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Care that Never Sleeps℠
Patient Case Study


Mary is a 90 year old female who resides in a long-term care facility. She was having pain and her
current prescribed pain medication was not effectively relieving her pain. The facility staff
contacted Great Lakes Caring to notify them of the inadequate pain relief.

A hospice nurse arrived at 5:00 pm, approximately 30 minutes after the facility contacted Great
Lakes Caring and spoke to a Great Lakes Caring nurse in the triage department. Upon arrival at
the facility the hospice nurse assessed the patient, contacted the physician and received an order
to increase the pain medication. The hospice nurse also updated the family on the changes to the
plan of care. The hospice nurse remained with the patient until the medication had been
administered and the patient was resting comfortably. The hospice nurse then reminded the
facility to call Great Lakes Caring if Mary had any changes in her status.

The facility called Great Lakes Caring at 2:30am speaking directly with a triage nurse to report
that the patient was showing signs of discomfort again. The triage nurse accessed the patient's
electronic medical record to review the visit notes and physicians orders from the previous day.
She instructed the facility to give the physician ordered PRN dose of morphine to the patient,
and let the facility know that a hospice nurse would arrive within the hour to assess the patient
status. At 3:05am, the hospice after-hours nurse on duty arrived at the facility. She spoke with
the facility staff and reviewed the documentation of what had transpired in the past several hours
prior to assessing Mary. Clinical assessment revealed Mary to be grimacing and moaning and
still exhibiting symptoms of pain. The hospice nurse contacted the physician and received new
orders to increase morphine and to manage pain. The hospice nurse initiated the new orders and
remained with the patient until 5:00am when the patient was observed sleeping with no signs of
pain. The hospice nurse reminded the facility to call Great Lakes Caring again if needed and that
a visit from the primary nurse was scheduled for the next morning at 9:00 am.

The primary nurse arrived the next morning, and because of the "Real Time" documentation,
she knew exactly what occurred during the previous visits and what changes had been made to
the patient plan of care. The primary nurse contacted the family after her visit and gave
an update regarding the changes to the plan of care, including the effectiveness and that the
patient was comfortable at this time.

Care That Never Sleeps℠ provided communication and continuity of care between the Great
Lakes Caring Hospice day and evening support staff, along with the facility staff and family. The
facility and family felt supported knowing that someone was available to speak with and visit the
patient when necessary. Mary's pain was successfully resolved and she avoided a more serious
outcome, as a visit to the emergency room or hospitalization.


Presented by Sarah Thurston, LMSW
Great Lakes Caring Director of Education
October 2017