I am anew RN grad that finally found a job at a SNF. My acute care training didn't provide me with LTC experience regarding "comfort care". I would appreciate any advice for my situation. I have a resident that has had all previous meds Dc'd (anti-anxiety, psychotropics, etc.) and is only prescribed liquid morphine PRN maximum dose 1 ml every 2 hours. She has now been comfort care for a month. While this controls her pain, it doesn't address her anxiety,crying, calling out in fear at being alone, constant feeling to void, (HX ofUTI and I know the morphine probably exacerbates that) etc.
I relayed info to attending MD and received an order for anti-anxiety and anti-depression meds.The order was intercepted by MDS and I was told that "it took a long time to convince the family to put her on comfort care, we can't just start giving her these meds again". WHAT! This resident pushes the call light over 20times during the night shift. She has become enough of a distraction to her roommate that she has requested a room change just to get some sleep.
My CNA's get tied up with her understandably needy behavior and pull precious time away from other residents while we're short staffed. I am totally disoriented this morning trying to wrap my head around the term "comfort care" and the obvious lack of comfort for my resident. Being new, I'm wondering if I'm missing something here? or is the MDS for some reason trying to control the nursing care he initiated? could this be a money issue? is this common practice because it seems inhumane to me?
I thought I was to advocate for my patient and this morning I basically got my hand slapped for requesting meds to help her with symptoms other than her pain.