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Hospice, Critical Care
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Zee_RN has 17 years experience as a BSN, RN and specializes in Hospice, Critical Care.

Zee_RN's Latest Activity

  1. Zee_RN

    Death Visit Protocols

    Hospice staff -- what are your protocols for death visits when a patient dies? Obviously, if it is a home patient an RN needs to visit and pronounce. But what if it's 2AM and they are in a skilled facility and the facility staff pronounces? Do you visit regardless? No family present, pt is whisked off to funeral home.... Do you have a policy on making death visits based on circumstances? Thanks!
  2. Zee_RN

    homecare homebase

    The Plan of Care does not meet compliance standards in the Commonwealth of Pennsylvania either as it cannot be customized (at least for hospice). You can tell hospice is a force-fit into this home care documentation system
  3. Zee_RN


    My organization is fortunate enough to staff in such a manner that our RN Case Managers rarely take call. They work a regular Mon-Fri 8-5p week (salaried position). They take "on call" only when our regularly scheduled on-call nurses are off; for instance, if one of our regular on-call nurses gets sick, takes vacation day, etc. We have a "back-up on-call" list in the event the regular nurse calls off. Also, someone has to staff the daylight hours on a holiday. We take volunteers first. So we have a nurse who works 5p-8a Mon - Fri and a w/e nurse who works Fri 5P to Mon 8A (so there's double-coverage on Friday nights). That REALLY cuts down on the amount of on-call our regular case managers have to do. Not bad staffing for a small hospice operation! Given the choice, I'd go with the MON-FRI routine. Our W/E nurse is awesome-saucebut she does *everything* on the weekends...all evals, consents, admits that may occur as well answer all the phone calls, pronounce patients, do visits, handle emergencies. We have on-call psychosocial too but usually it's the nurse handling everything. :)
  4. Zee_RN

    Coverage for incontinence supplies

    We cover incontinent supplies including briefs, chux, creams, wipes ... but we do not provide pull-ups as Medicare has classified them now as "underwear." Some hospices do, though. We have opted not to.
  5. Zee_RN

    question on aide coveage for hospice

    Our aides are scheduled 7 days a week...although few patients are actually seen every day. Some are, though. We like to start patients off with daily visits to get a full understanding of what they need; then we adjust their care plan based on the updated assessment. Actively dying patients are seen 7 days a week by the RN and the aide. GIP patients are seen 7 days a week by RN and aide (unless in hospital; aides don't see patients in the hospital).
  6. Zee_RN


    I would have ensured the patient was comfortable prior to removing the bipap. Bipap is not an absolute contraindication to hospice...but in a hospital setting, I can see where it would be viewed as incompatible with goals of care. I have had patients on bipap on an inpatient hospice unit with the understanding that once we could wean them off comfortably, it would not be re-applied once discontinued. I had an ALS hospice patient on a "sip-and-puff" ventilator once. So there aren't necessarily absolutes in the hospice world; it just needs to be very patient-specific with clear goals.
  7. Zee_RN

    Frequent Falls

    What are your procedures for patients who fall frequently? (Or any patient falls, for that matter). We spend A LOT of administrative time dealing with those frequent fall patients, particularly those in nursing homes. We complete an electronic occurrence report from which we then generate a paper occurrence report for signatures. The RN must gather the obvious data--date and time of fall and what exactly happened. He/she must also document what interventions were taken to decrease the risk of falling again. A Fall Assessment is done in the electronic record. He/she must also document the full name of the individual reporting the fall, the full name and title of the person they discussed the interventions with, the full name of the family/POA they notified and certainly the date and time the physician was notified as well. Any data incomplete results in the occurrence report being returned for completion. Sometimes we learn of the fall days to weeks after it occurred if the facility did not notify us in a timely manner. Regardless, all the data must be obtained. Obtaining full name and titles of individuals in the facilities is a huge difficulty here; tracking down workers in the nursing home or personal care home can be quite time-consuming. Also, when you have a patient who falls frequently and you've put in a low bed, perimeter (or 'scoop' mattress), fall mats, bed alarm, recommended q1h rounding (um, yeah), gotten a PT eval .... what ELSE do you do? Our organization insists on finding more interventions and yet it seems we've exhausted our possibilities. What does your organization do in these cases? Thanks!
  8. Zee_RN

