is this dispensing without a license?

I have an urgent question. it is two fold. first, can a hospice nurse tell a patient over the phone to take phenergan for nausea. or should she go out and evaluate the patient first before making decisions regarding care?
second, can dual certifications patients with both hospice and home health both have Skilled nursing care offered? as their main focus?
As a run of the mill home health nurse, I recently had a hospice patient. The 485 came from my agency, but my agency told me to call the hospice RN for questions or problems. When I talked to the hospice nurse she told me the case was with my agency because the hospice agency could not provide nursing care for the amount of required hours due to not enough personnel. I did nothing but general skilled care. There was a hospice comfort kit of meds in the home with PRN orders for them, but I only had to access it once and that was because the Mom insisted. Our night time hospice on-call RN gave orders to the night nurse on more than one occasion without assessing the patient in person, so I guess it is ok. The regular hospice visiting nurse came the next day to check the patient and they reinforced the orders to the patient family. We wrote the orders as TOs from the RN per their instructions. This is how this case went down for us, don't know what standard procedure is.

Yes, Phenegan is often a part of hospice standing orders for management of nausea. Standing orders are generally signed by the hospice medical director or attending MD upon admission of the pt. to hospice and are used to immediately implement a tx. plan for management of symptoms including pain, dyspnea, nausea, vomiting, constipation, etc. The nurse may suggest this as part of possibly triaging a call from a pt or their family to assist the pt. in the immediate management of the pt's. symptoms. The nurse should probably call back within an hour or so to see if the phenegan actually relieved the symptoms. If no relief, the nurse may make a visit. It is possible for a patient to be certified to both home health and hospice concurrently and recieving services. Hospice serves the pt. for the terminal condition when they elect no further curative tx and the focus is on maintaining comfort. It is possible that pt. develops a secondary condition requiring intermittant visits from home health (such as a fx related to a fall) and may require PT for strengthening, OT for transfer training of caregivers and home safety as well as a nurse for maybe teaching of levonox injections (which may not be covered by the hospice benefit.) It sounds like their is an ugency about your request, we're here to help. the Hospice board is a wonderful resource for questions regarding hospice and palliative care.

what if the hospice offers physical therapy? can the home health still go out? and should an lvn offer med advice over the phone without first assessing the patient

The way i am reading the rules and regulations if a skilled nurse is going into the home for hospice then the skilled nurse covers all the problems related to the hospice diagnosis. such as if the patient is diagnosed with liver failure they need to cover the insulin teaching also due to it relates back to the original diagnosis. is this true?

Teaching is not usually emphasized in hospice, rather comfort and pain control, to my knowledge. Teaching should be tailored to the situation at hand. If I were dying, I don't think I would be that interested in discussing the disease process. LVNs should defer to RNs when offering med advice, over the phone or in person.

i figure the teaching is for the family and the patient. they need to know what they are takin. i agree about the lvn. however, i am not so sure about offering advice over the phone to a patient without first assessing the vitals and overall condition of the patient.

This is probably more info than this discussion board should be into. And I have seen erroneous information already on this thread.Generally speaking, home hospice care usually does not offer PT/OT, because the pt is probably too weak or uninterested in these. PT & OT are usually reserved for people who are expected to improve.Sometimes there are both Home Health and Hospice on a case when the client needs something acute that Hospice cannot provide. IV antibiotics for an acute UTI, for example.And, yes, home health and hospice nurses can recommend that patients take their already prescibed prn meds when appropriate, without making an extra visit.If you feel that your family member is not receiving appropriate care, contact the social worker at the agency.

No, it is not dispensing without a license.

just a minor point adjustment...teaching is a huge part of hospice nursing in the field...it is just teaching of a different nature. We are teaching the family how to care for their loved one as health deteriorates toward death.

Quote from mamamerleeThis is probably more info than this discussion board should be into. And I have seen erroneous information already on this thread.Generally speaking, home hospice care usually does not offer PT/OT, because the pt is probably too weak or uninterested in these. PT & OT are usually reserved for people who are expected to improve.Sometimes there are both Home Health and Hospice on a case when the client needs something acute that Hospice cannot provide. IV antibiotics for an acute UTI, for example.And, yes, home health and hospice nurses can recommend that patients take their already prescibed prn meds when appropriate, without making an extra visit.If you feel that your family member is not receiving appropriate care, contact the social worker at the agency.

Quote from caliotter3Teaching is not usually emphasized in hospice, rather comfort and pain control, to my knowledge. Teaching should be tailored to the situation at hand. If I were dying, I don't think I would be that interested in discussing the disease process. LVNs should defer to RNs when offering med advice, over the phone or in person.