Something doesn't seem right about this hospice unit. Am I right?

[gt4everpn, BSN, RN]

hello everyone, i occasionally float through the hospice unit my ltc facility has, but something doesn't seem right with the how things are done, i wanted to know it this is standard in hospice or if this is unusual.. most of the patients there are cancer patients who are admitted to the inpatient hospice unit, plus they are assigned an outside hospice program like hospice of new york, or hopice care network etc.. usually when they are admitted to our inpatient hospice unit they only last for 6 wks, infact our unit really is for short-term hospice, patients have to be under 2 months to live to be admitted. a large majority of the patients still recieve life sustaining meds. for instance i had a 52 year old breast cancer patients who was recieving 2 antibiotics iv and she really had a very short-time to live. i've had pt's reciving bp meds and vitamins. sometimes pt's get peg feedings (usually by family request) i have had hospice pts with no dnr (which i now understand why) but still it is so contradicting even difficult at times, esp with the no dnr patient who is actively dying. my question is it normal for a hospice pt to still be recieving certain meds? i know a doctor that would d/c all other meds except pain and anti-anxienty meds because she said that they didn't need any other meds.. and she makes a point. is this right?

[Whispera, MSN, RN]

Patients are admitted to hospice with a specific terminal diagnosis. They don't get treatment to cure that diagnosis, but can get treatment for any other conditions they might have. The idea is comfort, ultimately, but medical conditions are treated. Sometimes the terminal diagnosis is treated too--it depends on how much the family pushes it and how willing the doctor is to order it. There's a great variation in that. Insurance won't pay for treatment that is intended to "cure" the terminal diagnosis. That's a big factor. It's very complicated.

[tommytwice]

Like Whispera said it can be pretty complicated at times. Sometimes families and patients want to continue their vitamins and other medications so they don't feel like they are "giving up." Sometimes for the mental well being of patient/family it makes sense to continue meds that really are no longer helping physically. All of us are going to die and all of us have our own ideas about death and approach it in a different manner. That's why it doesn't make sense to always discontinue all non-comfort meds.........we aren't just treating a physical body but a physical/spiritual/emotional person, and each of us are different and have unique needs.

tommytwice

[HappyJaxRN]

I agree with both of these previous posts. A lot of the meds we give in hospice are for comfort messures. For instance, I may be giving lopressor to control a BP so that the patient is more comfortable. Or a vitamin supplement. Sometimes a vitamin deficiency can cause pain and anxiety and it's best to continue the maintenence medications if the patient is able to tolerate it. A lot of the times, end stage dying, nothing is consumed and given only IV. Hope that helps. It believe your question was probably already answered by these other folks.

HappyJaxRN

[WENRN]

I have worked for a Hospice Agency for 3+ years and have had one doctor complain that we are treating a patient that has cancer with an oral antibiotic for an URI. In my opinion this is a comfort measure totally unrelated to their diagnosis of brain cancer. Why should they lay there coughing, with an elevated temp, and miserable. Hospice is for comfort, not for killing as soon as possible.

[leslie :-D]

I have worked for a Hospice Agency for 3+ years and have had one doctor complain that we are treating a patient that has cancer with an oral antibiotic for an URI. In my opinion this is a comfort measure totally unrelated to their diagnosis of brain cancer. Why should they lay there coughing, with an elevated temp, and miserable. Hospice is for comfort, not for killing as soon as possible.

much of it is going to depend on where they are in the dying process.

but if they are not actively dying, then yes, infection hurts!

and should be treated accordingly.

leslie