Editor's Note:This„bonus content to the November 2009 JEMS article,„"Sentimental Journey"„includes a downloadable sample program cover sheet. Download it at the bottom of this page.
The program is a collaborative effort between hospice organizations and EMS transport services to provide special trips to requested destinations for in-house and home hospice patients.„Each patient can have one or three family members accompany them on the ambulance or wheelchair van. Trips on the average can last anywhere between 2-5 hours.„Time of the trip can be during the day or evening, but not after the hours of 11:00 PM.
The parameters for the patients who can participate in this program are as follows, but exceptions can be made upon consult.
Screening for this program can originate from the Facility Team meeting or from any team member.„„ Recommendations would come from the Facility Team Meeting to the Clinical Manager of the unit.
Any staff member can recommend a patient for this service.„„ During the Facility Team Meeting, the members will apply the screening parameters to the request to ensure the patient is appropriate for the program
Coordination of the following services is required prior to the trip:
The arrangements for managing the medications during the trip will vary from patient-to-patient. Every effort will be made to administer medication prior to the scheduled trip. If the patient requires medication during the trip, the Charge Nurse will determine whether the patient can administer their own medications.„„ If this is possible, arrangements will be made to send medications with the patient. If the patient is incapable of administering the medications, a family member or friend who is willing to be responsible for the medication administration, will be requested to accompany the patient on the trip.
Patients without a family member or friend to accompany them on the trip„should be able to administer their own medications. Every effort will be made to schedule the trip between the medication dosage times.
EMS crew members may administer patient medication if cleared through their Medical Director or the Patient_s Physician.
Transportation for patients who are on IVs for pain control or hydration will be arranged on a case-by-case basis.„Attempts will be made to schedule patients during the time when the treatment is not being administered.„A patient who requires a continuous IV which must be monitored by a hospice nurse will be required to travel with the patient.
If the patient requires oxygen, the Charge Nurse will arrange for a portable tank(s) to accompany the patient.„The patient can use the 02 available in the ambulance during the trip to preserve the 02 in the portable tank(s) for the patients visit outside the ambulance.
Trip Day Process
On the date of the trip, the EMS crew will call the Charge Nurse to confirm the patient_s capability of making the trip.
The Clinical Manager is responsible for the following task:
The Charge Nurse_s Responsibilities are as follows:
Paperwork Required for the trip
The following documents are required for the trip and must be given to the EMS crew prior to departure:
If the patient becomes acutely ill during the trip, the EMS crew must return to the facility.„„ The following suggestions will assist the EMS crew in determining if there is an acute situation. This is not an all-inclusive list but suggestions of some acute situations. Imminent death, dynamic respiratory distress, seizures, sudden onset of increased and uncontrolled pain, uncontrolled nausea/vomiting, coma, fractures, and/or hemorrhage would necessitate immediate return to the hospice facility. The EMS crew will notify the facility of the acute situation through their dispatcher.
If the patient dies during the trip, the EMS crew will follow procedure listed below:
The program evaluation effort will focus on two groups:„„ the external customers, patient and/or family, and internal customers, EMS staff and hospice staff. The Clinical Manager of the facility will interview the internal customers to evaluate effectiveness of the program, how well the program functions, and are there any changes needed.„„ This evaluation should be done every month.„With the information gathered at these interviews, program improvements can be implemented more rapidly.
Program Development will interview the patients or their families to evaluate external customers.„This will be done every 3 months
Hospice training for EMS transport crews
Sentimental Journey EMS crews will receive basic hospice volunteer training before working with this program.„A basic familiarity with the hospice mission statement/ philosophy along with patient care team functions - including the nursing team, the physician team, the supportive services team, the spiritual care team and the volunteer services team, and the public relations team will be taught.„Not all classes will be necessary as EMS crews already have pre-existing training in some areas, i.e., patient lifting, certain medical procedures, etc.
Sentimental Journey is considered a complimentary therapy program to assist hospice and palliative care facilities in providing their patients with the very best care for those living with life-limiting illness.„„ Medical research has demonstrated that complimentary programs such as Sentimental Journey can be instrumental in relieving stress, decreasing pain, and adding quality to one_s remaining days.
From a personal standpoint, I have seen EMS personnel gain a greater insight and compassion towards the terminally ill.
This program helps remind us of why we entered EMS and can help add a greater sense of accomplishment and pride in our profession.
I promise you an experience of a lifetime
Let the journey begin'