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Great Ideas...Clinical
  • Experience Model IDT 
    The Experience Model is an interdisciplinary team (IDT) approach which is patient/family need-driven regarding end- of-life care issues.  The IDT participates in the admission visit together.  The patient/family's response to the question,  "What do you need from your Hospice team today?" guides the direction which the IDT takes on this visit and plans for future visits.  The IDT begins the assessment process on the initial visit.  The team disciplines who can meet the most urgent needs begin to do so and others participate as feasible.  Patient/families understand the IDT as a unit advocating for them.  They only have to tell their story one time and action begins.  The IDT meets regularly during the week to clarify their patients' needs, who can best meet them, and when.  The required standards of information, forms signed and advance directives,etc., are met as the patient/family needs have begun to be met.  Reassessment and care planning are ongoing with the Experience Model IDT.    Alliance of Community Hospices & Palliative Care Services, Inc., Hospice of Louisville, Louisville, KY  (This great idea is also listed in the Team section)

  • Voicemail Report-In with Summary
    After each visit (or every few visits) do a voicemail report-in. Check in several times a day. Use throughout the day. Code that you can send to the whole group. Start with "I am reporting on [Name]"–use first name and initial only for confidentiality on cell phones. Gundersen Lutheran Hospice, LaCrosse, Wisconsin

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  • Rolled Draw Sheets
    Leave with family: 2 rolled drawsheets for emergency incontinence. In roll: 1 top twin flat sheet; 1 chuck; 1 Depends; (opt.) 1 plastic garbage bag. Roll up all together and leave available for family emergency. Mercy Medical Center, Roseburg, Oregon

  • Massage and Music
    We use a massage therapist and harpist for our patients. Use designated funds for this. Hospice of Bend, LaPine, Oregon 

  • Triage
    Three years ago we implemented an evening and weekend program where hospice nurses answered the phone directly from patients and families, triaged the services needed (nurses visit, pharmacy, etc) or addressed patients/families concerns directly.  The nurses have computer access to all clinical data immediately available, can be called by physicians and pharmacists, etc. (This could be a joint project for several hospice programs combined). Hospice of Northern Virginia, Arlington, Virginia

  • Art Therapy
    Used with family groups originally, now also proving useful and fun for staff. Helpful with team when patients and families are seen differently by individual team members. Can help to identify internal team members, e.g., drawing a picture of your "family" or team. Anonymous

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  • Cover Sheet
    We have computer documentation and can print up cover sheets for each patient with travel directions, contacts, current medicines, etc. It is great to use when on-call to problem solve with caregivers, since we print new sheets with all medicine changes. It is also easier to read travel directions on paper rather than on a small hand-held computer screen. A good quick reference until we can modem for a chart. St. Mary's Hospice, Athens, Georgia

  • Patient Care
    Our hospice has attempted to offer to those patients who are interested and able an opportunity to do a formal life review. It has been done by social work staff as a well as by volunteers. The review is done over a series of visits with the interviewer leading patients through early memories, childhood, courtship, child rearing, etc. Upon completion, notes or audio tapes are put together and copies are provided to patient and family members. It allows for wonderful closure and makes patients feel this time of illness still has meaning. Hospice of Dubuque, Dubuque, Iowa

  • Daily Clinical Staffing
    Our directors meet each morning at 9am to review day and night before and review each patient with each discipline contributing. When we walk out of this meeting we all know what we have to do to begin to do it. Whispering Pines Hospice, Jackson, Mississippi

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  • Caregiver Teaching Packet
    We have a teaching packet in our patient information folder that has perforated sheets which can be torn off and reviewed with the caregiver/family on each nursing visit. Topics include such items as bed making skills, bathing, end-stage nutrition, skin care, pain medication, and oral care. These sheets help reinforce our teaching of needed caregiver skills--also have sheets for cath care, colostomy, etc. The sheets stay in the patient home for all caregivers to use. Hospice of Visiting Nurse Association, Van Wert, Ohio

  • Inpatient/Home Care "Sharing"
    In our inpatient unit, which has recently celebrated our two-year mark, many staff do not have hospice backgrounds. Therefore, varying levels of experience are helped by having staff accompany "home care" nurses for visits. This helps expedite the learning by observing the process entailed in terminal care--sort of an introduction. Anonymous.

