A few little stories from recent hospice experiences I thought might be amusing.
Well, that's a little premature . . . .
A couple of weeks ago, I was working an extra shift doing on call visits for the weekend. I put the address of a patient I was on my way to see into my GPS, since I'd never been there before.
As I approach my destination, the voice system tells me it's ahead on the left. I start scanning address signs, and see the house I am actually on my way to see, but drive by too fast to make the turn into the drive.
As I start looking for a place to turn, my GPS says, "Arrived, Destination, Address XX, on the left." I glance out the window to my left.
It's a cemetery.
I hope the GPS wasn't trying to tell me something . . .
In the house??
I didn't get this call, thank God. The night before my shift, I am listening to our voice mail system taking notes of important patient info, and the visits that need to be made the next day. One nurse notes her patient is very close to dying. If the patient died, whoever had to make the death call was to wash the body and place it in a casket that was already in the home.
Turns out the family had bought the casket off eBay. It had originally been used at a party. Rumor has it they planned to do the burial in the back yard, but a neighbor objected, so they planned to take the body to some property they owned out in the country.
Apparently, this is not a new idea.
I did what you told me!
This story isn't so amusing. It's more of a CoCW story.
I make a visit to a facility at the request of the staff there, as they found some new skin break down on one of our patients. There wasn't a nurse on duty at the facility, so I had to make the call to the doctor for wound care orders.
This particular doctor is a well known asshat who often takes hours to return phone calls from the facilities he covers. This had gotten to be such a problem for us, that we finally got him to give us his personal cell number and parameters for which we could use it, which included new skin break down. Since I couldn't dress the wound without an order, I had no choice but to call.
He was pissed and went on a rant about how we should always go through the answering service because then there would be documentation of the call, blah, blah, blah.
Yeah, right. Like this is really about documentation, you jerk. You just want to be able to ditch the calls again.
A little bit of snark goes a long way
We've been having problems lately with a nurse who leaves lengthy voice mails requesting visits, gets to the end of her message and doesn't tell us what she actually wants us to do on the weekend. Does she want a phone call follow up? Does she want a visit? What does she want us to do while we're there? An assessment? Wound care? What?
She had pissed off the entire on call team by leaving a snarky voice mail complaining that I never leave her voice mails to tell her what I did for her patient over the weekend . . . because it was a bald faced lie.
So I got her back. Yes, I was well and truly snarky.
She leaves this voice mail about a patient in a facility whom she's concerned that the nursing staff isn't giving pain medications to. She's done this before: she fears the staff won't follow her recommendations (they don't have to) when it comes to giving PRN (as needed) meds. There's a legit concern here; a lot of nurses won't give a PRN med unless the patient asks for it, and many hospice patients can't. They're still in pain though.
So I see the patient, who is indeed having problems. The nurse on duty recognized this as well. She thought a round the clock order would be more appropriate, and I agreed with her. I suggested she call the facility doctor and get an order to make the med round the clock (when there's a nurse on, she can do this as easily as I can), and she agreed to this.
I chart the issue and the resolution. Then I have to leave a voicemail on what I did. We have a new policy; voicemails on patients are to be sent to a distribution list to the entire team (all the nurses on a team share the patients, along with social work and chaplains) instead of just the primary nurse.
Me: Hi, this is Panacea reporting on Patient X, Team C, patient of Nurse S. I visited the patient at Nurse S's request because she was concerned the facility staff was not giving the patient pain medication; she wanted me to check up on this. *I then run down what I just described above.* I really don't know why Nurse S didn't simply call the facility doctor herself on Friday to get a round the clock order.
Yes, I said that. Because it was a total waste of time to make that visit when she could have resolved the problem herself on Friday by getting the right kind of order. It cost hospice $45 plus mileage to send me out there for this.
Making a visit to see if the change was effective would have been another matter. But I hate making visits to do work that the primary could have done had she exercised a little initiative and common sense.