[pansylvr523]

I have worked in nursing for 27 years and have never ran across this before. Hope you can help.

I work in a nursing home on nights. I have a resident called Ellen. She has a coccyx decub and back pain. She has a Fentynl 100 patch. Last night she was in so much pain all night long.The only med we have for overriding pain is Tylenol 2 every 4 hours and nothing stronger. The daughter who is POA doesn't want to "dope" her up. She won't let her have any a sleeper or sedative either.

We have gotten orders from the doctor for a stronger med, but it gets taken away because of the daughter.

Any suggestions on what to do? Should I contact the Ombudsman for our region?

Thanks for your suggestions,

Kathy

[Ann RN]

Do you have an Ethics Committee that you can go to?

[vamedic4]

Has anyone tried to reason with the daughter? It's clear from your post that both you and the medical staff want to help, but are unable to due to the daughter's refusal.
Try telling the daughter that you aren't seeking to "dope" her mother up, but simply to control her pain (I'm sure this has been done, but reiteration never hurts), and that once this pain is controlled, her mother will begin to "improve" and may be much easier to be around for her family.
Or you could just lay on a guilt trip and tell her that she alone is causing her mother to suffer intolerable pain and ask her if she'd like someone to do that to her if other options were available.
A doctor needs to sit her down (or one of you very caring nurses) and flat out tell this obviously hard headed woman that her mother is suffering, and she has a responsibility to do something about it.
I agree with Ann...send this up the chain, and to the Ethics committee. Something should be done for your patient.
Good for you for being such a patient advocate!!!!!!
Good luck!!

vamedic4
stupid people make me sick

[earle58]

what about upping the patch to 125mcg?

leslie

[sharann]

So is this daughter a medical professional working there? I think that maybe she has more power than she should. I would be medicating MY PATIENT as ordered until she is more comfortable.There is no law against medicating a patient in PAIN is there? I am so confused about this.Thanks

[ktwlpn]

Call the state department of health....We had a similar situation at the LTC a few years ago-the dtr was a nurse and would call the physician with her demands and he would call in verbal orders to us( that's another thread and I don't have the strength to got there now)....An anonymous staff nurse called the state and they found that "resident's needs must be considered over family demand" If you have lots of good documentation you won't have a problem... Over the years we have had several instances in which staff made anonymous calls and the DOH really does keep the info confidential.

[pansylvr523]

The daughter is the POA so after we get the order we have to call her, then she tells us no. We are supposed to do as the daughter says.

Kathy

[pansylvr523]

No the daughter is not a medical professional. I think she is trying to save money. I told the DON that the next time I saw the daughter I would give her a peice of my mind, so maybe she should look around for a new nurse. The DON is at wits end too.

Kathy

[ktwlpn]

Originally Posted by pansylvr523

The daughter is the POA so after we get the order we have to call her, then she tells us no. We are supposed to do as the daughter says.

Kathy

Please believe-it does not matter that she is the POA.If you have good documentation to show that this resident is not receiving adequate pain control the state and the ombudsman will advocate for the resident.The DOH has made this very clear-a residents needs come before family demands.Make the call......for the resident

[ktwlpn]

Our DON often turns to the DOH for input in this kind of situation...Your DON can make the call.I have seen cases in which the resident was made a ward of the state-if this resident was in the daughter's home this would be neglect.It's really no different in the LTC-you are her home and you have to deliver the appropriate care....Do it-make the call.Or send an anonymous e-mail now.They must investigate within 48hrs here in Pa.......Keep us posted....This resident deserves relief.....