I have been frustrated at work lately when dealing with a few pts.
First guy, admited with pancreatitis, so hes NPO and receiving iv pain medication Q2h. A CNA saw him down in the cafeteria eating a cheesburger, and staff from the other side of the hall saw him take a large cookie off a dying pts berevement(sp?) cart that is sitting in the hall for the pt family! Of course I confronted him and he denies it. I document, tell the md, but nothing is done. Same thing the next day, a cna saw him in the cafeteria eating bacon and eggs. I call the md...nothing.
Second guy, has had chrons for a long time. Has been on narcotics at home. He comes in for a bowel resection. All is well until he begins passing gas, gets his diet advanced, and the IV narcs get d/c. Even though the surgon put him back on his reg po narcs from home plus po narcs for breakthrough pain the pt says "its too painful to eat" So the pt begins to refuse food and refuse to ambulate. He ends up on TPN....still refusing food, still refusing to ambulate, refusing to do anything unless he gets more pain meds....This goes on for over a week...ct's and abd series show nothing.....hes just sittng there, taking up a hospital bed, doing nothing but taking po pain meds...FINALLY surgon gets a consult for an hospital doc to deal with this. The hospital doc tells pt he will be d/c to a nursing home if he continues to refuse to eat and walk. Still took the docs 5 more days to get him out.
Third guy, in with sickle cell crisis..due to some lab work, pts hx of leaving AMA, and the fact he has been banned from the hospital down the street, docs don't really believe hes in a true crisis. But they are treating him as it really cant be proven he is lying. So on eve shift he disapears for 3 1/2 hours. Is just no where to be found..They have security looking all over...Doc is notified, documentation is good etc. He comes back and said he "fell asleep" in the lobby. The next day on my shift pt appears to be high on something. Hes so figety, cant sit still, wont stop moving, talking fast, grinding the teeth...not acting the same at all from the previous day. I confront the pt, get the doc up there and again....Nothing is done.
I guess I just don't understand.....If a pt will not comply with treatment or sabotage there own treatment as in these above examples..why cant the docs just d/c them. I would think, if the documentation was excellent, that there would be no reason why not. Do you guys have any thoughts?