mmelvin

Hello Eveyone-I have been asked to give an inservice to our nurses (I am a registered dietitian working with Vista Care Hospice) on common problems and solutions with enteral feeds. We have many patients that come on to our service with PEGs that are still in use. The most common "problem" I don't really have an answer for is when to stop. What are the signs and symptoms that they should be looking out for? Many times it seems that these poor patients are having high residuals and just not tolerating and no matter what changes are made they still will not tolerate. I finally tell the RN just to stop and the patients seem calmer and pass in the next several days. Am I doing the right thing? Does anyone have guidelines that they follow? Thanks, Beth Melvin, RD, LD

You are absolutely right. I agree. I try to talk the nurses and MDs out of Megace everytime. It's just that many of our patient are admitted to our hospice already on it and unfortuately some of the nurses have the mind set that anyone admitted with failure to thrive should have an appetite stimulant. From reading the feedback from this list I now have some research to back up my proposition to evaluate the use of appetite stimulants with our patients. You guys have given me the knowledge and support that I needed to try to go forward. Now that Medicare has stopped paying for appetitie stimulants many of our patients are going to be in trouble with the high cost. Thanks for your help.

I appreciate all the feedback. I went through all our patients' charts and found 4 people on Megace (one for 2 years and the rest for 6 months or under-well that's how long they have been our patients-who knows how long before. I found several on Elder Tonic and one on peractin. I don't know how to present this to my group. I don't want to seem heartless. Most of the patients I am talking about are admitted with FFT. Anyway, thanks for all your input. Happy Holidays.

Hello- I am so glad that I found this website. I am a registered dietitian working with a hospice organization in Athens, GA. I have been with the organization for a few months and have been doing mostly patient and family educations (high cal, high pro; diet strategies to reduce N/V and constipation, etc). I am trying to become more involved with the organization and thought looking at the use of appetite stimulants (cost effective?) might be a good idea. My question to you is how long should a hospice pt. be on an appetite stimulant? Our appetite stimulant of choice is Megace, however several are on Decardron for mets, and bone pain and receive the added benefit of appetite stimulation. Many of our patients are admitted to hospice on Megace with continued poor po intake and are left on it for months and months. Does anyone have a standard of practice for these meds or just guidelines that you go by for the use and duration. I appreciate all your help.

Hello- I am so glad that I found this website. I am a registered dietitian working with a hospice organization in Athens, GA. I have been with the organization for a few months and have been doing mostly patient and family educations (high cal, high pro; diet strategies to reduce N/V and constipation, etc). I am trying to become more involved with the organization and thought looking at the use of appetite stimulants (cost effective?) might be a good idea. My question to you is how long should a hospice pt. be on an appetite stimulant? Our appetite stimulant of choice is Megace, however several are on Decardron for mets, and bone pain and receive the added benefit of appetite stimulation. Many of our patients are admitted to hospice on Megace with continued poor po intake and are left on it for months and months. Does anyone have a standard of practice for these meds or just guidelines that you go by for the use and duration. I appreciate all your help.