Discover and read the best of Twitter Threads about #hospice

Most recents (13)

Been processing my frustration w/ icu nurse who last week took it upon herself to tell a frail older pt who opted for #hospice care that he wasn’t dying & could beat covid. Pushed him to do deep breath exercises & ‘hold on’ until she was back on service in few days. 1-
She went on to question palliative team, icu team & anyone who would listen about her concerns that a pt sitting up & talking ‘wasn’t dying’. Despite two attending MDs, a very astute icu fellow, various residents, PAs & the pt himself telling her he was dying. 2-
She then insisted at change of shift that the pt did not understand he was opting for hospice care. The accepting hospice nurse then proceeded to have yet another very detailed goals discussion with the pt when he clearly expressed yet again his desire for comfort care. 3-
Read 12 tweets
🔴 Senate #Republicans have KILLED 400 bills passed by the House, most w/ GOP votes. #Dems need to win 4 seats (3 if #Harris is VP). 6 races are tossups: CO-Gardner, GA-Perdue, IA-Ernst, ME-Collins, MT-Daines, NC-Tillis.

thread: Bills Killed by Senate GOP newsweek.com/mitch-mcconnel…
🔴 BIPARTISAN Bills PASSED by the House but KILLED by Senate #Republicans:

Climate Action Act
Raise Minimum Wage
Violence vs Women Act
Corporate Transparent Act
Enhanced Background Checks
Gold Star Family Relief Act
Save the Internet Act
Equality Act
🔴 BIPARTISAN Bills PASSED by the House but KILLED by Senate #Republicans #2

Paycheck Fairness Act
Protect Preexisting Conditions Act
Lower Prescription Drugs Act
Ban Offshore Drilling Act
Invest in Maine Street Act
Lower Prescription Drugs Act #2
#STEM education
Read 45 tweets
@DukePallCare SUCCESS! Journal Club Time Machine: Speed Dating with the Classics. Format - everyone in attendance (MS2-Attending) teaches a classic article for 4 minutes, it is put in context by someone old for 1-2 min, and we move on. Here's the list! A #HPC thread:
No 1 - SUPPORT Trial: pubmed.ncbi.nlm.nih.gov/7474243/. 5 AMCs. Docs don't know pt's CPR preference, many DNRs within 2d of death, lots of ICU time and pain. RN led intervention gives docs data. Centers around communication. NO CHANGE IN KEY METRICS.
No 2 - Prognostication: pubmed.ncbi.nlm.nih.gov/10678857/. Docs of pts referred to #hospice asked for assessment of prognosis. Only 20% accurate (+/- 33%) with most over-optimistic. Average miss factor of 5.3! Longer pt/doc relationship = worse prognostication accuracy (#LoveThemTooMuch)
Read 13 tweets
REGISTER your Interdisciplinary Team(s) for @CoalitionHPC upcoming FREE Virtual Town Hall. #COVID19 Impact on #PalliativeCare and #Hospice, Now and into the Future. Thurs, July 23, 2020, from 3:00 - 4:00 pm ET. bit.ly/2Dzx3IP #hpm #pallicovid #retweet Image
Please note @ctsinclair that the date and time for this event have changed. Now Monday, July 27 from 1:30-2:30 EST.
Read 3 tweets
She was sleeping when I walked in her room, pushing the curtain aside with my elbow while cleaning my hands with Purell. She looked peaceful. Outside her window, night was falling. 1/8
"Mrs. M***," I lightly shook her left arm, which was folding across her chest. I almost never wake patients up in the hospital because their sleep is often more important than my visit. But this was my last chance. 2/8
She opened her eyes and blinked a few times. With my blue scrubs, white coat, and face mask, I was not easily recognizable. I told her my name. "I'm your oncologist," my smile was hidden by the mask. 3/8
Read 9 tweets
I have a grievance regarding my mom's care during her bout w/#sepsis. #dementia

At the end of October 2019, my husband & I awoke to find mom's breathing labored, & her mumbling to let her sleep. We let her rest. A fever spiked within the hour, & suddenly she became deathly ill.
She was twitching, sweating profusely, in full rigors, & unable to sit up/speak well. She looked TERRIFIED. I thought she had a stroke. Turns out, it was a high fever from an infected gallbladder. She landed in the #ICU. ALL her vitals were jumping around. It was horrible.
She landed in the ER & eventually the ICU. Turns out she had #sepsis from the infected gall bladder. The ICU's 1st step? Changing her meds around INSTANTLY. Specifically they rescinded ALL #opioids abruptly. After over a decade on them, she was thrown into acute withdrawal in ICU
Read 16 tweets
Lots of thoughts & opinions on patient #DataAccess & data sharing, figured I'd jump in. Take a seat for a few. I'll make it worth your while.

