Home	HOSPICE VISITS:

Overview: The most crucial aspect of this experience is the contact with a hospice patient in a home or inpatient setting. This site visit gives the student a unique experience outside of the acute care setting, to review a patient chart, to go on a hospice home visit, to interview, examine, and assess a hospice patient, their family, and discuss the patient's condition and plan of care with a hospice staff member. Students are expected to be self-directed. For some, this may be their first experience with terminally ill patients, and guidance from the staff is extremely helpful.

Hospice Assignments and Directions to Hospice Sites:
Students are assigned to hospice sites at the end of the first classroom session. Students are expected to contact their hospice sites in preparation for their visits, following the directions below. Students must bring their HOSPICE ACTIVITY SUMMARY form to their assigned hospice nurse. This is the only evaluation form required for this rotation. Please ask the nurse you are working with to complete and fax it to Dr. Shpritz at 410-328-2822. You may also bring it with you to the last day of class.  If you do not have this form, please print one out, using the link provided on this page. 

Report promptly at the expected time for your hospice experience. If you will be late or cannot get there due to illness or some other unforeseen circumstance, please call the hospice and let them know. Remember your learning experience is a planned part of their day – they are expecting you.  After notifying the hospice, call Dr. Shpritz at 410-328-3825 or email her at DShpritz@som.umaryland.edu.  She will work with the hospice to reschedule your clinical visit. Plan to spend at least 4 hours in each clinical visit.

Specific instructions for the hospice to which you have been assigned for your hospice experience and directions can be found below. If you have any questions, contact Dr. Debbie Shpritz at 410-328-3825 or DShpritz@som.umaryland.edu.

HOSPICE OF THE CHESAPEAKE (HOC) - MILLERSVILLE, MD
8424 Veterans Hwy, Millersville, MD (toward Annapolis, off I-97).  410-987-2003

Contact Person: Joan Brown, Administrative Assistant to the Director of Clinical Operations. Call Joan to report absences or if you will be late.

Directions: 695 S towards Glen Burnie. Exit I-97 at Benfield Road. Take a left over I-97, then a left at the light; HOC is on the left in a small plaza. Call the HOC at 410-987-2003 for additional directions to the hospice center

Students are to report directly to Joan Brown at the HOC promptly at 1:30 pm (please be on time). You will meet the hospice nurse who will be assigned to you for the hospice rotation. The hospice nurses will take you on your home visits. You will probably have the same hospice nurse each week and see a few of the same patients. Patients are seen until 4:30 pm. Please remember to give the attached HOSPICE ACTIVITY SUMMARY form to your nurse. There is only one form for the entire hospice rotation. Ask the nurse to fax the form to Dr. Debbie Shpritz at 410-328-2822.  You may also bring it with you on the last day of class. You are also encouraged to ask the nurse to provide you with verbal feedback regarding your performance at the hospice sites. If you have any question regarding this experience please contact Dr. Debbie Shpritz at 410-328-3825. or DShpritz@som.umaryland.edu.

CARROLL HOME CARE AND HOSPICE.
410-871-8000
Contact Person: Stephanie.
Report to the hospice promptly at 1:30p.m.

Please remember to give the HOSPICE ACTIVITY SUMMARY form to the hospice staff member. There is only one form for the entire hospice rotation. Ask the nurse to fax the form to Dr. Debbie Shpritz at 410-328-2822 or you may bring it with you to the last day of class. You are also encouraged to ask the nurse to provide you with verbal feedback regarding your performance at the hospice sites. If you have any questions regarding this experience, please call Dr. Debbie Shpritz at 410-328-3825 or DShpritz@som.umaryland.edu.

Directions: Take 695 to exit 19/Owings Mills/795. When 795 ends go to the right towards "Westminster". It is well marked. You are now on Rte. 140 N. Go about 11-12 stoplights or about 10 miles and turn left on Engler Road (landmarks are a bank and Shell station). After you turn left onto Engler, stay in the right hand lane. The Carroll Home Care and Hospice is on the right, just past a shopping center on your right and across the street from the Goodyear store. Don't worry about the address, it will only confuse the directions. 

HOSPICE OF BALTIMORE AND GILCHRIST CENTER.
Your assignment to the Hospice of Baltimore may be to one of three home care divisions, or to the inpatient division located on the campus of the Greater Baltimore Medical Center (GBMC).

