Patient Care and Safety

After Hours Services and Emergencies - Call (480) 637-4100

Your Hospice Nurse is generally available from 9:00 am to 5:00 pm, Monday through Friday. For routine matters such as ordering equipment, medication refills, changes in home health aide service and for questions about scheduled staff visits, please contact the office to reach your Hospice Nurse.

Pain and Symptom Management

Hospice physicians and nurses are highly skilled in the assessment and management of pain and other symptoms. Their goal is to keep patients comfortable and prevent unnecessary hospitalization. Many of the physical difficulties that face patients can be prevented or minimized by anticipation, prevention and timely intervention. Hospice treats pain as an emergency and works to alleviate any physical, emotional, spiritual or social discomfort. The Hospice medical staff constantly assess, monitors and treats all aspects of pain. Effective pain management allows patients to participate in an individually designed plan of care to help improve their quality of life.

Patients taking pain medicine are frequently started on a “bowel regimen” to prevent constipation. While this side effect is common, it is indeed uncomfortable. It is extremely important that patients taking pain medications adhere to this regimen if ordered. Nausea is another common side effect experienced when pain medicines are started. This symptom usually resolves in a few days. During this time, medication can be prescribed to relieve nausea so that the medications to treat pain are not interrupted.

Constipation

Constipation is a frequent symptom that can result from decreased activity, changes in diet and use of pain medications. Prevention of constipation is key to avoiding discomfort and unpleasant treatments,- such as enemas. An effective plan to promote bowel elimination must be started early by increasing fluids and dietary fiber, if tolerated. Stool softeners and/or laxatives will need to be ordered by the physician. Patients should move their bowels at least once every three days. Contact your nurse immediately if constipation occurs.

Urinary Symptoms

A catheter may be inserted, if needed, to relieve urinary incontinence or retention. Urinary retention can be caused by medication side effects or be related to disease progression. A catheter should only be inserted to relieve discomfort or to aid in wound healing by keeping the patient clean and dry. The Hospice nurse or physician will perform an examination and determine if catheter placement is required. The Hospice nurse will educate caregivers in catheter care and management.

Mouth Care

Dry mouth can be caused by certain medications, decreased fluid intake and mouth breathing. Keeping your loved one’s mouth clean and moist will add to their comfort. Avoid mouth swabs containing alcohol, as they will further dry the mouth. Clean and moisten the mouth with a Toothette® (ordered by your Hospice nurse) dipped in plain water or diluted mouth wash. Apply lip moisturizer frequently.

Respiratory Difficulty

Many times, hospice patients experience some degree of breathing difficulty. This feeling of “breathlessness” can be very distressing to patients and family members. Our Hospice nurses are specially trained in treatment modalities to help alleviate breathing difficulties. Oxygen, nebulizer treatments and respiratory therapists are available when needed. Narcotics, especially morphine, are often very effective in easing respiratory distress and may be used in combination with medications to reduce subsequent anxiety. Other techniques that assist in minimizing shortness of breath are energy conservation, circulation of air by opening windows or by using fans and air conditioning, elevating the head of the bed and pursed lip breathing.

Skin Care

The skin requires extra care to prevent breakdown when a patient spends a lot of time in bed. Hospice staff will instruct caregivers in the proper positioning and turning of their loved one to prevent skin breakdown. If reddened areas or skin breaks appear, notify the Hospice nurse immediately. The lower back, hips, heels and elbows are frequent points of pressure. An air mattress or other pressure-relieving device may be ordered by your Hospice nurse. Remember to keep bed linens clean, dry and smooth. Avoid causing friction of the skin when lifting or moving a patient. Patients who are incontinent of bowel and/ or bladder require special care, with application of moisture barrier creams and frequent changing. Your Hospice nurse will educate you in the use of a draw sheet to easily move the patient in a gentle manner. Sometimes pressure sores cannot be prevented or healed, but warrant treatment. The Hospice nurse will ask the doctor for orders to begin a wound care regimen that should help to eliminate or minimize the sore, or help provide comfort to the area. Patients can be given pain medication prior to wound care and repositioning to prevent discomfort.

