Please explain this nonsense to me!

  1. One of my residents fell out of the hoyer 3+ weeks ago. Didn't hit her head, but smacked her back on the leg of the lift. Nurse calls MD to send her to the ER, because she's SCREAMING in pain. No bones sticking out, so MD says, no, don't send her out. Family says "Well, if the doctor says no, then no." Doctor popped in the next day and the nurse had to basically DRAG him down the hall to look at her. She's got Vicodin on board, and she's still crying. He still says, nah, she doesn't need X-rays. He says it's muscular. So three-plus weeks later, she's STILL screaming every time she's turned, or even if you move her leg. Shouldn't it have healed a little bit by now? She doesn't remember the fall, so she thinks the staff is hurting her, and she's gotten pretty combative. It breaks my heart.

    So, since I'm a CNA, and I don't know beans other than my resident is hurting, and she's not getting better, can somebody please explain this to me? We're wicked pissed at the doctor. He just waves his hand and says "she's fine."
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  2. 33 Comments

  3. by   grambograham
    You are right.... muscle should have healed by now in most people in most situations. The funny thing about healing is that it occurs differently in different people in different situations. Older individuals tend to heal slower. However, three weeks is a long time. Any fall resulting in that much pain deserves an x-ray. It is up to the doctor, but steps can be taken to get another opinion if it is felt necessary.
  4. by   weetziebat
    Quote from lovingtheunloved
    so, since i'm a cna, and i don't know beans other than my resident is hurting, and she's not getting better, can somebody please explain this to me? we're wicked pissed at the doctor. he just waves his hand and says "she's fine."
    in this case, the cna knows a whole heck of a lot more than the md, apparently. anytime an elderly patient falls, especially when they hit something and are in pain, it needs to be x-ray'd. that's it.

    wonder why the nurse isn't taking it further. does administration know what's going on? guess if i were you i'd ask the nurse (as a courtesy) if admin knows and let her/him know how much pain the resident is in. perhaps suggest nicely she needs to let admin know and go above the md's head.

    good for you being a patient advocate. sometimes that is the most important thing you can do.
  5. by   lovingtheunloved
    The thing is, her son/POA says he's going by what the doctor says. Can something still be done in spite of him? It breaks my heart to see her in that much pain and there's not a darn thing I can do about it.
  6. by   explorer
    Does this border on abuse by the doctor when he ignores his patients cries
    of pain?
  7. by   tridil2000
    Quote from lovingtheunloved
    The thing is, her son/POA says he's going by what the doctor says. Can something still be done in spite of him? It breaks my heart to see her in that much pain and there's not a darn thing I can do about it.
    what if this was a child? what if the parent said... it's ok, dr says things are fine.

    what bs is right! the son doesn't know better and shame on the dr for not xraying his patient(which IS the standard of care)!!!!!

    was an incident report filled out after she fell? doesn't risk management follow up on falls??? if anything did break, it's very late now to fix it and there may actually be far more damage than if things were addressed earlier.

    shame on ALL licensed people involved! this is elder abuse and the facility and dr should be reported to the state, and joint commission if they're accredited.
  8. by   unknown99
    Quote from explorer
    Does this border on abuse by the doctor when he ignores his patients cries
    of pain?
    I agree with this statement and would like to add to it. Does it border on neglect by the staff of the nursing home? There is always a little thing called a resident's right to treatment and a resident's right to dignity? How can screaming in pain most of the time be considered dignified? If it were me, I would send her to the E.R. anyway... there is also that thing called nursing judgement. Patient first-- physician last!
  9. by   IMustBeCrazy
    If it's a Medicare/Medicaid facility then they have an ombudsman. One nicely placed anonymous note to them should do the trick.
    Last edit by IMustBeCrazy on Mar 6, '05
  10. by   happy&healthy
    "One of my residents fell out of the hoyer 3+ weeks ago. Didn't hit her head, but smacked her back"...

    Besides *advocacy*: willing to put themselves in her place, figuratively. I mean, were this their misfortunate lot, these Parties wouldn't like walking in her shoes as it were, carefully reconsidering.

    as you gently care for vulnerable folks:
    Encouragingly softly suggest to her, to "go ahead & allow your (whatever) to heal, now". You would be amazed how well that can work; just simple suggestions like that.
    As a CNA, you are fortunate in that you can spend much more time "chatting" with people. And you can help, those in your care, set in motion their *own, innate, healing powers*.

    Yes, even classes are available, for you learning how to do so more successfully - should you be interested

    THANK *you*, as a 'humanitarianly kind soul', for truely caring for anyone injured.
    Last edit by happy&healthy on Mar 16, '05
  11. by   begalli
    lovinghands,

    I admit that I don't know much about LTC, but can you place an anonymous call to the facility's ombudsman? Is that an option?





    whoops, edited to say that I'm sorry. I didn't see IMustBeCrazy's post. :imbar
    Last edit by begalli on Mar 6, '05
  12. by   germain
    Quote from begalli
    lovinghands,

    I admit that I don't know much about LTC, but can you place an anonymous call to the facility's ombudsman? Is that an option?





    whoops, edited to say that I'm sorry. I didn't see IMustBeCrazy's post. :imbar
    Yes you can- do that. I am training to be an omsbudsman and we are told to listen CLOSELY to staff. I think you definintely need to bring someone besides teh family/ facility into this. They don't have to know it was you who called. Be specific about what you are reporting. Good luck.
  13. by   Dixiecup
    In a LTC setting, it is legal for the administrator to go above the MD's head and send the pt to the ER. Also, if the Pt's doctor is not the facility medical director, the medical director can also overide the pt primary physician.
  14. by   2sassyRN
    The fact that this resident wasn't x-rayed is ridiculous AND neglectful. I knew of a facility that had a similar incident in which a resident fell, and no one thought anything was broken, but the next day she was complaining of severe pain. An x-ray was taken and it turned out that she actually suffered a broken hip. I believe the facility was cited by the state for neglect. Almost all facilities have contracts with portable x-ray services, and it's not a big deal to have them come out and take a set of films. As this person's CNA, I would tell the nurse again just how much pain she is in, and say "I think something may be broken". The nurse should act immeadiately on your concern by contacting the MD and POA and being very firm in her recommendation that the resident be x-rayed. The MD might be angry and yell, but if he's smart, he will take her suggestion. If the MD refuses the LNs request, she should go turn it over to her supervisor. If something is still not done, then the individuals involved and the facility should be reported to state. In my state, all LTC employees are mandatory reporters, and have no choice but to call the abuse and neglect hotline if they have reasonable suspicion abuse/neglect has occurred. Thanks for caring so much, you sound like a great CNA!

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