Just skimmed the above advice. As an "admissions" person you probably won't be putting in foleys, IV's, etc... (that's for the caseworker). I'm not saying you could be doing an admission, and some kind of emergency would come up and some sort of actual bedside nursing skill would be needed, but admissions is more about paperwork, history, reviewing it all, and setting everything in order. Your job is to make sure that the family actually does qualify for hospice, all T's are crossed and I's are dotted; you go through it all. A thorough head to toe on the patient is imperative as well (to check for pressure sores, bruises, IV's, fractures, etc).
Your own baseline is good to start off with. Question yourself as if it was you in the position; do they need a pressure relieving pad, turning schedule understood if bed bound, do they need a bsc if there isn't one ordered already, if patient still ambulatory is the house fall proofed...so much. I'm sure your company has a check list. If they don't; create one yourself.
There are many signatures to get; many, many, questions are asked. You set things in motion such as ordering the comfort kit, the supplies that your hospice can give weekly, do they currently have necessary medications, etc... You are the face that introduces your company and teaches the family your hospices philosophy and services that are available to them. What is covered by the health insurance, etc...
As for posting the DNR on the fridge, I don't do that unless they actually want me to. In many cases the kitchens are open areas visible to anyone entering, walking around, etc... What I do is pick out an area for the family to have a "command center" (cc). My cc idea came about to me one time I was working with this beautiful family when I first started out on my own as a caseworker. The layout of their house was open, so from the front room you could see the fridge directly. The hospital bed was set up in the front room; the person's house was on top of a hill that overlooked a fantastic view. What a view!
Placement of the bed for the patient in the residential home is a critical decision (another topic); this allows for easier access of visitors and family instead of sticking the person away in a back bedroom, unless the patient wants it that way. No one yet that I've journeyed with has wanted to... anyway; the DNR had been posted on the fridge by the admission's nurse.
On my first visit the son approached me, and asked if we couldn't be a little more discreet, and post the DNR somewhere where it wasn't so glaringly obvious. He told me that they all knew their mother was a DNR, but they didn't need to be reminded of it every hour of every minute (ours are bright green). So the cc idea came to me, and I posted it at the end of their kitchen island on the overhanging kitchen cabinet, along with putting all supplies, binders, medication documentation, etc... all right there in one place (including the 24 hour hospice phone line). I believe the family is entitled to privacy rights concerning the placement of the DNR as well. Posting it in areas visible to visitors and the like who do not have authority to have access to the patient's records appears to be a violation of their privacy rights.
The DNR needs to be in the patient's possession (in the house) and available for review by authorized health care staff and family.
As RNs, one of the more important hats we wear are as educators. Patient and family must understand why the DNR is in place, and what to do in case of any emergencies. In my state at the hospice I worked last, a correct DNR must be in place to qualify for hospice services paid for by CMS. It's not enough just to have a DNR, but that the DNR not have life supporting measure checked (as many do). It's often when admitting the person at their home, that you find life supporting choices have been checked. This is a much debated subject.
This area can be a tricky one, since I'm usually shocked that whatever doctor/nurse didn't teach about why we don't check the box to give fluids for lifesaving measures, and some of the other ones that should be for the full/partial CPR area only. That's why as an admissions RN you need to make sure you go over the DNR carefully. If a change needs to be made, you do it right there as you should have DNR forms that can be redone with the family and then delivered to the doc for signature. (in my state anyway)...every state has different laws and then there's CMS rules, regulation, requirements. Also, many hospice companies have p/p that supplements the regulations for the facilities and the familie's convenience.
In my experience it's two box that that are always checked; give antibiotics (Abs) can be given for blah, blah and supplemental nutrition via g-tube for life sustaining measures. I reassure the family and patient that checking the comfort care box can includes Abxs if a urine infection or cold presents to make the person comfortable (which we do if family wants), but that the two boxes can't be checked to qualify for hospice in the company I was with. Perhaps others can comment on this aspect from their experience and state'/CMS regulations/standing/rules. l
Now I see how the previous poster's post turned out to be long...as I start explaining one thing, other things pop up in my head, as everything is related. Back to the posting of the DNR. It's important for the family to understand the DNR. I tell them call us not 911 if anything happens. Along with the DNR posted in the cc area, I also tape up the 24 hour hospice phone number for the family/patient to call for help/advice/anything. The DNR can also be put as the first page in the medication binder or what ever tool your hospice uses for record keeping at the house. The regulation in my state is that the DNR must be with the patient in the residence (accessible to all interested parties able to view patient's records). Now when the patient goes from hospital to home the DNR must be reviewed. If the DNR is changed, then it will become active after a doc signs off on it, which usually isn't a big hurdle...usually. It's not enough for the family or patient to sign off on it; a doctor must sign for the DNR to be active.
Passing away at your home is a journey that should be taken with pride and dignity. Usually people have built their homes for many years and it's the very foundation where their children were raised; where they went through the stages of their lives. It is only fitting to take the biggest journey of your life at home. I am a huge advocate of passing at home.
Review many of the questions and discussions on this site for hospice; lots of good reading.
Good luck to you...