Hospice is a health care system of interdisciplinary services provided to patients and their families during the final stage of life. These services are delivered with sensitivity to the fact that, as hospice and palliative professionals, we have entered into people’s lives and affairs during a period of heightened need and potential vulnerability. The National Hospice and Palliative Care Organization (NPHCO) is an advocate for patients facing the end of life and their families and the voice of hospice and palliative care services. Through its standards, policies and procedures, NHPCO and the Agency seek to promote an ethical corporate culture involving both internal and external relationships. Because of the nature of our business, some requirements warrant specific mention here:
I. To meet the hospice and palliative care needs of patients and their families.
To remain sensitive to and be appreciative of the ethnic, cultural, religious, spiritual and lifestyle diversity of patients and their families.
To ascertain and honor the wishes, concerns, priorities and values of the patients and their families consistent with the law and the organization’s values as stated in its policies.
To support, affirm and empower the families as caregivers.
To acknowledge and respond with sensitivity to the interruption of privacy that is necessitated by care at home; to enter no further into family life and affairs than is required to meet goals of the plan of care.
To respect and protect the confidentiality of information concerning patients and families.
To provide quality hospice and palliative care services in a timely manner to all who qualify, regardless of race, religion, sexual orientation, ethnic background, or ability to pay.
To recognize the vulnerability of those who receive care, and thus refrain from accepting personal gifts of significant value.
To recognize the vulnerability and privacy needs of the patient and family, thus displaying extraordinary sensitivity in offering opportunities to promote hospice and palliative care.
II. To act honestly, truthfully and fairly to all concerned.
To fully disclose to patients and family’s information regarding cost, services and complaint policies, as well as any policies regarding discontinuation of service.
To honestly and conscientiously cooperate as an agency in providing information about referrals and to work with other agencies to ensure comprehensive services to patients and families.
To be truthful and accurate in public advertising and information dissemination.
To make and accept referrals solely in the best interest of the patients.
To refrain from giving or accepting gifts of value or monetary compensation for the purpose of obtaining or making referrals.
To make every effort to honor the intent of benefactors and donors supporting the hospice and/or palliative care program.
To ensure that hospice services are not diluted for financial reasons.
III. To instruct both local and national communities in the tenets of hospice and palliative care philosophy.
To encourage dialogue about hospice and palliative care in all appropriate public forums.
To encourage inclusion of hospice and palliative care in all federal, state and commercial health care plans.
To provide the consumer with sufficient information about hospice and palliative care, to enable true informed consent.
To act as a liaison in consumer discussions concerning decisions regarding end of life care.
To assume a leadership role in ensuring access to hospice and palliative care for all people facing the end of life.
To serve on committees or in groups concerned with policy-making decisions, which will affect health care in this country.
IV. To continuously strive for the highest level of skill and expertise of the staff and volunteers in the delivery of care.
To recruit, select, orient, educate and evaluate each staff person and volunteer to ensure competency based on identified job requirements.
To remain sensitive to and be appreciate of the ethnic, cultural, religious, spiritual and lifestyle diversity of staff and volunteers.
To support, affirm and empower the staff and volunteers in the delivery of care.
To recognize the unique stressors inherent in hospice and palliative care work and provide access to ongoing support for all staff and volunteers.
To ensure that contracted providers are properly trained and qualified, and that they provide care consistent with the values and philosophy of hospice and palliative care.
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Policy Number: P.C.M50
Medications - Management
Regulatory Citation(s): 42 CFR 418.106; 418.106(a); 418.106(b); 418.106(c); 418.106(d); 418.106(e)(1); 418.106(e)(2)
L-Tag(s): 686, 687, 688, 690, 691, 692, 693, 694, 695, 696, 697
Policy:
Medications related to the palliation and management of the patient’s terminal illness and related conditions are provided in accordance with the patient’s plan of care and State and Federal laws and regulations.
Procedures:
1. The IDG confers with an individual with education and training in drug management to ensure that drugs, complimentary and alternative medicine (CAM) and biologicals meet each patient’s needs.
2. Medications are provided on a timely basis and are available 24 hours a day and seven days a week as needed.
3. A licensed physician orders all medications.
4. The hospice physician determines which medications are and are not medically necessary and related to the patient’s terminal illness and related conditions.
