Caregivers and patients often have many concerns and questions when it comes to entering hospice care. One of the top concerns is often safety. Will the patient be protected from falls? Will they be protected from abuse and neglect? Can you assure they’ll get the medications they need when they need them?

Understandably, caregivers and families want to make sure their loved one is protected as they enter hospice and begin their end of life journey. Hospice patients are some of the most vulnerable in the healthcare system. For Patient Safety Awareness Week we’re addressing common safety concerns, best practices to keep patients safe, and how Heart to Heart ensures the safety and well-being of patients and caregivers. 

Key Safety Issues for Hospice Patients

There are many safety issues that caregivers and families are concerned about in regards to hospice care. This is by no means an exhaustive list, but we wanted to address the most common so caregivers and families can be aware.

Medication Management

Using medication to alleviate symptoms and manage pain is key to hospice care. The goal of hospice care is to help the patient feel as comfortable as possible as their terminal illness progresses. Therefore, patients must receive the right course of medication to keep them comfortable. Elderly patients are especially vulnerable to adverse effects of medication errors. In-home hospice situations, these errors can be more pronounced due to the more unstructured environment of home health care compared to a care facility.

Because of this, caregivers and hospice care teams must communicate effectively to ensure dosages are being properly followed and any changes in the patient are accounted for. Everyone must pay close attention to at-risk patients, make sure they are accurately documenting everything, and follow proper review and collaboration amongst the care team. 

Fall Prevention

Another common issue with hospice care patients is the risk of falling. Emergency care for injuries caused by falling is one of the most frequent issues among hospice care patients. For elderly patients, falls are the leading cause of injury-related death. Often hospice patients have conditions or medications that cause weakness, dizziness, or disorientation. This raises the risk of a potential damaging fall both at home and in care facilities, but it is especially risky in at-home settings where rooms may not be properly equipped.

Caregivers need to regularly identify risk factors for falls and take effective measures to prevent them. This includes modifying care areas by installing grab bars, utilizing proper and sufficient lighting, and using mobility aids (canes, walkers, motorized scooters). Equally as important is education. Caregivers and families must take the time to properly educate themselves on fall prevention strategies and environmental issue assessments. Since caregivers and families are usually with patients for a longer period, they must be educated about all the risks.

Wound and Pressure Ulcer Management

In hospice care, many patients become restricted to beds as their illnesses progress. They either become too weak to move around on their own, or, in the case of patients with dementia or Alzheimer’s, they lose the ability to move altogether. This can mean patients develop pressure ulcers (bedsores) or complications from surgical or injury-induced wounds that have difficulty healing. It is important for caregivers and care teams to identify when these issues become acute, and monitor them closely.

Caregivers and the care team should be knowledgeable in the use of “the full range of existing and emerging wound products, practices, and treatments and demonstrate skill in accurate wound assessment and staging.” Caregivers and families should also educate themselves on the risk factors of pressure ulcers and wound infections, regularly assess wounds and ulcers, and report any worsening symptoms to the care team. As with medication management, and all risks, communication is key.

Abuse and Neglect

Abuse and neglect are usually the concerns we hear about the most. We hear terrible stories of patients suffering at the hands of abusive nurses and physicians. When a patient enters hospice care, the hospice must respect the patient’s rights. If the hospice does not respect these rights, instances of abuse and neglect can occur, which can harm the patient. There are a few different types of abuse:

  • Verbal abuse: oral, written, or gestured language that is disparaging or derogatory toward patients or their families.
  • Mental abuse: this can include humiliation, harassment, and threats of punishment or deprivation.
  • Sexual abuse: includes, but isn’t limited to, sexual harassment, coercion, or assault.
  • Physical abuse: includes, but isn’t limited to, hitting, slapping, kicking, and controlling behavior through corporal punishment
  • Neglect: the failure to provide treatment or care to avoid physical or mental harm. This can include the hospice not addressing psychological, emotional, or spiritual distress, failure to manage symptoms or conditions that worsen pain or discomfort, lack of medication to address pain and symptom management, and insufficient care or response to wounds or emergency situations.

Many hospice care providers and staff have mandatory reporting requirements if they suspect abuse or neglect. This makes them legally responsible for reporting issues. By law, hospice care providers must immediately investigate reports of abuse or neglect, take appropriate action on state law, and report violations to state and local agencies.

Recommended safety practices

To best protect patients from the risk factors and issues we discussed, everyone involved–caregivers, families, and the hospice care team–needs to be educated and alert along with the other tips shared above. Caregivers should do their best to ask questions of the care team to glean from their expertise. Make sure the questions are specific to issues so you can know how best to assist the patient. Caregivers can also observe nurses and physicians as they treat patients to gain hands-on knowledge of how to treat wounds, assist with mobility, and keep treatment areas clean and sanitized. 

Doing proper assessments of patients and observing their condition will also help. Make sure you are checking wounds for changes in size or coloring. Make sure when you’re observing or assisting with movement you take note of any changes. This can help prevent infections and falls, and also allow you to be prepared should an emergency occur.

Communication is one of the most important things caregivers can utilize when caring for a hospice patient. Since caregivers are the ones around patients the most throughout the day, they must let the care team know of any changes or developments in the patient’s condition. This will help the care team adjust treatment plans as needed to make sure the patient stays comfortable.

If you ever have any questions or concerns about your loved one in hospice care, don’t hesitate to speak with the nurses and physicians on their care team, or administrators.

How Heart to Heart helps

At Heart to Heart, the safety of patients is our number one priority. We will always make sure your patient is receiving the best care possible. We ensure our care team is educated on the most up-to-date information on wound care, medications, and safety precautions. We also provide tips and key steps to keep everyone safe in this blog. 

Our CHPN Chief Clinical Officer, Tracy Sudduth, MSN, RN had this to say about Heart to Heart’s commitment to safety:

“At Heart To Heart Hospice, we continue to innovate and adopt safety protocols. This involves ongoing training, developing systems to reduce errors, and ensuring that safety is a priority in every aspect of our patient care. Effective teamwork and communication between all members of the hospice team – doctors, nurses, pharmacists, and field staff – are key to minimizing risk and delivering exceptional care.

While our hospice team plays a primary role in promoting safety, there are several ways that patients and their families can contribute to their own safety.

Our Patient and Family Handbook lists dozens of ways for our families to create a safe environment for their loved one. The topics include kitchen safety, fall prevention, fire safety, infection control, and many others.

Patient Safety Awareness Week is not just a reminder for healthcare organizations – it’s an opportunity for patients, families, and providers to come together in a shared mission to reduce harm and improve care.”