Patient probably was in the hospital for a while and declining despite best efforts. Sometimes, the patient is brought by family to ER and requesting hospice as the patient is very old and has severe medical problems and declining rapidly.
Social Worker will be first to be involved to call Hospice agency of patients’ family’s choice.
While waiting for hospice agencyRN to come and accept patient for General In-patient hospice, patient can be admitted to Med-surgical floor.
Once the papers are signed by the family with the hospice agency, patient needs to be admitted to in patient hospice admisson. Patient should be discharged from medical admission and Orders need to be entered again to admit to GIP/General Inpatient Hospice admission.
Some of the orders for in-patient hospice admission are:
Atropine Ophthalmic 1% 4 drops SL q 2-4hrs to minimize secretions [Ophthalmic but given orally]
Lubricant Eye drops
Roxanol (Morphine Concentrated Oral Sol) 5-10mg PO every 2 hrs for pain
Morphine IV drip if patient is suffering, to relive pain
Consult Case Manager/Social Services
Pastoral Care Consult
Level of Care: No code
(Usually there will be an order set for Hospice admission)
If Patient dies, Charge Nurse or Nursing Supervisor or hospitalist pronounces death. You have to sign the death certificate which is done online in some places.
If the patient dies with in 24hrs of admission or dies after a fall, trauma etc, Coroner needs to be called and he/she will ask questions to see if death was natural or not. This call is made by nursing staff. Autopsy option should be given to family but usually it is not done as patient is on hospice.