Palliative care in a hospice / MAID

[ChemGal]

Just know I got a lot of discontinued med orders towards the end.....comfort measures only that include various drugs to keep someone comfortable.

I would hope that includes prevent chronic issues from resulting in symptoms though. Not just using things like pain meds when the cause of some pain could be prevented in the first place. Even if no pain is felt, an attack isn't comfortable.

 

[Waterfall]

I would hope that includes prevent chronic issues from resulting in symptoms though. Not just using things like pain meds when the cause of some pain could be prevented in the first place. Even if no pain is felt, an attack isn't comfortable.

Each case is assessed individually.

 

[BetteTheRed]

So, with Dave, for instance, they took him off all his BP meds, and any other meds his GP/dialysis team were using to help him sleep/ease anxiety. Focussed on just alleviating any discomfort/symptoms from his kidneys shutting down, mainly a lot of opiates, I suspect. They put a picc line in his leg so that they didn't have to inject him repeatedly. A little bit of Ensure if he wanted it, swabs with cold water, a turn and fluff every two hours.

 

[Pinga]

Most of what I'm hearing is what people are observing during someone else's dying process, but how much do we really know about what that process means for those who are dying themselves? How aware are they of their former life, compared to their new existence?

Since none of us are dying...kinda hard to say.

Just know I got a lot of discontinued med orders towards the end.....comfort measures only that include various drugs to keep someone comfortable.

Yes, but, Waterfall, those are based on doctor's guidance.
@ChemGal - that to me would be something you put in your advanced directives -- ie ensure it is well documented

 

[BetteTheRed]

Since none of us are dying...kinda hard to say.

What we do have as "quasi" evidence are NDE's, right?

 

[ChemGal]

Since none of us are dying...kinda hard to say.


Yes, but, Waterfall, those are based on doctor's guidance.
@ChemGal - that to me would be something you put in your advanced directives -- ie ensure it is well documented

I've noticed healthcare workers are great at ignoring protocols unfortunately if it's not the norm for them.

 

[Waterfall]

I've noticed healthcare workers are great at ignoring protocols unfortunately if it's not the norm for them.

Yes, but, Waterfall, those are based on doctor's guidance.
@ChemGal - that to me would be something you put in your advanced directives -- ie ensure it is well documented

Could you both explain what you mean by these statements? Im not sure Im understanding what youre saying.

 

[ChemGal]

Could you both explain what you mean by these statements? Im not sure Im understanding what youre saying.

Healthcare workers regularly ignore proper protocol for treating hereditary angioedema attacks. - I have experienced this multiple times and I hear from others in HAE groups who have the same problems I've also had issues with prophylactic treatment, although less so.

 

[Waterfall]

Healthcare workers regularly ignore proper protocol for treating hereditary angioedema attacks. - I have experienced this multiple times and I hear from others in HAE groups who have the same problems I've also had issues with prophylactic treatment, although less so.

Sorry to hear that....is this beyond doctors orders?

 

[Pinga]

@Waterfall you had said "Just know I got a lot of discontinued med orders towards the end.....comfort measures only that include various drugs to keep someone comfortable."
and i responded Yes, but, Waterfall, those are based on doctor's guidance.

My point was, that a patient or a patient's family wouldn't be advising you to discontinue meds. To my knowledge, those twould come from whomever was responsible for the patient's medication orders, noting that that may change if they have transitioned to a place where the meds are managed. In our case, we saw it be for example, my Dad's GP directly with his pharmacy, then my Dad's GP through the retirement home's pharmacy to nursing staff, then LTC's GP through the LTC staff).
The changes to the medications were well thought out for ceasing, and clearing indicated, though, of course, there were some that were PRN and so discretion was there.

Are you indicating that someone else is able to decide to discontinue meds?

 

[ChemGal]

Sorry to hear that....is this beyond doctors orders?

It's ignoring what my hematologist has ordered.

 

[Waterfall]

@Waterfall you had said "Just know I got a lot of discontinued med orders towards the end.....comfort measures only that include various drugs to keep someone comfortable."
and i responded Yes, but, Waterfall, those are based on doctor's guidance.

My point was, that a patient or a patient's family wouldn't be advising you to discontinue meds. To my knowledge, those twould come from whomever was responsible for the patient's medication orders, noting that that may change if they have transitioned to a place where the meds are managed. In our case, we saw it be for example, my Dad's GP directly with his pharmacy, then my Dad's GP through the retirement home's pharmacy to nursing staff, then LTC's GP through the LTC staff).
The changes to the medications were well thought out for ceasitelng, and clearing indicated, though, of course, there were some that were PRN and so discretion was there.

Are you indicating that someone else is able to decide to discontinue meds?

Pinga not sure where you got that idea from......I do not do anything to jeopardize my licence/registration and work within the guidelines set forward by the CNO.
Orders that are D/C'd are from doctors, although Nurses are being given more latitude lately.

 

[Pinga]

Right, we are in agreement.

All medications changes are going to come from the doctor.

 

[Waterfall]

Right, we are in agreement.

All medications changes are going to come from the doctor.

Well........some things have changed

https://www.cno.org/globalassets/docs/prac/41075_authorizingmech.pdf

 

[Pinga]

Well........some things have changed

https://www.cno.org/globalassets/docs/prac/41075_authorizingmech.pdf

Waterfall, i trust you don't expect me to read a 14pg document.
Is there a specific section that you would like me to review or that you are referring to in order to educate us in terms of the prescription of medications by nurses?

 

[Pinga]

Sorry, @Waterfall -- I'm not enjoying the dance. If there is a particular item that you would like to explain, please do so, or if there is a clarification in language, please do so. I had specifically said "Are you indicating that someone else is able to decide to discontinue meds?"

 

[Waterfall]

Waterfall, i trust you don't expect me to read a 14pg document.
Is there a specific section that you would like me to review or that you are referring to in order to educate us in terms of the prescription of medications by nurses?

https://www.cno.org/en/trending-topics/nps-and-prescribing-controlled-substances/

 

[Waterfall]

Sorry, @Waterfall -- I'm not enjoying the dance. If there is a particular item that you would like to explain, please do so, or if there is a clarification in language, please do so. I had specifically said "Are you indicating that someone else is able to decide to discontinue meds?"

PInga, I am leaving this thread.......

 

[BetteTheRed]

Nurse-practitioners can also prescribe these days, so it gets a bit complicated.

 

[Pinga]

Thank-you that was helpful.

Here is the key piece that I think @Waterfall was trying to advise.
"Nurse Practitioners (NPs) in Ontario can prescribe controlled substances, if they have completed approved controlled substances education."

For anyone who knows and can inform us,
a) this appears to be Nurse Practitioners . I sense Nurse Practioners are in hospices, and may be common there. Is that correct? Are they common in LTC homes?
b) are there specific categories of meds that a NP can prescribe or is it relatively open, or does it depend on the certification
c) can an NP discontinue a medication previously prescribed by someone else (ie an NP on a different shift, or the patient's GP?)

I had said " all medication changes are going to come from the doctor", wich I think set it off.
What I think was missing from that statement -- "all medication changes are going to come from the originating source, ie if from the doctor. "
Is that correct? If the medication was prescribed by the NP, then the changes would come from them?

Trying to understand