Am I Wrong? - page 3

........or isn't Ambien 5 mg., Sonata 10 mg, and Rozerem (a new sleep medication) just a bit much to give a 90-something-year-old patient every night at bedtime? Here's my concern. The patient in... Read More

  1. by   Nascar nurse
    I would skip faxing the MD or NP and call them up and discuss this - pronto. Wayyyyy to much meds for a 90 year old. Sounds like just the kind of family member that demands control.. until things go wrong, then will be all YOUR fault. Good luck
  2. by   charebec65
    Quote from RNAnnjeh
    I agree. Leaving meds at the bedside is one big no-no. I'm curious...does she even take the meds that the daughter leaves at the bedside? Just to play devil's advocate for a minute....does the patient take these meds or do they mysteriously disappear in the night....or are they still there in the morning.RNAnnjeh
    I too was wondering if the client is actually taking all of this....or if it was being taken home by the daughter...
  3. by   charebec65
    sorry, must have hit send twice...
  4. by   rn/writer
    Marla, you da bomb! The daughter won't thank you and the mother probably can't. So we will. Thank you for being an excellent patient advocate. Thank you for looking out for your patient, yourself, your other residents, your facility, and the other practitioners. Thank you for not just looking the other way when the daughter made a stink. Thank you for setting a good example for the rest of us to speak up when we hear that "little voice," and we know something is not right. Thank you for sharing this with us so we can see a work in progress. Thank you for sparing this fragile old lady from a hip fracture or worse from oversedation.

    I look forward to more updates, especially after the daughter hits the fan.

    Once again, you rock!
  5. by   powernurse
    can anyone spell fall risk ??????
  6. by   HannasMom
    I am so glad I no longer work at an assisted living facility! Too many gray areas. I love my new job at the skilled/intermediate care facility I now work for, even if it is on the nightshift. If I just took one sleeping pill I would be snowed! Three sleeping pills is way too much. Melatonin is the sleep aid for me. Poor lady no wonder she is so confused. You are right Marla, not the daughter.
  7. by   GatorRN
    Way to go Marla!! Awesome job!! The daughter will probably be none to pleased, but, hopefully she'll realize you're looking out for her mothers best interest. Thanks for being such a great pt advocate!!
  8. by   NurseyBaby'05
    Quote from mjlrn97
    I heard back from the NP a little while ago, and just as I suspected, she did NOT intend for all three sleepers, plus a sub-therapeutic dose of Remeron, to be given! She D/C'd the Ambien and the Remeron, thanked me for my attention and concern, and stated she would follow up with the resident's primary care MD on another recommendation she made.

    Now, of course, I get to tell the daughter to take that Ambien out of the apartment because it's been discontinued, and of course she's going to be upset because I have, for the second time, "gone over her head" to change medications. But dang it, I'M the professional here, I'M the one who knows better, and it's MY responsibility to make sure people don't come to any harm while under my care. So there.........PFFFFFFFFFFFFT!!

    I know, yeah, THAT was real grown-up. But having laypeople treat me as though I went to school for four years to know NOTHING is one thing that really chaps my cheeks, and the worst part of it is, this is not in the resident's best interests. Sooner or later, she'd fall and break a hip or something else, or she'd take too many at once and overdose, and guess who would be left holding the bag.........that daughter would probably be on our doorstep with her attorney first thing the next morning.

    Once again, thanks to all who have offered advice thus far; I'll keep you posted as to the unfolding drama.
    I'm not too familiar with ALF regulations, but I would consider wasting them with another employee rather than giving them back to the daughter. I wouldn't trust her not to be slipping them to mom behind your back. Then what kind of creek would you be up? I know if a pt brings home meds, we have to send them to pharmacy in a tamper proof bag. The only way they can only get the narcs or other controlled meds back is with a doctor's order.
    Last edit by NurseyBaby'05 on Oct 13, '06
  9. by   mamason
    Quote from rn/writer
    Marla, you da bomb! The daughter won't thank you and the mother probably can't. So we will. Thank you for being an excellent patient advocate. Thank you for looking out for your patient, yourself, your other residents, your facility, and the other practitioners. Thank you for not just looking the other way when the daughter made a stink. Thank you for setting a good example for the rest of us to speak up when we hear that "little voice," and we know something is not right. Thank you for sharing this with us so we can see a work in progress. Thank you for sparing this fragile old lady from a hip fracture or worse from oversedation.

    I look forward to more updates, especially after the daughter hits the fan.

    Once again, you rock!
    DITTO
  10. by   VivaLasViejas
    Quote from NurseyBaby'05
    I'm not too familiar with ALF regulations, but I would consider wasting them with another employee rather than giving them back to the daughter. I wouldn't trust her not to be slipping them to mom behind your back. Then what kind of creek would you be up? I know if a pt brings home meds, we have to send them to pharmacy in a tamper proof bag. The only way they can only get the narcs or other controlled meds back is with a doctor's order.
    You make a very good point here, and I thank you!

    In Oregon ALFs, residents may keep meds in their rooms and self-administer them as long as a) there is an MD order that says they are competent to do so, and b) the facility nurse agrees after having assessed the resident. :wink2:

    Now, evidently all this was agreed to by the previous nurse, and maybe then it was appropriate (although I doubt it). Then, it was OK'd by the current NP for the Rozerem ONLY to be left at bedside---one pill at a time---for the resident to take when she is ready for sleep. HOWEVER, in this case my nursing judgment trumps "orders", and I am the final word on whether a resident is allowed to self-medicate.

    I am going to try, one final time, to sit down with the daughter and explain in detail all the rules, regulations, and nursing assessments that went into my decision to "go over her head" as she puts it. Then I'm going to document my fanny off, and if she wants to take her mother elsewhere, that's up to her.........we are having NO trouble keeping the apartments filled, and even if we were, I'd take this one all the way up to headquarters. In the meantime, my administrator trusts my judgment and is backing me up, and I'm thinking this may very well die down after the daughter has had a chance to think it through.........after all, both of us want what's best for the resident, even if our viewpoints of what's best differ from each other!

    Of course, all this could be a load of bull and the daughter IS diverting. She doesn't strike me as someone who would do that, but I don't know her all that well, and we all know that professional people are just as prone to human foibles as anyone else. I have to wonder about it anyway, since the resident is upright and ambulatory and awake much of the day........hmmmmmmm................
  11. by   SmilingBluEyes
    No you are not wrong. That is way too much for a frail elderly person. Heck it's way too much for me, who is neither frail or elderly.



    Marla, you have every right to your concerns.

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