  • Cross-Training
    Our home care and hospice aides and RN case managers can do both home care and hospice cases. On call is shared. Case loads run about 25 home care, only 2 or 3 hospice. Patients in home care then can keep same nurse for hospice. Hourly reimbursement. Palos Community Hospital Hospice, Lemont, Illinois

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  • "Hello, I Am...."
    Shortly after admission the on-call nurse makes a visit a) to connect with patient and family, b) to locate house in dark, and 3) to promote open communication. Essentially, "Hello, I am... ." Greenwich Hospital Home Care Hospice, Greenwich, Connecticut

  • Ventilator Patients in a Hospice Setting
    Our hospice has an acute in-patient unit that has accepted ventilator-dependent patients for the last 18 months. Patients are accepted with the understanding that weaning and extubation will occur within 72 hours after admission. Our purposes in initiating this innovative program are to a) ensure patient comfort during the process, b) provide teaching to patient/family, c) increase patient/family access to support services (e.g., social worker, chaplain, counselor, etc), and d) eliminate traumatic death experiences related to extubation failure and resultant sudden death. St. Anthony's Hospice, Amarillo, Texas

  • Complementary Task Force
    A group of hospice team members and volunteers continues to meet to discuss alternative methods of pain and symptom control in response to patients' requests for nontraditional approaches to managing their disease process. Task force work has resulted in on-site certification training for three treatment modalities: Healing Touch, Reiki, and Therapeutic Touch. Staff and volunteers complete required training and are then available to provide treatments to patients. Requests are made via the interdisciplinary team and treatment sessions are coordinated through the Volunteer department. Policy, procedures, and documentation protocols can be obtained by request. San Diego Hospice, San Diego, California

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  • Patient Photos for IDT
    We take photos of our patients on intake (or ask for a photo if taking one is not appropriate) and have transparencies made that are used at IDT with pertinent patient info recorded on transparency.  Especially helpful for on-call staff to have "seen" all clients at IDT when a call comes in- helps patients remain people in our minds. Hospice of North Idaho, Coeur d'Alene, Idaho

  • Admit/Discharge Voice Mail Box
    Our idea is an admit/discharge communications voice mail box. It's a very cost effective way to keep the entire team informed and it keeps everyone involved and aware of the changes that are occurring with patients and staff alike. Mission Hospice, Oklahoma City, Oklahoma

  • Language Bank
    We implemented a language bank of volunteers who speak a second language and enter in computer to use as a resource for non-English speaking patients/families. Hospice of the Western Reserve, Cleveland, Ohio

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  • Holiday and Birthday Services and Support
    The staff who celebrates the holidays other than on Christmas day will spend this Christmas day visiting our patients who are alone on Christmas. We also do birthday parties for our patients, there is support, available staff, favorite cake, red birthday crown, card, balloons, singing, and picture taking. Ingalls Hospice, Harvey, Illinois

  • Caregiver Support Groups and Publication
    Caregiver support group meets second and fourth Tuesdays, 1:00-2:30. Volunteers provided. Three parts to meeting: --HHA- personal care --RN- meds or disease process --MSW- stress management, emotional stress Caregiver Gazette- Little paper about meetings-typed and sent to each patient family whether their caregiver attended or not. Snowline Hospice, Placerville,California

  • Family Practice Residency Referral Program
    Associated with family practice residency program in our area's acute care hospital in order to get residents in the program to "rotate through" our Hospice program, thereby learning what we do in end of life care and allowing them to act as salesmen/marketers for hospice care and our organization in particular. Mesilla Valley Hospice, Las Cruces, New Mexico

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  • Caregiver Luncheons
    Once a month the volunteers arrange a place to have some food. Perhaps from a church or some sort of community. Only bereavement and volunteers usually go because these caregivers need to get away from patients. We provide aids on volunteers to stay with patients while caregivers go to luncheon. They have really enjoyed this. If the nurses staff is available they stop by to lend support and visit about patient caregivers own feelings. Hospice of the Panhandle, Pampa, Texas

  • Primary On-Call Nurse
    Our weekend on-call one nurse is designated primary each day. Primary Saturday will be on back-up on-call Sunday and vice versa. We also have one social worker on-call all weekend. She makes visits at the Hospital for hospice patients and prospective intakes. The following week the two nurses on-call that past weekend will be off on-call during the week. We do not have a social worker on-call during the week. Hospice of North Idaho, Coeur d'Alene, Idaho

  • Patient Report Line
    Dedicated one of our phone lines with voicemail as a "patient report line." Nurses report off each day on changes in patient conditions. On care nurse picks up this report and reports off again in the morning. Nurses listen to report in the morning. Others can also access report to be updated. Mercy Hospice, Redding, California

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  • Protocols for Standing Orders
    We developed protocols and standing orders. Involved MD's-staff nurses. Good because it's better system for MD for symptom management orders. Protocols have been good marketing tool. Anonymous

