Hospice Patients Alliance: Consumer Advocacy


Hospices function differently from what you might be used to when visiting a physician's office, clinic or hospital. When your loved one enters a hospice program, the physician has certified them to be eligible for what is called the hospice benefit. The hospice benefit includes all services, supplies and equipment needed by the patient for care related to his or her terminal illness. The physician agrees to supervise or direct the care that is provided, in collaboration with the entire hospice team. The case management of your loved one's care is mainly handled by the RN assigned to you. This RN case manager has authority to start medications in certain very specific situations in order to treat these certain problems that routinely arise in caring for the terminally ill.

Each hospice has a list of routine medications or treatments which may be begun (ordered) without contacting the physician beforehand. This list of medications or procedures is called the list of Standing Orders. Hospice patients experience many common problems and symptoms which are treated in routine ways. Because the symptoms are so common, and the medications used to treat these symptoms are used over and over again, the RN case manager is able to recognize which medications fit the conditions specified in the hospice Standing Orders and which your physician has approved. If your physician did not approve these Standing Orders, he or she would notify the hospice, and the Standing Orders would be modified according to the physician's discretion.

The use of Standing Orders allows the hospice nurses to intervene immediately when symptoms arise and helps to assure quality hospice care for your loved one. It also frees up the physician to see patients in the normal course of his or her medical practice without literally hundreds of calls each day for routine medical orders which he has already specified in the Standing Orders.

Even though the Standing Orders are started by the licensed nurses caring for your loved one, the physician is notified in writing that these medications have been started. In the case of strong narcotic medications, the laws governing pharmacology require that the physician actually give the order to start these legally controlled medications. There are certain exceptions in emergency situations, however, the physician will certainly be notified before any narcotic is released from a pharmacy.

What is important to understand about hospice and Standing Orders is the idea that care for your loved one is managed by the hospice Interdisciplinary Team. The physician is not normally called day after day for routine orders. Many of the orders are started by Standing Order and written notification is sent to the physician for his or her signature. The physician is not involved so much on a daily basis, unless he or she chooses to remain that involved. In the situation where the Standing Orders do not address the specific problem which is occurring, then the licensed nurse will call the physician for specific orders. The nurse will also call and consult with the physician for new orders if the medications prescribed by Standing Order are not effective.

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