    Thinking of leaving hospice

    I work for a small, for-profit hospice. Average census around 63. We have dedicated on-call nurses who cover the evening/nights (5pm-8am weekdays) and the weekend (Fri 5p to Mon 8a). The only times our regular RN CM take on-call is if the on-call nurse calls off, takes a vacation or a day off. It is definitely one of the great things with my company; a lot of small hospices like ours rotate their fulltime staff to cover on-call. Look for a place like ours!
  9. Zee_RN

    Question About the Certification Exam

    I'm registered for the exam on June 8. The only thing I'm worried about is opioid-equivalent equations and such. I've never done that stuff. How much should I worry? And what is the BEST resource for studying? I have the Core Curriculum and I read it through but wasn't terribly impressed with it (typos and other errors, like duplicating a chapter). I took and passed the online $35 practice exam. Hints, help?
  10. Zee_RN

    The Other Professions of Nursing

    Yeah we have that script too. I WILL always ask the patient the first part "Is there anything else I can do for you right now?" with a easy and relaxed attitude. I will NOT outright lie to the patient and say "I have the time..." I anticipate caring for 14 patients tonight on a med/surg/tele/ped unit with the assistance of an LPN. I will NOT have the time for much!
  11. Zee_RN

    The Other Professions of Nursing

    Mover: because you have to transfer the patient in the semiprivate room, and all his furniture and medical equipment, to another room because the lab test just came back +MRSA. Or because he wants a better view. Or because he's transferred to a lower level of care. Many moves... PR Specialist: I don't think I need to explain this one. Liar: "Is there anything more I can do for you? (here it comes....) I have the time!"
  12. Zee_RN

    Nurses obtaining blood consent

    I'll have to call the BON. They've just never been helpful in the very few calls I've made in the past -- downright rude, actually, so I was hoping to avoid that. Thanks for the replies!
  13. Zee_RN

    Nurses obtaining blood consent

    In emergency situations, blood can be given without a consent. In nonemergent but middle of the night situations, I've worked in places were (a) the resident -- in a teaching hospital -- was called to obtain consent or (b) the house doctor got consent or © the ER doc got consent (they REALLY hate that). Nurses did NOT get consent, period.
  14. Zee_RN

    Nurses obtaining blood consent

    Thank you for that link and the document. Unfortunately, I need documentation specifically about blood transfusions; that is speaking of surgical informed consent. There is mention of a complication the plaintiff claimed came from the administration of blood but the consent for the blood was not an issue itself. So if anyone knows where I can support the claim that registered nurses cannot obtain informed consent for the blood transfusion, I would be grateful. Physicians are maintaining that nurses can get the consent because they are the ones administering the blood -- as opposed to surgery where it is the physician performing the surgery. This runs counter to what I've always held as true and have seen at other facilities. But I can't find the documentation that supports it. Thank you.
  15. Zee_RN

    Nurses obtaining blood consent

    In the Commonwealth of Pennsylvania, I have always been told that registered nurses are not to obtain informed consent for blood transfusions; it is out of their scope of practice. Only physicians can obtain blood consents. Does anyone know where I can find documentation of this fact? The internet is NOT being my friend today. :) Thank you!
  16. http://news.yahoo.com/s/ap/20080804/ap_on_re_us/death_penalty_cooey;_ylt=An5U56QIixgljHBYwQ8QDHWs0NUE COLUMBUS, Ohio - A death row inmate scheduled for execution says he's too fat to be put to death, claiming executioners would have trouble finding his veins and that his weight could diminish the effectiveness of one of the lethal injection drugs. ...