Weekend and evening admissions?

saribeth · Feb 14, 2004

Hi Aimeee...I work for a hospice within the VNA...yes, we do weekend and evening admissions on a regular basis and no, we don't have an admission nurse...our on call nurse does the evening adms and she is responsible for the entire agency (approx 200pts and those are just the ones with wounds, tubes etc) We, (Hospice) usually get the heads up on Friday for a weekend adm so we are able to contact the family for a Sat or Sun adm. It is difficult to get DME delivered, but they have come through in an "emergency"; our hospital coordiantor really tries to set things up very well with O2 and pain Rx...but our on call nurse does run into problems at times with proper orders and meds etc and you are right, so many times they are at death's door...and there have been times when the on call nurse has to leave an admission and we have had to follow up the next day but mostly with paper work...that dreaded word! Hope this helps and we also will do holiday admissions! The home care nurses were complaining that the weekend visits were mostly hospice pts, so we now cover every weekend for scheduled visits and admissions and I know I myself will do pronouncements for the on call nurse when I am on if they are during the day...it was almost every other weekend for a very long time until we got more staff, but that is a whole other situation!!!! Hope this helps

Angelica · Feb 14, 2004

Wow... I've only worked with hospice for a couple of months, but I can't imagine being on call and responsible for 200 pts. I live in a small community and our census runs between 30 and 40 pts. Anyway, our on call nurse does weekend and evening admissions, but we don't do a lot of them. Most are admitted during normal working hours.

renerian, BSN, RN · Feb 14, 2004

Hubby's hospice has weekend people or else your weekday people get very tired.

renerian

DMB FAN2 · Feb 15, 2004

Our Hospice only does admissions during the week mostly. If it is a real emergency (the pt is immenently dying and really wants to be home) they will go and do it. We have 3 counties and about 150 patients that they are responsible for so as you said- they don't want to be tied up with that. We also have a back-up on call nurse who is an LPN/RN and she makes visits and does any admissions if they come up. We have alot of admissions on friday's d/t the hospitals want to empty out- and they usually come home with half-assed :angryfire orders- and it's hard to get meds on a friday afternoon.......anyway....we try to do them during the week .....hope that helps!

nursechris1 · Feb 16, 2004

We are lucky to have 2 nurses who work every weekend to do admits and emergency visits. I recently hired a 12-8 LPN to do admits for us after hours, as it seemed we had more and more requests for admits after family got off work in the evening. It is working out pretty well so far.

hpyrn · Feb 17, 2004

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I'm just curious what other's do. Do you do weekend and evening admissions on a regular basis? If you do, does your oncall nurse do it? And what kind of a census population is the oncall nurse serving? Do you have an oncall admission staff?
I'm just asking because this is continually an issue for us. We do it now and then, but generally only when it is well planned in advance and unavoidable. Its just too great a burden for the limited oncall staff. If they are tied up for hours dealing with an admission then other patient's who are needing support can't get the timely service THEY need. I had to refuse 2 cases yesterday because they wanted to send people home from the hospital on the weekend that we had no previous contact about who were already at death's door. Everytime we DO accept one it ends up being a frustrating mess for everybody because invariably the hospital staff in ill-informed and they are sent home without appropriate orders or communication and our staff spends hours spinning their wheels trying to get things in place. :angryfire And then when looking back in the physician's notes, I can't tell you how many times I will see that there was mention of hospice consideration as much as 3 days prior!
Sorry for the rant, but it just really makes me burn, because in the end it is the patient and family who suffer, and aren't they already suffering enough already? I think they deserve a well planned, calm, and orderly discharge.

Where I work we have 5-6 rn's on every week-end, we have been averageing about 15 admissions a week-end. Our coordinators dont ever say no, many could be done during the next week but it is our policy never to turn anyone away. During the week our evening person can do admitts but usually they go do a tuck in and we finish the next day. Week-ends have been a real bone of contention lately because its so much work to do a admitt and then if we have 3 in 2 days that means alot of home work so its finished for monday. It is really crazy, we cover i think 6 counties and service about 300 pt with hospice and home care supportive care. Whew no wonder I'm tired.

Linda :eek: :uhoh21:

Shannon Grey · Feb 17, 2004

I am so sorry you are hit so hard by weekend admissions it is quite difficult to understand at our hospital we initiate discharge planning on admisssion and it is quite well managed our social worker and care coordinator follow nursings recommendations and the physicians are rather cowering in corners when it comes to timely discharge by our utilization reviewers. Our social services and nurses review and correct the orders for hospice and we will obtain the medications at least to go through the weekends. This allows our patients to receive un interrupted care and eases them into the transition to hospice. Perhaps the problem lies with the referral center. As a matter of fact most of the hospice agencies we work with have a Baylor plan where nurses work on Saturday and Sunday only with a "regular " staff member to rely on for extra heavy days. Hope this helps and would like to thank all of you Hospice does an extraordinary job with patients and families in most difficult situations

God Bless Shannon:)

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Where I work we have 5-6 rn's on every week-end, we have been averageing about 15 admissions a week-end. Our coordinators dont ever say no, many could be done during the next week but it is our policy never to turn anyone away. During the week our evening person can do admitts but usually they go do a tuck in and we finish the next day. Week-ends have been a real bone of contention lately because its so much work to do a admitt and then if we have 3 in 2 days that means alot of home work so its finished for monday. It is really crazy, we cover i think 6 counties and service about 300 pt with hospice and home care supportive care. Whew no wonder I'm tired.
Linda :uhoh21: