Using hospice protocol

[sparkyswife]

Just wondering how all of you are using the hospice protocol. It used to be that it was user friendly and we were able to get narcotics out to patients and help them. Now with the C2 forms becoming more and more strict, we are dealing with the physicians, etc. and unable to get what we need. Anyone have a solution?

[Nascar nurse, ASN, RN]

The best advice I can give you is to get ahead of the "game" and stay on top of it. When admitting a patient, try to get physician to write for Morphine 120ml fill in 30ml increments, or Lorazepam 100 tabs- fill in 20 tab increments. It gives some "refill" room without being an actual refill - helps a lot when someone runs out or needs more than expected on a weekend. Make sure to ask each time it's "refilled" - "How many is left on that script" and get a new script early.

[4boysmama]

our hospice medical directors are my go-to for the c2 scripts. they are always available by cell phone and willing to fax scripts to our hospice pharmacy (enclara) with a very quick (usually less than a hour) turnaround. in the absence of cooperative hospice MDs, I would do as the previous poster uggeted, and ask for copious scripts with partial dispenses with start of care orders.

[Call me Al]

Make getting prescriptions for roxanol and their other control 2 drugs part of the admission process. Our docs in this area are used to us asking for them with admission orders. Other meds like Ativan, levsin, atropine are part of our protocol which docs sign on admission and we can call them in without needing a hard script. Our medical director is also awesome in helping when primary docs are elusive.