[cargal]

Had this new admit to hospice recently, dtr had issues, don't quite know, thought the education/ emotional support went well. Pt in resp distress, agitation, dtr, not poa, only next of kin there, said no roxanol, then agreed, but the pt refused. Then, while I was there the next day, did alot more emot support/education to a son and dil and thought it went well, came back into the room & the pt sat up (elderly, many comorbidity factors) with a panicked look in her eyes and increased resp distress. I asked the pt if she would let me get & give her ativan for anxiety, and she nodded, I looked at the dtr and she nodded and I obtained and administered ativan intensol, and it was effective. A couple days later another nurse made a visit and the POA had arrived and stated, what I say goes and no ativan. Well, I found out tonight that she still hanging on, has been active for a week and I am on call and the family doesn't want me there because I " administered ativan against their will". It is the first ans only time she has had it and is now suffering from terminal agitation. I feel so bad. I feel like I have failed to educate, failed to communicate, failed the patient, and that administering a med against will is kin to assault and battery. BTW, she had previously been on xanax for anxiety attacks. ***** What is wrong here?

[frannybee]

You *know* that you educated, informed, communticated and obtained consent before administering the ativan. It's the family and POA that need to get their butts into gear and agree on the care of this poor woman. You did what you could for that patient. You haven't failed her, her family have failed her. Big hugs coming your way, babe - you sound like you need 'em.

[sunnygirl272]

Originally posted by frannybee
You *know* that you educated, informed, communticated and obtained consent before administering the ativan. It's the family and POA that need to get their butts into gear and agree on the care of this poor woman. You did what you could for that patient. You haven't failed her, her family have failed her. Big hugs coming your way, babe - you sound like you need 'em.

ditto.
always kinda makes me wonder what issues from earlier in life are being played out in spots like this...

[cargal]

Yanno, that is what I wanted to hear. The thang is- this kinda thing puts a bug of doubt in the supervisor's ear. I am new at hospice, but geez, what is it about nursing that puts us in such vulnerable position that there is someone always unhappy- the family, the management, etc, but mostly not the patient! Thanks for the support.

Blessings and hugs to you too!

[kids]

What does the Doc say?
Any hope of getting him on the phone and having him/her explain to the family thay the meds are not going to prolong her life and will keep her from suffering?

Is it to late to get APS out there?

Sorry you are having to witness this.

[aimeee]

Sounds like your real problem is a POA who has control issues and you are caught up in the middle of it. You educated the son and DIL but they are not the ones holding the legal reins in this case. You did not administer meds against the patient's will. You gave the appropriate drug in the appropriate circumstance. You did what needed to be done for her and hopefully you documented who said what and when well.

When I have a POA with control issues I find the best thing to do is invite them into the decision making process. At this point, if you need to provide care for this woman and the POA has a problem with that, call her yourself and let her vent at you. You don't have to say you did anything wrong...you can just use active listening techniques like "you are upset that she received ativan in your absence" and yada yada. After she has spewed her venom, hopefully you can say something like "I would like to work with you to make a plan for keeping your mother comfortable in case she has another episode of respiratory distress" and explain you need a med to address the anxiety, and one that will lessen the air hunger. Do your homework ahead of the time and work out a couple alternatives and then let her choose between them. How about liquid Haldol and Oxyfast?

So sorry to hear you are caught up in this mess. Control freaks. Arrrgh.