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How would you deal with a Hospice Patient?


EMS2712

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VentMedic, I hope you are not taking what I have stated as bashing Hospice. I may have differences with SOME of the policies that Hospice follows, but I do think they do good work as witnessed with my grandmother. I QA the report, and some of the questions I posted were those that were brought to me from the crew on the run. I will also admit that I am not an expert on Hospice care which is part of the reason I brought it up for discussion today.

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This is all exactly why I wanted to find out more. In past years we've have serious problems with a lot of the "more affordable" nursing homes(i.e.- the ones that didn't cost several months or even a year's pay per month) abusing and/or neglecting patients. I know there is no way anyone I care about would ever go to one a facility around here at this point. I just wouldn't want that to mean they had to suffer without proper pain management. It sounds like it is a difficult situation all around. I can see a pt being cancelled from hospice if they are rescusitated, but not for seeking treatment for comfort even if that comfort means attempting to better manage their condition. Out of curiosity, why would the hospital counteract all pain meds and raise their bp? Is this regardless of the reason they are there?

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EMS2712

My comments were not directed at you.

Out of curiosity, why would the hospital counteract all pain meds and raise their bp? Is this regardless of the reason they are there?

They are being brought in by EMS to be resuscitated. ED doctors know that Hospice patients have a lot of pain meds on board so they may need to get those off if they want to attempt to get the patient conscious and increase BP.

Before the ED doctors can give anywhere close to what the patient was receiving for meds in hospice there will have to be some clarificaton of the patient's and family's wishes. There will also have to be serious discussion with their primary doctor. This could take awhile. In the meantime, attempts may be made to make the patient comfortable but it may mean putting them on a ventilator and pressors to which they may not come off alive. Thus, an ICU bed will be taken by a terminally ill patient indefinitely.

Hospice patients are rarely happy campers in the ED or ICU and usually they are there because of their family members' issues...not theirs.

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