Symptom Management
What are the hours that hospice is available for symptom management or questions?
24/7
An on call nurse is always available
The hospice discipline that does not stop within days after patient has died
What are Hospice Bereavement Coordinators
True of False:
Hospice can provide education to facility staff?
Yes, hospice can be an additional resource for education on topics such as pain management, advanced care planning, behavior management and principles of death and dying.
What services can be added to enhance quality of life?
Complementary Therapies (Massage Therapy, Music Therapy and Expressive Arts)
What is the busy blanket, also known as a fidget blanket
Another option Masonicare offers is the automated cat
Name two medications that are used at end of life to help control secretions…
Levsin, Scopolamine, Atropine are three commonly used examples. Our agency uses Levsin as formulary and first line of defense. Atropine and scopolamine patches are added when Levsin is not enough.
Other symptom management medications are:
Morphine 5 mg prn is used for a starting point of pain management or soc
Ativan 0.5 mg is used for anxiety (often provided anxiety, agitation)
Haldol 0.5 mg used for agitation (sometimes omitted when in skilled nursing home setting)
Levsin 0.125 mg – see above
Bisacodyl suppository
Assistance with guiding a facility with ways to support staff in understanding professional losses, and offering community grief groups
What areas are included in scope of practice of a Hospice Bereavement Program?
When should hospice be recommended to patient or family?
When MD gives patient life-limiting diagnosis, significant overall decline such as decline in ADLs, Weight Loss, Metastatic Disease, goals of comfort care verses aggressive treatment
Name 3 non verbal signs of pain.
Moaning, frowning, rapid or increased/unusual breathing, grimacing, grinding teeth, flinching, guarding specific body part.
The maximum amount of time an individual can be on hospice
WHAT IS NO LIMIT
After the first two 90 day periods, hospice staff will complete a comprehensive assessment to determine hospice eligibility. Must continue to show decline and qualify as if disease continues normal trajectory patient will pass within 6 months or less.
This medication is commonly used to decrease bone flares in patients with metastatic disease.
What is Dexamethasone.
It is an anti-inflammatory – Decrease inflammation and decrease pain.
Having trouble concentrating; questioning previously decided health care decisions; becoming spontaneously tearful
What are some examples of normal grief responses?
This person is contacted when hospice is being recommended for a facility patient.
Liaisons will review terminal diagnosis, ensure process of referral, coordinate with patient, family, facility and Masonicare staff for a smooth transition into our services.
This document requires two medical doctors to sign, it is based on the nurses narrative and confirms the prognosis and officially admits the patient to hospice.
What is the Certificate of Terminal Diagnosis?
What tool is used to measure the functional status of a patients with Dementia.
The Functional Assessment Staging Tool or FAST.
Senile Degeneration of the Brain/Alzheimer's need to be a 7C or greater unless accompanied by co-morbidities that will decrease life expectancy such as continued weight loss.
FAST
7 a - speech limited to 6 words or less
7 b - Speech limited to single word
7 c - Ambulatory ability is loss
7 d - Cannot sit without assistance
7 e - Loss of smile
7 f - Cannot hold head independently
How long can a Macy Catheter remain in place?
28 days
Macy Catheter's can be used when hospice patients are no longer able to take medications orally.
Recommended commonly in patients with seizure disorders.
Consider in nausea or excessive pain management situations.
Questioning why God doesn't take me home; the need to celebrate life accomplishments and explore regrets; the need to receive and give forgiveness.
What are issues the Hospice Spiritual Care Coordinator can address?
This discipline can assist with family/patient coping, social, emotional, and practical challenges, counseling and community resources?
Name 6 (out of 10) services that hospice can offer to support patients and families.
Massage Therapy
Volunteer
Music Therapy
Pet Therapy
Medical Social Worker
Spiritual Care
Bereavement
Nursing
Home Health Aides
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What are the different levels of hospice?
Routine, Continuous Care, General Inpatient
Routine - Most hospice patients on this level
Continuous Care - When symptom management is not controlled and hourly assessment of the patient is required to titrate medications - normally provided in home and ALF when nursing staff is not already available
GIP - when symptom management is not controlled and requires elevated level of care not able to be provided in home setting, example continuous medication provided via IV
What level of care can be provided when symptom management is not controlled and requires elevated level of care not able to be provided in home setting, example continuous medication provided via IV
General Inpatient (GIP)
Reaching; looking up; mentioning deceased loved ones
What is near death awareness?
Patient is confused, forgetful and unable to understand information provided in order to make decisions—both medical and financial. Patient refusing care needed in order for patient to remain home safely. Family involved and at a loss as what to do with patient.
Encourage family to petition the court to move forward with Conservatorship for patient.
What percentage of volunteer should a hospice program provide?
5% is volunteer goal.
Masonicare is at 7.1% presently
The Medicare Hospice Benefit was enacted by congress in this year
WHAT IS 1982