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Apr
14

We Must Do Better

Dear Colleagues,

I have a request. And it isn’t a small one.

But it’s a crucial one.

You see, I work in an inpatient hospice unit. Inpatient hospice signifies that patients require a level of care that cannot be managed in the home setting. They must have active symptoms to qualify for inpatient care. It’s basically a “hospice ICU” in that we are constantly titrating drips and pushing meds and doing everything we can to keep our patients comfortable. We’re not trying to save lives but we’re certainly trying to make them feel better…and in a way, that’s saving lives too. It’s a busy, busy place.

I’ve been noticing that every so often (too often), I admit a patient from another facility whose condition is appalling. Not because they’re dying. Because they were made “comfort care” in a hospital two days ago and yet they arrive to us covered in defibrillator pads and EKG stickers. Because they were living in a nursing home or assisted living facility with visiting hospice care and they come to us with pressure ulcers because the staff deferred skin care to the hospice nurse who only comes once a week. Because they have been incontinent for days and sitting in their own urine to the point that their perineum is excoriated and putting in a Foley catheter to protect their skin causes excruciating pain.

I know being a nurse is exhausting. I know working on a hospital unit or nursing facility means a heavy workload and way too many patients. But I’m begging you to pay as close attention to the ones who are dying as you do to the ones you are trying to keep alive. I know the temptation is to assign your “comfort care” patients to the nurse who has the most difficult group of patients – I’ve actually heard charge nurses say out loud: “Oh they’re comfort care, so they won’t need anything. They’ll be easy and you can focus on your other patients.”

No.

The fact is that if your patient is comfort care and you are doing your job, you’ll be more busy. You’ll still be rounding on your patient regularly, remaining vigilant about any symptoms that need to be addressed.You’ll be providing compassionate care to families, acknowledging that even your worst day at work pales in comparison to their worst day ever. You’ll be advocating to providers for better pain control, or more interventions for dyspnea. You’ll be working your ass off to help your patients die with dignity and comfort.

I’m not trying to tell you how to do your job (but I kind of am). Please pay attention to those patients nearing the end of their lives. DNAR means “Do not resuscitate” – it does not mean “do not provide care”. Many of them won’t make it to inpatient hospice. They won’t be stable enough to transport, or their families may not wish to have them moved if they are actively dying, or there won’t be a hospice bed available. We all have to pitch in. We all have to provide excellent end-of-life care, no matter where we work.

We can do better. We must do better.

Thanks for hearing me out.

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