mslavender1982

Our town is landlocked and you can only enter by boat or plane (Juneau, AK). So there are no surrounding counties that could formally pick them up on their service. Our team has pondered seeing if other hospices in our state could be a remote resource for our end of life patients.

The hospice agency in my small remote town is shutting down next month. They stopped taking new admissions a month ago. I am a nurse case manager at our hospital, and we are trying to come up with a short-term solution for our end-of-life patients until we can put together a more long-term solution. (I was a home health and hospice nurse for 10 years, so I'm coming at this with a little bit of a knowledge base.) Any ideas or advice from this group would be much appreciated! Some things we are working on so far: - Palliative packet for patients discharging home - education sheets on symptoms (pain, dyspnea, constipation, anxiety/agitation), medication instructions in plain English, basic skin care, short booklet about the dying experience and what to expect, important contacts (physician, pharmacy, mortuary); our SW team and chaplain are also contributing to this packet - Doc-to-doc handoff between hospital physician and patient's PCP - Post-discharge - a couple of phone calls from an RN within the first week to make sure they picked up their meds from the pharmacy and understand how to use them - Community partners - we have a small mobile integrated health team that consists of an LVN, an EMT, and a paramedic that can offer check-ins and limited assistance Some concerns: - The physicians in our community are worried about the burden this will put on them and the clinic staff - There is no nighttime or weekend coverage for these patients/families - Hospital admissions and hospital lengths of stay will increase; our facility only has 40 medical beds that service our town and the surrounding villages Some questions: - Is hospice/palliative services via telemedicine an option? - Is there some sort of phone-triage service that can offer support or advice during the night and weekend?

I admitted a new hospice patient about a month ago with metastatic colon cancer. She had just had surgery for colon cancer, and now has only 8 feet of bowel left. She has elected to not have further diagnostic studies or treatment. She's doing well post-operatively, but she is struggling with diarrhea. The only instructions the doctor has given her is to take immodium. Taking too much causes her to not have BM's completely. Taking too little causes intractable diarrhea. She is completely miserable! Any suggestions?