INPATIENT DIVISION/GILCHRIST CENTER - located on the 1st floor of the Gilchrist Center

6601 N. Charles Street, Baltimore, MD 21204 – on the campus of GBMC 

Report promptly at 1:30 p.m. Upon arrival, contact: Robin Elza, RN, Gina Ranieri-Bender, RN, or Tina Ranieri, RN. Phone: 443-849-8203, FAX: 443-849-8284, E-mail: relza@gbmc.org, gbender@gbmc.org, or tranieri@gbmc.org. 

Directions: Take 695 (Baltimore Beltway) toward Towson. Take Exit 25, Charles Street, South. If you are coming from the West you will go on Charles Street until you get to the 3^rd light. If you are coming from the East you will get on Charles Street and go to the 4^th light and turn left into the Greater Baltimore Medical Center (GBMC) campus. After getting a parking ticket, bear left at the "Y". Make the first left which leads up a hill. As you continue on this road, you will eventually see Stone Country Manor building. This building is the Gilchrist Center. Parking is available around the building. (Please do not park in the circular driveway.) Gilchrist will validate your parking ticket.

HOME CARE DIVISION, BALTIMORE – 

Located on the campus of GBMC (Greater Baltimore Medical Center) located in the lower level Gilchrist Center. Directions as above for Inpatient Hospice.
Contact: Kathy Marino, RN  Phone:  443-849-8242; FAX: 443-849-6761

HOME CARE DIVISION, HOWARD COUNTY:

Hospice of Howard County, 5537 Twin Knolls Road, Suite 433, Columbia, MD 21045

 

Contact Person: Blanche Ventura, Team Manager, Phone: 410-730-5072, FAX: 410-730-5284,

E-mail: bventura@gbmc.org.

 

Directions: Take 695 West to Rt 70 West to 29 South to Route 175 East.  Turn right at the first traffic light, Thunder Hill Road. Make the first right onto Twin Knolls Road. Follow Twin Knolls Road to the third right hand driveway that is the Twin Knolls Professional Center. Hospice is building #5537, suite 433

HOME CARE DIVISION, HARFORD COUNTY: 

Hospice of Baltimore, Harford County, 4-C North Avenue, Suite 422, Bel Air, Maryland 21014. 

Contact: Sarah Rech, RN, BSN, Team Manager. Phone: 410-638-5103, FAX: 410-893-8776, E-mail: srech@gbmc.org. 

Directions: Take 95 North to Exit 77B, bear right to Rt 24 North toward Bel Air. Take Rt 24 to exit for Rt 924. Take first left on to North Avenue and make a right into the office buildings. Hospice is building 4C, suite 422.
 

Note: For all Hospice of Baltimore students, please remember to give the attached HOSPICE ACTIVITY SUMMARY form to the hospice nurse. There is only one form for the entire hospice rotation. Ask the nurse to fax the form to Dr. Debbie Shpritz at 410-328-2822 or bring it with you to the last day of class. You are also encouraged to ask the nurse to provide you with verbal feedback regarding your performance at the hospice sites. If you have any questions regarding this experience, please call Dr. Debbie Shpritz at 410-328-3825 or DShpritz@som.umaryland.edu.

JOSEPH RICHEY HOSPICE (JRH) BALTIMORE, MD
820 N. Eutaw St., Baltimore, MD (near Maryland General Hospital).

410-523-2150

Please call Joseph Richey House for directions and to report absence or if you will be late.  Students are to report directly to the JRH promptly at 1:30 p.m. to meet with one of the hospice staff members. JR hospice has both inpatients and home patients. The hospice staff member will either take you on home visits and/or see hospice inpatients at the JR House. You will see patients until 5:30pm or according to the situation. Please remember to give the attached HOSPICE ACTIVITY SUMMARY form to the hospice staff member. There is only one form for the entire hospice rotation. Ask the nurse to fax the form to Dr. Debbie Shpritz at 410-328-3825 or you may bring it with you on the last day of class. You are also encouraged to ask the nurse to provide you with verbal feedback regarding your performance at the hospice sites. If you have any questions regarding this experience, please call Dr. Debbie Shpritz at 410-328-3825 or DShpritz@som.umaryland.edu.

STELLA MARIS AT MERCY HOSPITAL - BALTIMORE, MD
Stella Maris is an inpatient hospice and palliative care unit on the 8^th floor at Mercy Medical Center. 

