Recently, I enjoyed reconnecting with colleague Deanne Sayles, R.N., and learning of her receipt of the honor of Hospice Nurse Fellow from the Hospice and Palliative Nurses Association. Deanne and I created a presentation called “Interdisciplinary Medication Management for Hospice” for the 2013 NHPCO Clinical Team Conference and a webinar for our Brainy Brunch series in 2012 on Pediatric Hospice and Palliative Care. She’s an exceptional collaborative partner, with particular insights about the provision of hospice pharmaceutical care from the nursing perspective. This article features highlights drawn from a recent conversation about the importance of collaboration between pharmacists and nurses when caring for patients.
Deanne, why would you say this designation is important to the hospice nurse profession?
The recognition is important within a team or in a company, as it means they are selective and that there’s someone on their team who has achieved the highest honor in hospice and palliative nursing. You see the importance of that kind of thinking every day, Mary, in Delta Care Rx’s commitment to have excellent, high quality nurses working alongside excellent, high quality pharmacists.
So you see pharmacists and nurses as care team partners?
Yes. The knowledge a hospice and palliative care nurse offers to the team includes caring for patients across care settings, whether at home or in inpatient settings such as nursing homes. That insight helps the Delta Care Rx pharmacist understand what it’s like to be at the bedside when someone on the team reaches out for assistance.
Delta Care Rx offers continuing education training to hospice and palliative care nurses. Why should nurses consider pharmaceutical care related topics for furthering their knowledge?
You’ll find that the bulk of education and product training aimed at nurses focuses on delivering care and administering medications to the patient. When patients are cared for at home, those medication teachings sometimes need to be supplemented by the expertise of the Delta Care Rx pharmacist during a consultation or webinar education.
What are some of the greatest challenges hospice and palliative care nurses face while working in the field?
When patients live a great distance from town, and pharmacies can’t deliver… Delta Care Rx, for example, overcomes this barrier to care by shipping medications quickly and without non-transparent added costs. But in severe pain cases, or during severe weather such as a blizzard in mountainous regions, the nurse may need to ensure the medication gets there by other creative means. That’s a situation that occurs rarely, but nurses are committed to finding solutions for their patients. Another great challenge is the rigorous, frequently changing regulatory scrutiny hospices experience. The documentation requirements put a lot of pressure on nurses to deliver care quickly and efficiently. Additionally, compassion fatigue and lack of self-care drain the nurses’ empathy banks. We need to address the continual “giving” burden that nurses experience by identifying and using ways to re-charge.
You are a nurse, but also a consultant. How did you find your niche?
Quality client services require a certain level of expertise in hospice and palliative learning. When I help other nurses acquire those skills, they can offer the best support to patients and families. That’s my focus: helping nurses give the best quality care to their patients. I also focus on helping hospice agencies train and educate their staff on best clinical practices in hospice and palliative care.
What about nurses who are new to hospice care?
Nurses need to carefully prepare for each visit, which includes a thorough review of the medications listed on the patient profile. I strongly recommend they have a mentor with whom they debrief, at least monthly. This work is very intense. Most of us need to bounce patient cases off someone else to help deal with our own feelings. We are unable to help people manage grief, unless we’ve dealt with our own.
From this perspective, how should hospice nurses best work with pharmacists in patient care?
It’s incumbent upon the nurse to study medications, know what medications are and what they do, to discuss and observe side effects with patients and families. The nurse manages medications, notes side effects, and requires ready access to a medication management expert. The pharmacist is that expert. Having a hospice PBM on board with consulting availability is ideal; the nurse can be at the bedside of a patient and consult a pharmacist while observing symptoms.
How would you explain this relationship to a pharmacist or nurse new to the field?
It works like this: Nurses pick up the phone and reach out to pharmacists as needed. With a new patient, the medications get organized; with an existing patient, the nurse knows when medications change. It’s his or her job to monitor patients for therapeutic responses to medications and adverse experiences. In turn, the pharmacist provides recommendations and expertise in medication management so that care can be delivered safely and effectively.
The nurse brings those recommendations to the hospice physician and interdisciplinary team. Ultimately, it is the responsibility of the hospice physician to use the information provided to make a decision in prescribing. This is how pain and symptom management issues get resolved.
How do you feel about receiving the hospice nurse fellow recognition?
It was absolutely mind-blowing to be in the room. The board of directors held a reception for the 11 new fellows. One of the nurses was someone I had worked with in AIDS care back in the 1980s. There was a wide range of expertise. We’re functioning as a mini-team now, setting up phone conferences and brainstorming about how we wish to contribute to the Hospice and Palliative Nurses Association and the future of the profession.
Mary Mihalyo, PharmD, is the CEO of Delta Care Rx.
About Deanne Sayles, R.N.
Deanne Sayles, R.N., received Hospice Nurse Fellow recognition in January 2017. She has cared for the terminally ill since 1979, experiencing life-limiting disease across care settings, and managed protocols for both curative and palliative pharmaceuticals at a large pharmaceutical company for 7 years. In 2010, she founded the first local chapter of the Hospice and Palliative Nursing Association. Since 2003, her consultancy focuses on elevating patient and family experiences through quality hospice and palliative care nursing.