Standing orders/protocols

Hi,

Here I am again, begging for answers!

New to Hospice for only a month. Is it standard for Hospices to have standing orders/protocols? I was told we have none and I think that is strange.

If you have standing orders, could you tell me what type of things you have them for?

Thanks again:redbeathe

suppositories alone:.

n/v, anxiety = thorazine, abhr, compazine

pain = ms04, apap, ibuprofen

pheno = agitation, seizing

i know we have more, but they're not used often since np/md is readily available at facility.

but i remember being amazed at the quantity of rectal meds when i started.

leslie

We have a ton of so's that include meds for just about every symptom imaginable. I can't imagine being able to manage care very well without them and it sure does make the doctors happy to not have to be called for everything.

pain - ibuprofen, tylenol, roxanol, hydrocodone

nausea - compazine

dyspnea - roxanol

hiccups - thorazine, baclofen

thrush- diflucan

agitation/anxiety - ativan

I can't remember all of them, they literally take up a whole page

my former hospice had a contract with http://www.hospicepharmacia.com and they have "comfort paks" that have an assortment, a "buffet" if you will of medications from handling secretions (atropine drops), to pain (morphine elixir = roxanol), abhr suppositories (for agitation and nausea. The good thing is you can add as you wish to the comfort pak order so you can have topical ativan or morhine, etc...

Whatever you believe you will need, write it on your IPOC worksheet, so you already have an order...

linda

I work for the home health team of our VNA but I always joke that the hospice nurses have it made b/c when it comes to making the care plans...they click a button and "poof" it appears ( not the case with home health) but here is our hospice care plan standing orders (adjusted as needed for each patient) ...

STANDING PHYSICIAN'S ORDERS:

Hospice care offers the following services as standard care to enhance patient comfort.

(NOTE: Plysician may cross off any standing orders that do not apply for this patient)

ORDERS FOR CARE

Hospice Nurse to Visit:

Observe and teach patient and caregivers in signs of disease progression. Teach patient and caregivers transfer techniques as appropriate and safety measures. Assess nutritional status. Teach patient and caregivers in diet modifications and provide dietary guidance. Assess patient and caregivers coping mechanism and provide emotional support. Utilize volunteers and spiritual support as needed. Assess vital signs and cardiopulmonary status. Assess symptom management. Assess pain control. Establish pain medication regime with with physician order. Bowel care-Over the counter laxatives, enemas (Fleets or tap water) or rectal suppository PRN constipation-nurse may adjust accordingly. May digitally remove stool from patient's rectum PRN impaction. Insert foley catheter PRN comfort or urinary retention; change monthly and/or irrigate with NSS PRN malfunction or obstruction. Oxygen 1-6L/M N/C or mark PRN comfort measusres; Oxygen saturations PRN to monitor oxygen levels. Medications may be administered by patient, family or caregiver as instructed. Teach patient and caregivers in the administration of medications with prescribed dosages. Teach caregivers in personal care techniques and to monitor skin for evidence of skin breakdown. Teach caregivers preventative skin care measures. Teach appropriate wound care measures to caregivers as needed. Calmoseptine or over the counter barier creams to reddened or open areas PRN to prevent further skin breakdown. Hydrocolloidal therapy to open areas PRN to protect skin and prevent further skin breakdown. Tegaderm to open areas PRN to protect skin.

Social Worker Services: Initial assessment visit and PRN

Psychosocial assessment

Assess grief and bereavement needs

Hospice Aide Services:

Bath/Personal care and supportive services as needed

Assist with ADLs as needed

Special skin care as instructed by Hospice nurse and needed.

Hope that helps!!!

Hi This thread might be gone but I was just sent to For Comfort Always at North Memorial in Minneapolis, and they have standing orders 9 pages in length. I have received a copy of the orders from Black River Memorial and am waiting to receive a copy from North Memorial. My intention is tointroduce them to our director and our attendings in hopes that we can save time and prevent inappropriate dosing from physicians not familiar with common Hospice practices.

We don't have "standing Orders" but we have protocol that we use.

This is our "Comfort pack" We don't have it prepackaged nor do we have a specific pharmacy that we use, we just get regular Rx's from MD and use whatever pharmacy that the pt prefers.

Roxanol 20mg/ml 0.25-1 ml Q hr PRN pain, SOB,

Ativan 0.5 mg 1-2 tabs Q 1 hour PRN anxiety, restless, nausea

Atropine drops or Scopolamine patches for terminal congestion/excess secretions

Also usually we will get senna-S 1-2 tabs QD or BID PRN for constipation

We will also use Compazine or Reglan for Nausea, sometimes Haldol for anxiety or nausea of other things don't work

Sometimes will use long acting pain meds like MS contin or Oxycontin if pt taking pills (can give these rectally if need be)

One of the nurses in our Hospice group is developing a hospice order set that is based on diagnoses. She is hoping to design it as a checklist similar to what is used at the hospital. We are also attempting to design admission packets and check off sheets simialr to what is used at the hospital for admissions and discharges. It would be great if we didn't have to reinvent the wheel so I am wondering how many Hospices have something similar already. I am willing to share what we create and open to any ideas.

I work for the home health team of our VNA but I always joke that the hospice nurses have it made b/c when it comes to making the care plans...they click a button and "poof" it appears ( not the case with home health) but here is our hospice care plan standing orders (adjusted as needed for each patient) ...

STANDING PHYSICIAN'S ORDERS:

Hospice care offers the following services as standard care to enhance patient comfort.

(NOTE: Plysician may cross off any standing orders that do not apply for this patient)

ORDERS FOR CARE

Hospice Nurse to Visit:

Observe and teach patient and caregivers in signs of disease progression. Teach patient and caregivers transfer techniques as appropriate and safety measures. Assess nutritional status. Teach patient and caregivers in diet modifications and provide dietary guidance. Assess patient and caregivers coping mechanism and provide emotional support. Utilize volunteers and spiritual support as needed. Assess vital signs and cardiopulmonary status. Assess symptom management. Assess pain control. Establish pain medication regime with with physician order. Bowel care-Over the counter laxatives, enemas (Fleets or tap water) or rectal suppository PRN constipation-nurse may adjust accordingly. May digitally remove stool from patient's rectum PRN impaction. Insert foley catheter PRN comfort or urinary retention; change monthly and/or irrigate with NSS PRN malfunction or obstruction. Oxygen 1-6L/M N/C or mark PRN comfort measusres; Oxygen saturations PRN to monitor oxygen levels. Medications may be administered by patient, family or caregiver as instructed. Teach patient and caregivers in the administration of medications with prescribed dosages. Teach caregivers in personal care techniques and to monitor skin for evidence of skin breakdown. Teach caregivers preventative skin care measures. Teach appropriate wound care measures to caregivers as needed. Calmoseptine or over the counter barier creams to reddened or open areas PRN to prevent further skin breakdown. Hydrocolloidal therapy to open areas PRN to protect skin and prevent further skin breakdown. Tegaderm to open areas PRN to protect skin.

Social Worker Services: Initial assessment visit and PRN

Psychosocial assessment

Assess grief and bereavement needs

Hospice Aide Services:

Bath/Personal care and supportive services as needed

Assist with ADLs as needed

Special skin care as instructed by Hospice nurse and needed.

Hope that helps!!!

awesome info;-) thank you so much.:bowingpur