THREAD 👇👇

#PatientAdvocacyProblems #UnblockHealth #hcldr #hitsm #medtwitter @S4PM #EHR #DataBlocking #pinksocks #PtExp
@S4PM 1) A patient with multiple comorbidities has been in & out of the hospital w/what now has been diagnosed as advanced congestive heart failure. At about 5 pm yesterday (Fri), patient & family were told to seek a 2nd opinion asap. Told patient being discharged today. #UnblockHealth
@S4PM 2) The urgent 2nd opinion is to see if the patient is a candidate for a particular procedure. If not, #hospice. Appt can’t be scheduled until ALL records & images on CD are received & reviewed by the 2nd opinion dr’s office (at another hospital, in another state.) #UnblockHealth
Read 19 tweets
1/ So I got quite a bit of "pushback" when saying that I would probably/most likely/am considering no longer using the joined # of #hpm or #hapc ... when tweeting about #PalliativeCare exclusively...

I also said I would explain myself to those wondering why...
2/ Quick disclaimer: I will entertain thoughtful discussion and opinions in this thread...

I won't entertain one sided views that try to shut me down with that "I'm big & your small, I'm smart & your dumb..." talk

I am expressing MY thoughts, keep your gaslighting to yourself
3/ One of the #CAPCSeminar19 keynotes was on messaging and how we brand ourselves.

It was a great conversation with Diane Meier and Mark Ganz (intentionally not tagging them) with the sharing of ACTUAL CAPC data but also ACTUAL life stories involving Mark's parents.
Read 15 tweets
Wrote this piece with the help of a great team including @DrKevinHill. Below I'll share some of my thoughts about #opioids and opioid use disorder and how they present in #hpm and #palliative care, plus why we need to do a better job of addressing #addiction at end of life. 1/x
2/x Training in #KY gave me a front row seat to the #opioidcrisis. With an interest in #hpm I kept wondering what would happen to these individuals who developed an OUD and years later were prescribed opioids. How would I keep those patients safe and manage their pain?
3/x I continue to think that our field will struggle in years to come when survivors of the #opioidcrisis age, develop serious illness, and develop pain. Thinking about this, and reading @jeff_deeney article in @TheAtlantic theatlantic.com/health/archive… made me want to do more.
Read 13 tweets
THREAD

Today, @OIGatHHS released two reports on #hospice quality and oversight. The reports highlight poor-quality care and gaps in current hospice quality oversight and reporting. 1/ oig.hhs.gov/newsroom/media… Image
The @OIGatHHS reports echo themes raised in research by @VUHealthPol David Stevenson, PhD, supported by @MooreFound resulting in two @PalliativeMed_j papers. One, from late 2018, was focused on #hospice complaints. 2/ liebertpub.com/doi/10.1089/jp…
The other, from the May 2019 issue of @PalliativeMed_j, covered quality oversight of #hospice agencies. 3/ liebertpub.com/doi/10.1089/jp…
Read 18 tweets
On a serious note:
Tuesday is my father's 2nd yahrzeit
Sunday 4/21 was the 2y anniversary of his death.

In reflecting back, I have some thoughts for #medtwitter, #Jews and the general public...
1/

#death #dying #grief #PalliativeCare #medicine
1. Condolence notes just need to say, "I am thinking of you" or "I was sorry to hear your news" or "I am sorry for your loss."

Don't overthink it, and don't offer false platitudes. Send your note or make your call, and the person who is #mourning knows you care.
2/
2. Show up.
For #shiva, for #kaddish. The first week, there's a lot of people around in a #Jewish house of mourning. Then everyone goes home, and we are left alone.
Offer to go to lunch. Bring dinner. Take a walk.
Join us in shul. Kaddish that first time in services was hard.
3/
Read 14 tweets
The other night at the hospital, I witnessed some shocking behavior & sub par care by a night shift #hospice #nurse-Hospice nurses ensure a dying patient receives dignified #EOL while being kept as comfortable as possible. For 12 hours -2/28-3/1, Melissa didn't get either. THREAD
I was sitting with Melissa, trying to calm her, she was agitated. RN Deb came in. She looked at me & asked who I was. Due to her tone, I told her I was family. She wanted to know who was staying over. We were curtly told only 2 were allowed, not 4. SHE was mistaken. #Hospice
Michele, patients mother very upset. RN Deb yelled at Melissa's Nieces. Told the little girls they were very bad & didn't belong up here. The girls weren't misbehaving. They weren't doing anything wrong, nor unattended in the common area of the #PalliativeCare #Hospice wing
Read 15 tweets
1. What’s #Hospice? It’s a recent term coined by #MotherTeresa to serve dying & destitute without any proper medical investigation. Simply put, feed them without any medical aid till they die, even if they recover & serve the society. #StJosephHospice
2. #Hospice keeps patients against their will (read #kidnapping). They served us in their youth, worked in the farms to create crops, vegetables etc.. which we might have consumed. In-turn, our shameless society has no regard & leave them to die as destitute? #StJosephHospice
3. Having a #Hospice is understandable in a financially or medically challenged society. TN is lacking neither of that. Why do we need it? Above all, why a foreign church needs to fund & organize these kinds of activities? @PMOIndia and @CMOTamilNadu needs to answer
Read 12 tweets

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