Unsafe Discharge?

I am currently a Clinical Director for a Hospice Agency.The Hospital wanted to send a patient home who was actively dying, with a lopressor drip. This was to take place on a Friday afternoon during a snowstorm. Our Medical Director supported this plan.I refused due to lack of staff on weekends, no policy for this intervention and most of all I felt it was an unsafe discharge.What has happened to the Hospice Philosophy? Was I wrong?

what kind of parameters were written?

were there weaning parameters?

as long as it's noted (by med'l dir) that pt is actively dying:

that this is pt/poa's wishes, despite futility, and there are concrete parameters, i don't see where anything is unsafe...

unless your staff is not trained in iv gtts.

the biggest concern, is that aforementioned documentation has indeed, taken place by med'l dir, or at least, by an MD...specifically noting the active dying process and futility of care.

leslie

I agree with Leslie - I think the patients wishes are paramount - if they wanted to die at home and the family wanted to support this then I would support this.

That being said I am from the UK and there is support form the community nurses to provide the appropriate drugs to keep the patient comfortable and pain free.

Please forgive me if this is a dumb question but why would someone who is actively dying be on lopressor?

Please forgive me if this is a dumb question but why would someone who is actively dying be on lopressor?

That's exactly what I was wondering!

Please forgive me if this is a dumb question but why would someone who is actively dying be on lopressor?

That's exactly what I was wondering!

the lopressor caught my eye as well, i think that is what Leslei was getting at with "is there a weaning schedule/parameters" perhaps the patient wouldnt survive the cessation of the lopressor, and, wanting to die at home, it was to be continued until (s)he could get there.....?

the lopressor caught my eye as well, i think that is what Leslei was getting at with "is there a weaning schedule/parameters" perhaps the patient wouldnt survive the cessation of the lopressor, and, wanting to die at home, it was to be continued until (s)he could get there.....?

that's more or less it, morte.

po lopressor is indicated for htn, angina, mi and prophylactic use.

iv lopressor is indicated for mi, vtach, acs and sev'l other cardiac anomalies.

assuming the pt's primary/admitting dx is unrelated to the heart, then supportive care is fine- and i'm quite sure this was ordered to get the pt in their home environment.

a temporary measure.

even if pt's hospice dx was r/t cardiac, the med'l director can always override and authorize pretty much, anything s/he chooses to.

leslie

Thank you, morte and Leslie for the explanations. I should have looked up the med for other indications but was wondering why with (I'm assuming since pt was actively dying) an already dropping b/p they'd be given a drug like that. Hope the pt was able to make it home before passing on since that was the wish.

i am currently a clinical director for a hospice agency.the hospital wanted to send a patient home who was actively dying, with a lopressor drip. this was to take place on a friday afternoon during a snowstorm. our medical director supported this plan.i refused due to lack of staff on weekends, no policy for this intervention and most of all i felt it was an unsafe discharge.what has happened to the hospice philosophy? was i wrong?

i don't see the danger in sending a patient home to die... snowstorm, late friday afternoon, lack of staff, whatever, there's nothing unsafe in those circumstances. what was the worst that was going to happen??

what is the hospice philosophy? is it not to die at home comfortably with family by one's side?

I agree with Leslie on this. But, have some comments. Lopressor will DECREASE blood pressure, if this patient is actively dying, why continue it? I question a medical director who would approve of the patient going home with IV Lopressor.

And, the unsafe part....well, to me anyway, is the snowstorm! Given that I live in Massachusetts, I can confirm that it IS a safety issue when driving in these recent snowstorms! Just a week ago, someone passed me, going WAY too fast in a snowstorm, and lost control and crashed into a telephone pole in front of me....the person was fine, but the car was totalled.

I agree with Leslie on this. But, have some comments. Lopressor will DECREASE blood pressure, if this patient is actively dying, why continue it? I question a medical director who would approve of the patient going home with IV Lopressor.

And, the unsafe part....well, to me anyway, is the snowstorm! Given that I live in Massachusetts, I can confirm that it IS a safety issue when driving in these recent snowstorms! Just a week ago, someone passed me, going WAY too fast in a snowstorm, and lost control and crashed into a telephone pole in front of me....the person was fine, but the car was totalled.

if this med'l dir was advocating for pt to die at home, i applaud him.

sure, lopressor will decrease bp, as will morphine and sev'l other meds.

i 100% support pt going home to die.

leslie

I applaud him or her, too...but, why complicate matters and continue futile interventions (lopressor). With good family support, (I assume the hospice admitting nurse was at the hospital to assure support to transfer the pt home), usually the family can be educated and supported to d/c unecessary meds/procedures....or, maybe I missed something.