A speech theapist made a recommendation to either place a G-tube or not feed a resident and then they contacted the resident's guardian and I'm not sure how this was explained but supposedly the guardian chose to with hold food and water, a telephone order was obtained and followed for 11 days. This resident was eating 100% of food and had no weight loss in previous 6 months and several of the nurses tried to find out why the order was obtained and by who, for what, apparently an MDS coordinater ask the attending physcian for order on the speech therapsist say so no nurses notes were charted. After following the chain of command I received no clarification and finally spoke to the resident's guardian after she returned to town she had been rushed into the decision by MDS coordinator and when an option for thickened liquids and pureed diet was offered she gladly accepted the alternative. I am writing this to assure that the hands on Nursing staff are the ones to talk with families and assure that families and guardians are well informed in these cases. Please let me know if there are other cases like this out there or if this was an isolated incident.
Oct 12, '98
What you experienced does happen and is why the role as a patient advocate is so important. When I received orders to with hold care from a patient that I did not believe was ethical or appropriate the guardian lived out of state, I made an Adult Protective Services report on a Friday at 1 pm. I was in a judges chambers testifying by 5 pm. By 5:30 pm the patient had a guardian ad litem who reversed the previous decision made that morning until the decision process could be clarified with the physician and guardian.
My patient only went 7 hours without care. It was a frightening step but it was in the best interest of the patient.
Oct 12, '98
Thank you sharon for the information regarding what to do in these cases I will for sure do what you did. Being a patient advocate has become extremely important to me I wish I had had this information sooner. The resident is doing well and it has been exactly 1 year since this happened but it is never far from my thoughts.