Hydration and Nutrition of the Terminally Ill

As a person’s body begins to slow down, the need for food and fluid may be decreased. Well-meaning family members sometimes encourage the person to continue to take nutrition. This act is customarily seen as a normal part of taking care of someone. However, at this time, it does not necessarily improve the patient’s quality of life. It may, in fact, worsen it. It is normal for people to reduce their intake of food as they begin the process of dying. Loss of appetite and lack of hunger are part of the slowing down of the body as death approaches. Some people simply refuse to eat. While it may be difficult to watch a person go without eating, it is important to respect their wishes and to allow the end to come naturally. There are many reasons for diminished thirst and appetite in terminal illness, including the disease process, medications, swallowing difficulties and compression of the bowel. Forcing nutrition and hydration on a person who is dying imposes a burden of food and water that the person’s body cannot adequately process and negatively impacts his or her quality of life.

Artificial nutrition does not contribute to the relief of symptoms. In many cases it causes increased discomfort, does not prolong life, and may exacerbate the dying process. IV hydration provides very little clinically significant benefit to a person who is dying, and the adverse effects of hydration include swelling, fluid in the lungs and tissue and skin breakdown. Please let your loved one be the guide. He or she will let you know if food or fluid is needed or wanted.

Medication Information/Family Instructions

This Medication Instruction form is provided to each family member to ensure optimal safety in the handling, storage and/or destruction of all unused Hospice patient medications. Your nurse has given you verbal instructions and is leaving this form as a continuing reminder.

Storage and Handling of Medications:

• Store in high, out-of-reach places that are safe from children.

• Never leave medications unattended in open areas.

• Always keep medications secured or locked within a cabinet.

• Identify household members who may be at risk for possible medication abuse.

• Assign one family member to oversee all issues regarding medications.

• Observe the “four rights” of medication administration: 1) the right medication, 2) the right time, 3) the right route and 4) the right dose (amount). • Follow the individual instructions given for each medication.

• Call the Hospice immediately if the patient has an unexpected reaction to a medicine.

• Call the Hospice with any concerns about medication supply.

• Please follow instructions for refrigeration.

Destruction of Medications & Controlled Substances

Please see Medication Disposal Policy and Instructions on pages 23-24 of this guide. Inappropriate use of opioids, both unintentional and intentional, is a public health safety risk, see page 23 for our policy.

Services a Hospice Aide May Provide

• Assist patient with bath (tub, shower, sponge) and personal hygiene.

• Assist with transfer from bed to wheelchair, walker, toilet, etc.

• Change bed linens for patient.

• Assist with meal preparation and special diets ordered for the patient.

• Launder personal clothing and linens of patient only.

• Limited grocery shopping at the nearest store for patient’s needs only.

• Light housekeeping of patient use areas.

The Hospice Aide May Not Provide The Following:

• Give medications.

• Scrub or wax floors, wash walls or windows.

• Remain in the home if the patient is not in the home.

• Handle finances.

• Transport patient in their car, move heavy furniture.

The time required for the above duties will be under the direction and supervision of your assigned Hospice Nurse. We will try our best to assign the Hospice aide to you at the time most needed for your care. However, we do care for many patients daily and the assigned times must be made according to patient priorities. Please feel free to discuss this with your nurse at the time of his or her visits with you.

Tips on Preventing Falling in the Home

Falls are the leading cause of home injury and death among adults aged 65 and older. Each year, more than 4,700 Americans in that age group die as a result of falls, and more than 1 million elders are admitted to hospital emergency rooms to treat injuries related to falls, according to the Home Safety Council.

How to Prevent Falls in the Home:

• Conduct a safety check all around your home.

• Make sure all stairs and steps have a secure banister or handrail.

• Make sure all porches, hallways and stairwells are well lit.

• Use night lights to help light hallways and bath- rooms during nighttime hours.

• Keep stairs, steps, landings and all floors clear. Reduce clutter and safely tuck away telephone and electrical cords out of walkways.

• In homes with children, make sure toys and games are not left on steps or landings. When very young children are present, use safety gates at the tops and bottoms of stairs.

