Hospice of the Shenandoah at Augusta Health
April 2023
Hospice of the Shenandoah
at Augusta Health
Hospice
Augusta Health
Fishersville
,
VA
United States
Amy Eye (Lead), RN, Heather Carter, RN, Cindy Brislen, RN, Jody Warwick, RN Laura Craig-Sims, RN, Nena Ferris, RN, Briana Via, SW, Gracie Turner, CNA, Christopher Heck, MD, Lindsey Wallace, NP/Hospice, Liz Lee,
This story is about how a team came together to provide a dying patient with her last wish. K was a 25-year-old female who had been fighting a glioblastoma for the last 5 years. Treatments were not working so she and her family made the decision to stop all aggressive treatment and to spend what time she had left at home with her family. K’s road was complicated. Her disease progressed quickly. The cancer caused her to be paralyzed on her left side and quickly caused the same on her right. She became bedbound within a week of being on hospice. The glioblastoma started causing seizures. She was unable to take her po Keppra to prevent them. The next step would be to admit her to the Shenandoah House so she could receive IV Keppra. However, K’s wish was to stay at home and her family wanted badly to honor this wish. Dr. Heck and Lindsey Wallace went to the patient’s home multiple times to see her to determine a plan of action and to see if anything could be done to keep her at home. The patient had a port and Keppra could be given through the port, but it would have to be given twice a day and it would take almost half an hour to an hour visit to do so. This would be very taxing on the hospice team to do in the home and was not something that is usually done at home.
It was discussed with the manager of the hospice who approved it and then it was discussed with those that would be doing it. Amy was her lead care manager and only worked part time and would not be able to do it every morning at 0800 so Heather volunteered to do it on the days that Amy was off, and Laura and Cindy would do it at night or if Heather or Amy could not do it in the mornings. They had a plan; hurdle number one had been jumped over. Jody Warwick from the Shenandoah House volunteered to come show Amy and then Laura and Cindy a refresher course on giving the Keppra as it is not something they do every day.
Hurdle number 2 came when K was needing more care and became incontinent. Then Gracie stepped in as the CNA and saw the patient 7 days a week to bathe her and clean her and turn her. The RNs would step in and do these things as needed when they were there as well.
As K’s symptoms worsened such as pain and shortness of breath, Lindsey and Dr. Heck would make visits to see what needed to be done which reassured the family and showed how much the team cared and how invested the entire team was. Briana helped to provide extra emotional support as the SW to a family who was about to lose their young daughter and to help prepare them for the coming days when K began the active dying process.
Then came hurdle number 3. K began the active dying process. Her respirations were 48 a minute and she was in pain. She was also unable to take liquid pain meds. We were going to start a PCA pump but that would take hours to get made and we did not have hours. It seemed like we were going to have to transfer her to the Shenandoah House after all. Then Dr. Heck and Liz Lee discussed giving her IV morphine as needed through her port at home. The patient got the morphine every 3 hours through the night and the next day. Laura gave it through the night and Amy went back and forth giving it through the day. The patient's respirations slowed down and her pain was controlled. The PCA was ordered and was to start that night. However, the patient passed peacefully a little before 2000 surrounded by her family at home where she wanted to be!
This amazing team was able to give K her last wish! It took lots of teamwork, sometimes making 4 to 5 visits to this patient a day but this team only cared about the patient and her family and making sure she got the best care possible where she wanted it, at home!
It was discussed with the manager of the hospice who approved it and then it was discussed with those that would be doing it. Amy was her lead care manager and only worked part time and would not be able to do it every morning at 0800 so Heather volunteered to do it on the days that Amy was off, and Laura and Cindy would do it at night or if Heather or Amy could not do it in the mornings. They had a plan; hurdle number one had been jumped over. Jody Warwick from the Shenandoah House volunteered to come show Amy and then Laura and Cindy a refresher course on giving the Keppra as it is not something they do every day.
Hurdle number 2 came when K was needing more care and became incontinent. Then Gracie stepped in as the CNA and saw the patient 7 days a week to bathe her and clean her and turn her. The RNs would step in and do these things as needed when they were there as well.
As K’s symptoms worsened such as pain and shortness of breath, Lindsey and Dr. Heck would make visits to see what needed to be done which reassured the family and showed how much the team cared and how invested the entire team was. Briana helped to provide extra emotional support as the SW to a family who was about to lose their young daughter and to help prepare them for the coming days when K began the active dying process.
Then came hurdle number 3. K began the active dying process. Her respirations were 48 a minute and she was in pain. She was also unable to take liquid pain meds. We were going to start a PCA pump but that would take hours to get made and we did not have hours. It seemed like we were going to have to transfer her to the Shenandoah House after all. Then Dr. Heck and Liz Lee discussed giving her IV morphine as needed through her port at home. The patient got the morphine every 3 hours through the night and the next day. Laura gave it through the night and Amy went back and forth giving it through the day. The patient's respirations slowed down and her pain was controlled. The PCA was ordered and was to start that night. However, the patient passed peacefully a little before 2000 surrounded by her family at home where she wanted to be!
This amazing team was able to give K her last wish! It took lots of teamwork, sometimes making 4 to 5 visits to this patient a day but this team only cared about the patient and her family and making sure she got the best care possible where she wanted it, at home!