Contact Person: Jackie Surfling, CRNP

Please call 410-332-9534 for directions, to report absence or if you will be late. Students are to report directly to the 8^th floor at Mercy Hospital promptly at 1:30 pm to meet with the Nurse Practitioner, Jackie Surfling. Jackie will take you to see inpatients. You will see patients until 5:30pm or according to the situation. Please remember to give the attached HOSPICE ACTIVITY SUMMARY form to Jackie and she will fax it to Dr. Debbie Shpritz at 410-328-2822. There is only one form for the entire hospice rotation. You are also encouraged to ask Jackie to provide you with verbal feedback regarding your performance at the hospice sites. If you have any questions regarding this experience, please call Dr. Debbie Shpritz at 410-328-3825 or DShpritz@som.umaryland.edu.

ST. AGNES HOME CARE AND HOSPICE - BALTIMORE, MD.
St. Agnes Home Care and Hospice is affiliated with St. Agnes Hospital and provides care to patients in their homes.
3421 Benson Avenue, Baltimore, MD, 21227
410-368-2825

Contact person: Cindy Polchak, RN – Hospice and Home Care Coordinator 

Report to St. Agnes Home Care and Hospice at 1p.m. Cindy Polchak, RN will orient you to the hospice, your visit and the nurse you will be working with. You will accompany the hospice nurse on home visits. Your experience should end around 5-5:30p.m. If you have any problems and cannot make it to your clinical experience, call Cindy (410-368-2825) and let her know, then call Dr. Shpritz.  Give the HOSPICE ACTIVITY SUMMARY to the hospice nurse you are working with. Ask the nurse to complete it and fax it to Dr. Shpritz at 410-328-2822 or you can bring it with you to the last day of class. This is the only evaluative form for the hospice rotation. You are encouraged to ask the nurse to provide you with verbal feedback regarding your performance at the hospice sites.  If you have any questions regarding this experience, please contact Dr. Debbie Shpritz at 410-328-3825 or DShpritz@som.umaryland.edu. 

Directions:  95S to Caton Avenue® Exit #50 towards Wilkens Avenue (this will take you towards St. Agnes Hospital; if you pass the hospital you have gone too far). Turn left at the first stop light onto Benson Avenue. Go approximately ½ mile to #3421 (professional building) on the left. There is plenty of parking. The Hospice office is located in the basement – take the elevators where you enter the building.  

HEARTLAND HOME HEALTH CARE & HOSPICE

Heartland Home Health Care & Hospice provides services to terminally ill patients and their families in the home environment. They are also affiliated with the Jewish Hospice Program of Maryland.  

4805 Benson Avenue, Baltimore, MD 21227
410-247-2900

Contact Person: Christie Petti, RN – Director of Clinical Services 

Report to Christie Petti, RN at Heartland Hospice promptly at 1:30 p.m. – please be on time.  She will orient you to the hospice. You will be required to sign a confidentiality agreement at this time. The nurse you will be working with may already be in the field making visits. Christie will arrange for you to meet the nurse at a patient’s home.  

Give the HOSPICE ACTIVITY SUMMARY to the hospice nurse you are working with. Ask the nurse to complete it and fax it to Dr. Shpritz at 410-328-2822 or you can bring it with you to the last day of class. This is the only evaluative form for the hospice rotation. You are encouraged to ask the nurse to provide you with verbal feedback regarding your performance at the hospice sites.  If you have any questions regarding this experience, please contact Dr. Debbie Shpritz at 410-328-3825 or DShpritz@som.umaryland.edu.

OBJECTIVES OF THE HOME OR INPATIENT HOSPICE VISIT

1.      To gain a better understanding of hospice care and its value as a component of professional practice

2.      To experience a hospice home or inpatient care setting as a valuable place of care for the dying patient

3.      To provide the junior medical student a supervised opportunity to develop their knowledge and skills concerning the care of the dying patient by developing a rapport, interacting with and caring for hospice patients and their families in the home or inpatient setting.

4.      To explore the roles and responsibilities of the primary care physician for the hospice patient

5.      To explore one's own feelings and reactions in caring for a dying patient and their family.

EXPECTATIONS OF STUDENTS AT HOSPICE SITE VISIT:

1.      Students will report promptly to the assigned hospice site on the assigned Wednesdays or Thursdays.

2.      Upon arrival to the hospice site, a hospice health care provider will be assigned to the student and accompany the student on all of the home or inpatient visits to act as a resource and to supervise the experience (see hospice worker role, below).