• Use a non-slip mat or install adhesive safety strips or decals in bathtubs and showers. If you use a bath mat, choose one that has a non-skid bottom.

• Install grab bars in bath and shower stalls. Don’t use towel racks or wall-mounted soap dishes as grab bars; they can easily come loose, causing a fall.

• Keep the floor clean. Promptly clean up grease, water and other spills.

• If you use throw rugs in your home, place them over a rug liner or choose rugs with non-skid backs to reduce your chance of slipping.

• Use a sturdy step stool with handrails when climbing is necessary.

• Follow medication instructions closely. Using multiple medications and/or using medications incorrectly may cause dizziness, weakness and other side effects that can lead to a dangerous fall.

For more information on preventing falls and on safety in the home, visit www.cdc.gov.

Home Infection Control - How to Prevent Infection in the Home:

• Wash your hands after contact with bodily fluids, such as blood, urine, stool, respiratory secretions and drainage from wounds.

• Clean, disposable (not sterile) gloves should be available in the home to assist with care when body fluids will be contacted.

• Gowns may be worn if drainage is expected to soil clothes. The wearing of gowns is to protect clothing from soiling, not to prevent the spread of infectious organisms.

• Masks are not necessary unless you are specifically instructed to use them.

• Soiled linens or clothing can be cleaned in the washing machine with hot water, detergent and one cup of bleach. (Detergent and bleach should be added to water before washing linens to minimize fading)

• Soiled tabletops, toilets, showers or floors can be cleaned by washing spills with hot, soapy water, then disinfecting with a solution of one part bleach to ten parts water.

• Separate eating or cooking utensils are unnecessary. Eating utensils should be washed in hot, soapy water after each use.

• Toothbrushes and razors should not be shared, since bleeding may occur during their use.

Safe Disposal of Household Sharps

Millions of people use needles, syringes and lancets at home to care for their health. These items are called sharps. Used household sharps must be stored safely and disposed of properly to protect people from diseases. Used sharps may hold blood infected by HIV (the virus that causes AIDS) or hepatitis C. Someone who accidentally gets cut by a used sharp could get infected by the blood.

Safe Disposal of Used Sharps:

• Protects children, pets and workers who come into contact with trash and recyclables from illness and injury.

• Prevents sharps from being re-used or shared, which can spread disease.

• Protects the environment. How to Store Used Sharps: • Put used sharps (needles, syringes, lancets) in a sharps container.

• You can buy containers at your local drugstore. If you do not have a sharps container, use a plastic bottle that cannot be broken or punctured, such as a bleach bottle. Close the screw-on cap tightly.

• Put tape over the cap and write, “CONTAINS SHARPS” on the bottle.

• Put sharps into your container as soon as you use them. Keep the container closed and away from children and pets.

• Bring your container with you when you travel.

• Do not recycle used sharps.

• Do not put your used sharps container in the trash.

• Do not flush used sharps down the toilet or drop them into a sewer drain.

• Do not clip, bend or put the cap back on used sharps.

• Do not put loose used sharps or your used sharps container in with the recyclables.

• Do not put used sharps in soda cans, milk cartons, glass bottles or containers that can be broken or punctured. Coffee cans are not safe because the plastic lids come off easily or may leak.

Safe Disposal of Used Sharps Container

When your container is almost full with used sharps, bring it to a safe disposal site. Some drugstores, health clinics, and community service agencies have large metal boxes (called kiosks) for sharps disposal. The American Diabetes Association sells a container that safely holds used sharps. When it is full, you mail it back to the American Diabetes Association. Call 1-888-232-2737 for information. The place where you live may have special hazardous waste collection days or drop-off days. Get the number of your local public works department from the blue pages of your phone book.

Oxygen Safety at Home Oxygen can be used safely in the home. Follow these rules for oxygen safety. Oxygen is a medical treatment, too much or too little oxygen may be harmful. Only use the amount ordered by your doctor.

Fire Warning: Oxygen itself does not burn. Oxygen can feed a spark and cause it to become a large fire in seconds. Follow these rules to prevent fire: