Plans, organizes, directs and provides hospice care to meet the identified needs of patients/families in accordance with this company's Hospice policies and procedures, accepted standards of nursing practice and palliative care, and applicable law and regulation.
· Completes an initial/comprehensive assessment of the patient/family to determine hospice needs which includes a history of current and previous illness(es), as well as a physical assessment of the patient, with emphasis on the management of pain and other symptoms.
· Completes ongoing assessments of the patient’s physical status and the psychosocial status of the patient/family.
· Initiates and develops a plan of care in collaboration with the Interdisciplinary Group (IDG), the patient/family and the attending physician.
· Makes necessary revisions to the IDG plan of care as the patient’s/family’s status and needs change.
· Primarily responsible for the coordination of care among IDG members and other healthcare providers external to the IDG, to ensure the continuous assessment of the patient/family needs, as well as the implementation of the IDG plan of care to guide the delivery of services and achieve the goals of hospice care.
· Evaluates and coordinates the need for services provided to the patient/family in accordance with the IDG plan of care.
· Facilitates the consideration of another level of care (i.e. inpatient, respite, continuous care) when indicated by the patient’s/family’s status/needs.
· Administers medications and treatments as prescribed by the physician and in accordance with nursing standards of practice.
· Ensures that equipment, supplies, drugs and biologicals and other necessary items and services are available.
· Provides education and interventions to support the effective management of the patient’s pain and other physical symptoms as well as assesses the patient/family’s response to intervention and treatment.
· Provides education/instructions to the patient/family in accordance with the IDG plan of care.
· Directs the services provided by and supervises the LPN/LVN, Hospice Aide, and Homemaker assigned to the patient/family.
· Completes accurate and timely documentation of patient/family services provided.
· Regularly attends Interdisciplinary Group meetings.