3. A patient with end-stage cardiac disease declined to create an advance directive. Oxygen needs have increased to 6 liters per minute at rest, and the next hospice certification is in 2 weeks. Which of the following is the BEST action for the hospice team to take?
Answer: D
Reevaluate the goals of care
The best action for the hospice team is to reevaluate the goals of care. This is crucial in ensuring that the patient's current needs and preferences are aligned with their treatment plan, especially given the increased oxygen requirements.
A) Assess patient for anemia
While assessing for anemia could be relevant in a comprehensive evaluation of the patient's health status, it does not directly address the immediate concern of the patient's increased oxygen needs and declining health. Furthermore, anemia may not be the primary factor impacting the patient's end-stage cardiac condition, making this option less pertinent in the context of hospice care.
B) Discuss advance directive with the proxy
Discussing the advance directive with the proxy is important, especially since the patient declined to create one. However, without first addressing the patient’s deteriorating condition and current needs, this discussion may not be effective. The immediate focus should be on adapting the care plan to the patient's current situation rather than solely on advance directives.
C) Discharge for cause from hospice
Discharging the patient for cause from hospice is not appropriate in this scenario. The increased oxygen needs reflect a change in the patient's condition, which necessitates a reevaluation of care rather than a discharge. Hospice care is designed to support patients through the progression of their illness, not to terminate care based on changes in medical status.
D) Reevaluate the goals of care
Reevaluating the goals of care is essential for ensuring that the hospice team provides the most appropriate and compassionate support tailored to the patient's evolving medical condition and preferences. This option allows for a comprehensive approach to address the patient's increasing oxygen needs and to align care strategies with their end-of-life wishes.
Conclusion
Reevaluating the goals of care is the most appropriate action as it directly addresses the patient's current health crisis and allows the hospice team to adapt care to better meet the patient's needs. Other options either fail to consider the immediate medical situation or do not adequately support the patient in this critical time, reinforcing the importance of a tailored approach in hospice care.