  • Hospice Inpatient Unit Meeting Diverse Needs
    The development of a Hospice Impatient Unit to accommodate any/all patients from the 200 patients Hospice require symptom control/ pain management of a level which cannot be provided in the home. The unit is also available to provide end of life stories for patients with no caregivers or with caregiver who feels helpless to support their loved one rather than calling 911. The unit is available to all existing hospices within the state whose patients fall within the same alone mentioned categories. The unit is located is a nursing home. We lease 10,000 square feet from them and have done our own renovations and staff the unit. Hospice Care of Rhode Island, Pawtucket, Rhode Island

  • Symptom Relief Kit
    A "symptom relief kit" for all Hospice patients ordered as PRNs to provide relief of distressing symptoms in terminal illness: MSIR liquid, tylenol suppositories, pentobarbital suppositories, Levsin tablets, and ABHR suppositories (made with Activan, Benadryl, Haldol and Reglan). Kit ordered upon admission to Hospice and kept in patient's refrigerator. (Useage explained to patient and to family/caregivers, who then call our agency when symptoms occur. They then will receive a visit and/or instructions for use of appropriate medicines in kit. Heritage Home Health and Hospice, Meredith, New Hampshire (Warning to reader: Please be aware that the medications and dosages listed here might have been incorrectly transcribed from handwritten materials and that the list of medications might not be updated to current care standards because this great idea was submitted in the past.   Dale Larson)

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  • Symptom Relief Kit
    (Formerly emergency kit) Ordered by physician for each patient as needed by prescription, made as follows: --Liquid morphine in syringes (oral) 3cc per syringe x 4 syringes at 20mgs per cc for pain and dyspnea --pentobarbital supp. For severe agitation or seizures --2 ABHR supp for nausea and/or vomiting and anxiety A-Activan B-Benadryl H-Haldol R- Reglan --1-Acetaminophen supp --4-Levsin tabs Put together by compounding pharmacist. Designed for use when physician not readily available, for example, nights and weekends. VNA Hospice, Manchester, New Hamphsire (Warning to reader: Please be aware that the medications and dosages listed here might have been incorrectly transcribed from handwritten materials and that the list of medications might not be updated to current care standards because this great idea was submitted in the past.  Dale Larson)

  • Symptom Control Kit
    To have a symptom control kit in each patient's home. This allows us to have the most immediate response to symptoms 24 hours a day. In this kit we put 3 MS supps, 3 compazine supps, 3 tylenol supps, 3 thorazine supps, and a scopalimine patch (when available). This kit has been a wonderful way for us to allow immediate symptom control for our patients. Visiting Nurse Hospice of Pioneer Valley, Springfield, Massachusetts (Warning to reader: Please be aware that the medications and dosages listed here might have been incorrectly transcribed from handwritten materials and that the list of medications might not be updated to current care standards because this great idea was submitted in the past.  Dale Larson)

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  • The Tear Cloth
    A few days up to minutes before death we as nurses had noticed one tear form in the eyes of our patients. The tear is significant that the patient may not be able to talk and we explain that this final tear is a way of saying good-bye not the emotional crying that comes from both eyes. The tear is dabbed onto white squares of linen by family members and kept by families after the patient has died. The family has the "tear cloth" as a bury memorial and is used by any family members for uses at family occasions. It is worn on Christening, communion, confirmation, wedding gown, graduation gown. Anonymous

  • Bridging to Hospice Program
    We are part of Home Health Agency and as a Hospice program have implemented a "Bridging" program in which our terminally ill patients came to us before they are "ready" for Hospice care. This has provided a "consistency in care from the same staff from the bridging to Hospice and therefore, does not cause disruption of care and families and patients are very happy with it! VNA Hospice of Greater Milford, Hopedale, Massachusetts

  • Social Worker Accompanies Intake RNs
    Social worker accompanies intake RNs for families with known history of psychosocial issues. Hospice of the Great Lakes, Northbrook, Illinois

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  • The House of the Dove
    A hospice home (residential group type home): 10 individual rooms for patients; patio, rooms for family, homelike living room--home atmosphere; staffed 24 hours by 2 CMA's; RN case manager; volunteers cook home made meals; alternative to nursing home setting. St. Joseph's Hospital Hospice Services, Marshfield, Wisconsin

  • Music Therapy Program
    Music therapy program started by a local musician. Volunteer put together tapes and asked for donations for players, etc. form community. Range from classical, movie sound tracks, gentle jazz, spiritual. Used in hospital and at homes. Lake Forest Hospice, Lake Forest, Illinois

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©2011 Dale G. Larson, Ph.D.