5. A Medication Profile is maintained for every patient and includes a listing of the current medication orders for each patient and specifies whether the medication is or is not related to the patient’s terminal illness.
6. The Medication Profile includes all prescription medications, over the counter drugs, vitamins, and herbal and alternative supplements/remedies including cannabis.
7. During the admissions process, patients that have Medicare Part D are identified, Part D sponsors are notified of the patient’s hospice election and hospice collaborates, as required, to ensure proper payment responsibility for drugs that are related or not related to the patient’s terminal illness and related conditions.
8. The RN Case Manager communicates with patients and/or their representatives, as needed, to explain medications that are no longer medically necessary and that should be discontinued.
9. The RN Case Manager monitors the medications, biologicals and CAM offered and dispensed to and used by the patient.
10. Medications, biologicals and CAM are included in the plan of care and reviewed during IDG meeting.
11. Medication is only administered by persons who have authority to do so under State laws and regulations.
12. If the hospice offers CAM services, providers are selected based on their years of experience, variety of services offered and staff competency. The Director of Quality will evaluate potential CAM service providers and make recommendations to the Chief Nursing Officer and Chief Medical Officer for final decision.
13. The RN Case Manager or designee provides and documents instruction to the patient/family regarding the safe administration of medications including potential side effects and expected responses, and proper storage, handling and preparation of medication. The patient’s/family’s ability to safely administer medications is evaluated and documented.
14. Medication errors and adverse drug reactions receive immediate response and are documented and reviewed to ensure corrective action is taken to prevent future occurrences.
15. Medications are dispensed in sufficient quantities to meet the needs of the patient and to minimize the potential for waste.
16. Medications that are no longer needed are disposed of in accordance with accepted standards of practice.
17. At the time when controlled substances are first ordered, the hospice nurse: a. provides written and oral information to the patient/family regarding the safe management and disposal of controlled drugs in a language and manner that they understand; and b. documents in the patient’s clinical record that the written and oral information regarding controlled substances was provided.
Policy Number: PC.M70
Medications - Use and Disposal of Controlled Substances
Regulatory Citation(s): 42 CFR 418.106(e)(2); 418.106(e)(2)(A); 418.106(e)(2)(B); 418.106(e)(2)(C)
L-Tag(s): 694, 695, 696, 697
Policy:
Azorna Healthcare instructs patients/caregivers in the safe use and disposal of controlled substances in accordance with State and Federal regulations.
Definitions:
Controlled substances - drugs or other materials that, because of their potential for abuse, are closely regulated by the Federal government and are classified according to Schedules 1-V..
Procedures:
1. At the time when controlled substances are first ordered, the hospice nurse:
provides a copy of the hospice’s written policies and procedures on the management and disposal of controlled drugs to the patient or patient representative and family;
discusses the hospice’s policies and procedures for managing the safe use and disposal of controlled drugs with the patient or representative and the family in a language and manner that they understand to ensure that these parties are educated regarding the safe use and disposal of controlled drugs; and
documents in the patient’s clinical record that the written policies and procedures for managing controlled drugs were provided and discussed.
2. Patient/family education regarding the hospice’s policies and procedures on controlled substances may be in the form of written educational information on the safe use and disposal of controlled substances.
3. All education/information provided to the patient/family related to controlled substances is documented in the patient’s clinical record.
4. The hospice nurse counts and reconciles medications during every visit to ensure that proper quantities are available and are taken by the patient as prescribed by the physician.
Disposal
1. Controlled drugs no longer needed by the patient are disposed of in compliance with State and Federal regulations and disposal instructions and activities are documented which includes: the type, of controlled substance, dosage, route, quantity as well as the time and date of the disposal.
2. A “hospice employee” for purposes of these provisions is a physician, physician assistant, nurse or other person who:
Is employed by a qualified hospice program;
Is licensed to perform medical or nursing services by the State in which hospice care is provided;
Is acting within the scope of their employment and d. The employee has completed training by the hospice in the disposal of controlled substances in a secure and appropriate manner.
3. Hospice staff provide information and education to hospice patients and members of their households regarding safe and effective methods for disposing of controlled substances, including voluntary options such as drug take-back events, mail back programs and collection receptacles for drug disposal.