Transfers to GIP

[nursecathi]

I have to vent. I work on s 5 bed inpatient unit inside a hospital. One RN, one LPN who work as a tech. Most of our admissions are transfers from other units within the hospital. It makes me so mad (and sad) when they transfer a patient to me who looks like they've been thrown in the bed, sheets snd blankets wadded up under them. Sometimes soaked in urine. Sometimes with stool. It's not like the staff had had to move the patient off one bed to another. We use the same beds (except ICU) and just "exchange" beds. It's like the actually "withdraw care" when they put them in comfort care. Sometimes we have the patient 10 minutes before they pass. I know the units are in a hurry to get the patient out of there so they don't have to "deal with" the paperwork. Why can't nurses treat patients respectfully instead of as a bother.

[nutella, MSN, RN]

I am not sure why your title says "GIP".

Anyways, if you receive pat who are obviously not taken care off you should bring it up.

When pat receive comfort and care they do not have to move to a special unit in my opinion though I think that they should not be in the ER or critical care area if any possible. Perhaps you should point out that withdrawing care does not mean "no nursing care" and that the pat still requires washing, checks, repositioning, mouthcare.....

GIP in the hospice world means that a patient has so severe symptoms that they can not be managed in a less restrictive setting and require hospitalization (under Medicare). Although a patient may receive comfort measures only in the hospital, it does not automatically mean the pat is eligible for GIP level of care! If a patient is imminently dying they do not get transferred out of an acute hospital (means dying within 24-48 h), but if a patients hangs in - they get transferred out of the acute care hospital into a different setting.

And - no, just because the patient is on a morphine drip does not mean the pat automatically qualifies for GIP level of care...

[nursecathi]

GIP=general inpatient

[nutella, MSN, RN]

GIP=general inpatient

LOL - yes - I know what GIP means.

But your problem does not seem to be related to GIP level of care to me as GIP conditions per Medicare.

[heron, ASN, RN]

On my hospice inpatient unit, we used to admit pts from other units for transition to home or LTC as well as pts who were way more complicated than could be cared for otherwise - usually from ICU.

The geography of my unit was such that when our census dropped, we had to take an assignment on the acute unit next door in addition to the hospice pts left on ours. I'm here to tell ya that in an acute setting, the comfort needs of a hospice pt. drop to the bottom of the list of priorities. It has to. The acute care nurse has to juggle the needs of people being actively treated - complete with the duty to rescue and provide timely interventions - with the need for comfort for a hospice pt. This doesn't make them incompetent, neglectful or uncaring.

It may mean that they had to start a transfusion, administer chemo, work up a fever or admit a fresh post-op before providing incontinent care or straightening some blankets.

This is is an explanation ... not an excuse. My guess would be that the acute care nurse is as upset as you are over being unable to provide the care the pt deserves.

[nutella, MSN, RN]

On my hospice inpatient unit, we used to admit pts from other units for transition to home or LTC as well as pts who were way more complicated than could be cared for otherwise - usually from ICU.

The geography of my unit was such that when our census dropped, we had to take an assignment on the acute unit next door in addition to the hospice pts left on ours. I'm here to tell ya that in an acute setting, the comfort needs of a hospice pt. drop to the bottom of the list of priorities. It has to. The acute care nurse has to juggle the needs of people being actively treated - complete with the duty to rescue and provide timely interventions - with the need for comfort for a hospice pt. This doesn't make them incompetent, neglectful or uncaring.

It may mean that they had to start a transfusion, administer chemo, work up a fever or admit a fresh post-op before providing incontinent care or straightening some blankets.

This is is an explanation ... not an excuse. My guess would be that the acute care nurse is as upset as you are over being unable to provide the care the pt deserves.

I totally agree with you!

An acute hospital is not the best place to die - though patients and sometimes relatives are convinced it is!

The acute hospital is not only noisy, the staff is very busy with other patients who are more acute.

Patients who elect to stop tx go home with hospice, long-term care with hospice or hospice house. Only rarely does a patient meet GIP level of care criteria and when that occurs, it is only short term. If a patient is not imminent and is still alive after 48 hours, the pat needs to get transferred to a less acute setting or GIP hospice house.

Not that long ago I saw a patient who turned out to have advanced cancer and complications - sure to be dying within the next 2 weeks. The pat absolutely did not want to leave the hospital and managed to stay there for more than a week until she died but it was not a great situation.