What do you think of this?

  1. An elderly lady was admitted to our M/S a few days ago with chest pain R/O MI. Yesterday, her family was having a Christmas party that she really wanted to attend. The doc was not ready to discharge her but evidently told the patient and her family that she could go to the party. The patient's nurse (not me) was not aware of this arrangement. The doc did not write an order because he did not want it on the record for insurance reasons. The nurse got back from lunch and went to do her assessment of this patient, only to find that she was not in her room. The patient's family had taken her out and not told anyone that they were doing so. The shift supervisor evidently knew of the arrangement and only then told the patient's nurse about the family taking her to the party. The supervisor also told her not to document anything and just look the other way. My question is, is this a case of elopement? The patient was not discharged. She returned to us after the party. The patient's nurse was very concerned that if something would have happened to her patient during this outing that her license would have been in jeopardy, along with that of the doctor and nursing supervisor. If this had been my patient, I would have charted up the wazzoo to cover my butt, regardless of the advice from the supervisor. What does anyone else think of this situation? I would appreciate comments. Thanks!
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  2. 14 Comments

  3. by   WashYaHands
    I'm with you. If it was my patient I would have charted it. In the event something would have happened to this patient outside of the facility, there could be big trouble for all involved.

    There should have been a doctors order authorizing the temporary leave from the facility. In my facility we have a form that indicates that 1. there is a doctors order. 2. All safety precautions and teaching have been provided to the family. 3. The patient signs the form (if competent), and whoever is responsible for removing the patient also signs the form, gives info regarding where the patient will be taken, and accepts responsibility for the well-being of the patient while away. Also, times and dates of departure and arrival back to the hospital are documented on both the temporary leave form as well as in the nursing notes.

    Linda
  4. by   nur20
    I AGREE !!!!!
  5. by   hoolahan
    I am with you 100%!! That is... I don't know what to call it, but it's not right!
  6. by   kaycee
    First of all if she was well enough to leave the hospital to attend a party then she should of been discharged.
    I would also have documented my a$$ off. This is very inappropriate and I would of had no qualms telling the MD and the supervisor that there would be no cover up from me!
  7. by   P_RN
    That's insurance and/or Medicare fraud. Plus the liability that the hospital and the Nursing supervisor faced should there have been adverse events.

    Health insurance and Medicare rules are a whole new game anymore. There are no temporary passes in the new world order.

    Sorry we can't MAKE people stay in the hospital, but we ALSO can't be placed in such a ridiculous position. Occurrence report and documentation would be my take on it.
    P
  8. by   cmggriff
    I suspect the insurance problems the Doc was trying to avoid involved his own malpractice and not Medicare or some other 3rd party.
    I'm not sure about documenting my ass off as I don't have much and I need it to sit on. However, I believe every nurse should keep a little notebook for documenting unusal occurences such as this as a back up for the time when some hospital executive needs a reminder of how valuable each of us is. It is not a breach of patient confidentiality unless you show it someone outside the hospital. Gary
  9. by   babsRN
    What about an occurance report? I think that's where I would document my a** off. To Gary's mention of the journal keeping...I have been told by risk manager types many times that those are discoverable items during litigation...though ya'll might want to know. Our risk manager advises against journal keeping and speaks out constantly that..." if it's that important, put it in the notes or in a occurance report, but don't keep a journal"
  10. by   mustangsheba
    Agree, agree, agree! Also agree that if she was well enough to party, she's needs to be discharged.
  11. by   thisnurse
    babs...i hope while your risk manager is telling you that stuff about keeping a journal, you are writing it down in your journal...lol

    i think i would have charted that when i came back from lunch the patient was not in the room. i would have told the supervisor that i had a big problem with that because i was assigned as her nurse. id say i would be glad to look the other way if the supervisor assigned her to another nurse who might be willing. i would also explain that i was being put in a bad situation as i am legally responsible for her.
    i would then chart that i informed the supervisor the patient was not in her room and let it go..IF she assigned her to someone else. if she did not i would have no choice but to go above the supervisors head and report what was going on. then i would go to the nearest store and get a newspaper because i know after that i would have to get another job. the consequences of what could happen to me by going along with THEIR plan outnumber the benefits of shutting up about it.
    you know its one thing to co-conspire with someone but its quite another to expect someone else to go along with YOUR plan.
  12. by   workinurse@aol.
    We all fear getting in trouble and covering our liabilities, the stress to the nurse is the problem here.
    Patients are customers buying medical goods and services but we want them to be hostages.
    What I am interested in is--did the patient benefit? the family?
    What was the result?
    Maybe we can learn something new by thinking outside the box.
    Lets find a way to make it legal and quit worrying about a customer customizing their care--or lack thereof just as we see in DNR and hospice orders.
    Family at home on Christmas benefits the patient in ways hospitals can not.
  13. by   nur20
    I don't feel this would be the time to think outside of the box.I have nothing against a patient going home or anywhere else, something that may benefit both parties, however, the proper documentation, orders, etc. must be done.WE are responsible for this patient until something in writing says we are not. That's the way the judge would look at it. In this case there would be a long line of defendents in court should something have happened. I agree with the above poster that i would document that my superiors were aware
  14. by   workinurse@aol.
    I do agree with documenting whatever is needed to keep out of court.
    The stress of worrying about going to court is damaging to our bodies, the stress of being in court would be much more injurious.
    Stress hormones cause actual physical damage, not the least of which is physical changes to the brain, (amygdula and hyppocampus)
    I think we need laws to relieve our stress when patients and doctors decide to customize care.
    Stress is killing us.

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