to a different hospice care plan. Anyone out there who really loves/ likes theirs? If so, where did you find it? I cant imagine there is no hospice specific diagnosis/careplanning books out there for purchase however I am not coming up with anything. Please offer some suggestions. Thank You!!!!

example: clonazepam is scheduled TID AND Q4 hours PRN. Question: do you take these as two seperate orders or as one order. To clarify.... If the scheduled dose is at noon and in one hour they are still not managed can you give the PRN dose at that time or do you need to wait until 4 pm to give it? There are many different opinions on this. I believe it is two seperate orders and we should be able to give the PRN dose one hour later. Other nurses believe the PRN can not be given until the 4pm mark to make sure there are 4 hours between doses. Asking for some insight and other opinions on this. Thanks!

I was a hospital nurse for about 3 years before going into hospice. I think its always a great idea to start in the hospital to get the basics on nursing, medications and things, prior to getting involved in any specialty.

hey, thanks for the support. I am hammering away on that study question book and everything else I have. Thanks again.

Thank you for your kind words. However, I did not pass. My score was a 97 and 98 was passing. I also had a lot of ALS questions as well as superior vena cava syndrome and spinal cord compression which unfortunatly I have not had in the years I have been in hospice. There were many questions regarding QAPI as well. I have already rescheduled my exam and will be taking it again in june. I also felt it was more a test on vocabulary. Many questions about mouthcare as well. It was not at all what I was expecting however now I certainly know how to study for it the next time around. Studied my butt off on the medication converstions and what not....one question regarding that was on my test. Frustrating! Tough test.

:)I have been studying using the core curriculum, study guide as well as the flash cards. I take the test in two days. I am not sure as to what to expect but I am getting a little nervous. I have been in hospice about 4 years and took the online sae as well. Crossing my fingers!!!! Any reassuring words would be greatly appreciated!

I have had this reaction with the patch. I am not a big fan of those patches.

Thanks for all the input. I will suggest an inservice on this to the NH staff. Unfortunatly, the DON is one of the people who is dc'ing orders. Quite frustrating.

I am with a hospice who is "affiliated" but not "owned" by a nursing home. We are having much trouble with the nursing home as far as us getting referrals from "anyone", the nursing home wants to "screen" for appropriateness before it goes to hospice, so unfortunatly there are many patients who could use our help however are deemed inappropriate by the nursing home... and no, they have no experience in hospice. Also, we are now having problems with the nursing home dc'ing our orders when they feel it is not appropriate as well as dc'ing problems we initiate on the POC. This has been getting worse over time and is now interfering with the treatment of the patient. Hospice is not notified when things are dc'd. Any suggestions??

morticians have wonderful ways of fixing things up when they need to, and MY patients are MY patients until I walk the funeral home out the front door. They dont become the morticians until they are driving MY patients body down the road. SO...I applaud all of you who take pride in caring for the patients 5 minutes after they pass away...the exact same way you would care for them 5 minutes PRIOR to them passing!!!!!!

I dont have any new ideas as far as drainage and bandaging goes. I have used ostomy bags on fungating tumors however that would not work on the face. I also used flagyl, crushed and dissolved in 0.9NS and syringed onto the tumor.

a patient may be able to have PT if it is not related to the terminal diagnosis. example...lung cancer patient with broken hip receiving PT for the hip is fine and medicare will cover it even with the hospice involvement.

Hospice never pays for the patients "stay" in the nursing home. If the patient has money he/she is "private pay" in the nursing home for room and board. If the patient does not have money they will be medicaid(T19) and they will pay the room and board. If the patient has some money but not enough to last him until his last days then he will be required to use the money he has and be private pay until his money runs out to where medicaid takes over. So basically, hospice gets "paid" from either medicare or medicaid and then divides the money up to the proper places. So Hospice never pays for the room and board but does pay for all other care related to the terminal diagnosis. This is what I understand of it thus far anyway:)