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Froedtert Hospital

Virtual hospice nurses have been a valuable asset to bedside nursing staff

Froedtert Hospital, Milwaukee, Wisc.

TEAM: Inpatient Virtual Hospice Program of Horizon Hospice

CATEGORY: Best Adaptability

ENTRY SUBMITTED BY: Katherine Walczak, BSN, RN, CMSRN, palliative care clinical nurse coordinator

Our inpatient virtual hospice program was established in January 2015. It brings in expertly trained hospice nurses from Horizon Hospice to partner with the palliative care experts within Froedtert Hospital's inpatient units. This allows for support and improved patient and family experiences during end of life.

The program was developed as a bridge to a future inpatient hospice unit, which is projected to open in the next year or two. The virtual hospice program was the first of its kind in our area, and it provides inpatient hospice support to patients and families with anticipated hospital death who were unable to transition to home or a hospice facility. The partnership provides 24/7 hospice nursing support, enrollment of patients into the hospice benefit, and enhancements to the patient's room.

The knowledge and mentoring the hospice nurses bring to the inpatient setting are pivotal to the success of the program. The inpatient virtual hospice program served nearly 200 patients and families in 2015. Preliminary patient/family satisfaction data have been outstanding, with an overall score of 97.9% at the 1-year mark. We have also seen a halo effect of increased hospital discharges to residential hospice and inpatient palliative care consultations, resulting in substantial decreases in inpatient mortality.

The virtual hospice nurses' workflow includes rounding with the bedside RNs of the hospice patient to aid with symptom management and family support, and to act as a link to the palliative care provider on service. The virtual hospice nurses have been a valuable asset to the bedside nursing staff throughout the inpatient units of a busy level I trauma center. Many acute care nurses can be uncomfortable managing end-of-life care. Having that added layer of support for the bedside nurse to build confidence in the care of this patient population has been rewarding on multiple levels.

An increase in the bedside nurse's knowledge of medication management for pain, nausea, delirium and respiratory distress has resulted in enhanced comfort for patients at the end of life. Family members often require ongoing education on the dying process of their loved one. Communication with the family members about the symptoms they are witnessing is a technique at which the virtual hospice nurses excel. The convenience of the bedside nurse calling the virtual hospice nurse and receiving a quick response allows the bedside nurse to provide interventions sooner. All nurses caring for the patient can consult and collaborate on the best nursing intervention for the current situation.

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Should the patient need a new order from the provider, the virtual hospice nurses manages this, thus allowing for the bedside nurse to prioritize additional nursing cares within his or her assignment. Care management staff, such as case managers and social workers, can connect with the virtual hospice nurses for questions on hospice enrollment or general home hospice questions.

The virtual hospice nurses rotate attending interdisciplinary rounds within the five ICUs, to listen in and advocate for patients who may benefit from the services provided. The presence of the virtual hospice nurses at these rounds increases care team providers' awareness of the benefits and added support of hospice, including bereavement services. 

The virtual hospice nurses are an amazing team of nurses who have made a big difference in the end-of-life experience for the patient and families at our hospital.

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