3.      Students will accomplish the goals of the hospice experience and receive feedback of their clinical performance at the home or inpatient visits from the assigned hospice health care provider.

4.      Students will select one patient to present during the interdisciplinary team (IDT) conference held on the last day of the hospice rotation.

5.      Students will complete a palliative care workup of the selected hospice patient, and submit the completed workup to the Hospice rotation Medical School faculty on the last day of the Hospice rotation (See Day 4, Schedule, above).

6.      Students will be prepared to utilize/share the knowledge and experiences gained on the home/inpatient visit in the mock interdisciplinary team (IDT) conference held on last day of the Hospice rotation (See Day 4, Schedule, above).

7.      Students will complete an evaluation form of the Hospice Home or Inpatient field experiences on the last day of class of the Hospice rotation (Day 4) as feedback to the medical school faculty.

8.      Students will maintain confidentiality of all patient information.

HOSPICE HEALTH CARE PROVIDER ROLE:

1.      Select appropriate patients for the student and provides reason for the home visit, as well as pertinent information about the patient that is necessary for the visit.

2.      Provide the student access to the patient's chart for aid in assessing, interviewing and providing care to the dying patient.

3.      Act as a resource for the student in the home when assessing, interviewing and providing care to the dying patient.

4.      Guide the student in an appropriate workup for hospice patients as compared to a patient in acute care setting.

5.      Supervise the student during the home visit, and serves as a role model.

6.      Provide emotional support to the student as this is a new experience for most of the students.

7.      Discuss with the student any follow up care, referrals or other interventions needed by the patient and/or family as well as the role the primary care physician played in the care of the client.

8.      Provide verbal feedback to the student regarding student’s behaviors on the home visit and complete a written feedback form that is returned to the hospice site liaison person.

9.      Communicate with hospice liaison as needed regarding students and/or experience.

Junior Medical Student Hospice Visits

Some Suggested Goals.

1.    Primary goal: try to identify the major causes of the patient’s symptoms or suffering, including physical causes, emotional/psychosocial causes and spiritual causes. After formulating working diagnoses, formulate a ‘working’ palliative care plan that we will discuss at the ‘mock’ Interdisciplinary Team (IDT) meeting during the final classroom session.

2.    At the ‘mock’ IDT meeting, you will have at your disposal various members of the interdisciplinary team, including a social worker, chaplain or spiritual advisor, medical director, and nurse. Ask for their input into your ‘working’ palliative care plan.

3.    Information can be obtained from the patient, the patient’s family members, the hospice chart and care plan, and the hospice nurse/worker that accompanies you.

4.    Some suggestions for things to look for and to discuss at the lDT meeting:

·         Is the symptom control satisfactory under the current palliative care plan (formulated by the hospice and the patient’s doctor)? If so, outline the key elements of the plan that make it successful. If not, identify areas where symptom control should be improved—we will discuss these at the lDT meeting.

·         If the patient is being treated for pain, is the treatment appropriate for the intensity of the pain as recommended by the W.H.O. ‘Pain Ladder’? Is the pain satisfactorily controlled?

·         If opiates are prescribed, were appropriate laxatives prescribed? If sustained-release opiates are used, were PRN doses of opiates prescribed for breakthrough’ pain? Were the PRN doses appropriate (should be the opiate equivalent of one-sixth of the total sustained-release opiate dose, given q2h PRN)

·         If the patient requires more than 2 doses of PRN opioid for ‘breakthrough’ pain, it may be time to increment the sustained release dose.

·         Is the patient having neuropathic or bone pain? Has an appropriate adjuvant medication been tried?

·         Is the patient taking unnecessary medications for a patient with a short life expectancy such as low-dose aspirin or "statin" drugs to lower cholesterol? Are there unnecessary dietary restrictions such as a low fat diet?

·         How is the patient and/or family coping with the illness? Are there psychosocial or spiritual issues that are contributing to the patient’s suffering? Are the patient/family’s needs being adequately met?

Bring these for discussion at lDT (Session 4).

GUIDELINES FOR WRITTEN ESSAY -- See Assignments on Introduction Page

PATIENT PALLIATIVE CARE WORKUP -- See Assignments on Introduction Page

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