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Vitas Offers In-Home Hospice Care 24/7

Monday August 25, 2008
Jeff Mack, RN
Jeff Mack, RN
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The toughest times for patients and caregivers are when they're on their own, particularly when they can't reach healthcare providers. Since "after hours" can be both difficult and dangerous, Vitas Innovative Hospice Care of Broward, Fla., decided to replace the on-call service model with Telecare — routine, round-the-clock staffing to respond to its 1,400 patients.

"When a patient is in crisis or in pain, every minute is an eternity, and if they're at home, the agitation and anxiety is horrific if you have no idea where to go," says former client Kimberly Vinton, now an after-hours Telecare LPN. "When my husband had terminal lung cancer, I kept him at home because I'm [an LPN]. But even though I had worked in hospitals and rehab for nearly 20 years, it was completely different. I used Vitas, and it was such a relief to be able to pick up the phone and call if it's a crisis, no matter how minor. It's very comforting to be able to give the patient relief, and to know there's someone to turn to who can make the patient comfortable, or decide to send the patient to the hospice or hospital."

"Knowing there's a call center relieves caregivers and gives them confidence," says Jeff Mack, RN, patient care administrator. Since caregivers may be panicked by symptoms, "having staff available at night eases anxiety and decreases emergency department visits," he says.

A typical night shift

"We can get up to 200 calls at the Telecare call center per night," says Team Manager Nadine Brown, RN. "The triage nurses can handle most calls by phone, but if not, [the nurse] prioritizes them, and dispatches an RN or LPN runner. Priority one is basically emergent care and symptom management for pain, breathing difficulties, fall with trauma, Alzheimer's sun-downing, and any abnormal activity or something we can't handle over the phone. Priority two includes dressing changes, medication teaching, and other things that aren't critical. Priority three is something such as reordering supplies."

The most common reasons for calls are shortness of breath, anxiety, pain, and falls. The log from a recent weekend listed fall, fall with injury, agitation, caregiver distress, weakness/edema, supplies, medication review, death, breathing difficulties, leaking Foley catheter, medication side effects, altered level of consciousness, change in vital signs, and an ED admission.

During the weekend, eight nurses work as Telecare runners from 8 AM to 4 PM, and seven from 4 pm to 8 am; weeknights, six work from 4 PM to midnight, and three from midnight to 8 AM. In addition to responding to new concerns, they also provide care scheduled after typical business hours for the convenience of patients and families. "They're dispatched by priority and regional area, so the closest nurse can get there fastest, usually within a half hour for priority one calls," Brown says. Nurses carry all necessary supplies except for medications and durable medical equipment; those services are also on-call and couriers usually make deliveries within an hour.

Since nurses legally can't carry controlled substances, hospice physicians often prescribe a comfort pack of morphine, Haldol, Ativan, and other drugs for patients to keep at home until needed.

Vitas nurses will go to the ED to help patients return home, or decide if they need inpatient care at the hospital, a nursing home, or one of the four Vitas hospice units. "We can admit patients during the night whenever patients and families prefer," he says. "It may be because of agitation, pain, difficulty breathing, caregiver distress, or if the patient is dying and they don't want the death to occur at home, especially if children are present."

In the final hours

Deaths often occur at night. "Nurses can provide round-the-clock care to enable patients to remain at home, go out to stabilize the patient as much as possible, and make patients and families as comfortable emotionally and medically as they can," says Vinton.

After death, the nurses can pronounce the patient, call the doctor, support the family emotionally, bring in a chaplain or social worker, and help with practical arrangements such as the funeral home.

"We're there for families afterwards through contact, calls, support groups, and cards," says Mack. Grieving families who need phone support can call any time.

Wendy Bonifazi, RN, CLS, APR, is a senior staff writer with Nursing Spectrum.


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