Waking up hospice patients at night?

joyflnoyz, LPN · Mar 23, 2005

I am new to hospice and I usually have 5 patients at night. 3 of my 5 patients have to be awakened at 12 midnight and 6am for their routine meds. I thought if you were "dying" you would be free from these kinds of interruptions. I guess even if we're dying we are still not going to be allowed to rest in peace. :angryfire Does your hospice do this too?

What are the meds? Why are they given? ABTs for a UTI? Miralax to avoid constipation? cardiac meds? Admission to hospice means no further treatment for the diagnosis related to admission. If you've got a lung cancer pattient, it doesn't mean automatically DCing diabetes, or cardiac meds..

Just because they are in Hospice does not mean "don't take care of" usually,(where I work) meds are continued until the patient is "active" or if taking the meds causes more discomfort than going without the medication.

BTW: everyone starts to die the moment they're born

Long Term Care Columnist / Guide · Mar 24, 2005

If those are pain meds you're giving at those hours, I can understand the rationale.....after all, the meds are most effective if used on an around-the-clock basis. But if you're waking people up for stool softeners, BP meds or suppositories, then yes, adjustments should be made in the schedule to allow for maximum uninterrupted rest. There's no good reason not to give most, if not all meds during the day, and I think one of the most inhumane things that can be done to patients is to wake them up at some ungodly hour in the AM with a 'silver bullet'. :stone

Blackcat99 · Mar 24, 2005

I don't object to any of the meds given.They are just routine meds not pain meds such as meds for high blood pressure. It's just that in most LTC's qid means 9am,1pm,5pm,9pm.These are the times when most people are still awake. This sounds more humane to me. At the hospice qid is 6am, 12 noon, 6pm and 12 midnight.

Long Term Care Columnist / Guide · Mar 24, 2005

I don't object to any of the meds given.They are just routine meds not pain meds such as meds for high blood pressure. It's just that in most LTC's qid means 9am,1pm,5pm,9pm.These are the times when most people are still awake. This sounds more humane to me. At the hospice qid is 6am, 12 noon, 6pm and 12 midnight.

Yanno, that sounds like something the care manager did at this one nursing home where I used to work: she set a similar medication schedule because she didn't think the night-shift nurses had enough to do. Forget the residents' rights, forget the fact that frequent sleep interruptions help to create alot of the behavior issues we dealt with in LTC.......nope, gotta give that Toprol XL at midnight :angryfire

People who are in a hospice setting deserve as much uninterrupted rest as they can get. Perhaps you need to speak up for them and let your managers know that QID means QID, not Q 6 hours.........and if they don't think you've got enough to do, then they can assign paperwork or cleaning tasks or checking equipment, not waking people up for meds that can be given more easily during the day. :stone

jnette, ASN, EMT-I · Mar 24, 2005

Yanno, that sounds like something the care manager did at this one nursing home where I used to work: she set a similar medication schedule because she didn't think the night-shift nurses had enough to do. Forget the residents' rights, forget the fact that frequent sleep interruptions help to create alot of the behavior issues we dealt with in LTC.......nope, gotta give that Toprol XL at midnight :angryfire
People who are in a hospice setting deserve as much uninterrupted rest as they can get. Perhaps you need to speak up for them and let your managers know that QID means QID, not Q 6 hours.........and if they don't think you've got enough to do, then they can assign paperwork or cleaning tasks or checking equipment, not waking people up for meds that can be given more easily during the day. :stone

Boy, do I ever agree, Marla !

That is ridiculous and totally uneccessary. I would addresse this with your manager, and pronto. Advocate for those patients and let her know how you feel about how unfair it is to THEM !

OneThunder, BSN, RN · Mar 25, 2005

Boy, do I ever agree, Marla !
That is ridiculous and totally uneccessary. I would addresse this with your manager, and pronto. Advocate for those patients and let her know how you feel about how unfair it is to THEM !

I think the easiest way around this issue is to speak to the Hospice case manager. She would simply discuss this with the Hospice Medical director, get a his/her order to give the meds at a more convienient time, (specifically)write the order and be done with it. Then discuss with the DON to possibly give an inservice dealing with hospice symptom control. During the inservice touch on the subject.

Blackcat99 · Mar 26, 2005

Thanks all for your great suggestions. :idea: I need to speak to the manager about this situation at the next staff meeting.

LYNNORA · Mar 26, 2005

When I worked in Hospice, we would use the 12hour release meds such as MS Contin. We would give at 10am and 10pm, this seemed to suit our pts and we were not waking them up Q4hrs for pain meds.

We also used Kadian which is a morphine product that releases over 24hrs.