"I'll sue you"

[nurseby07]

My company has been going through some major changes; people quitting without notice being the biggest culprit. I have been moved to another area that I wanted to be in and in the process I have been precepting.

This last week I had to do wound care on a woman M,W,F. She had been admitted to our services on the Saturday previously. The admitting RN documented that the woman had just been discharged from the hospital with gangrenous wounds on her lower legs and that the woman refused to allow the RN to change the bandages. So Monday I try to see her but she is at the lake for a family reunion (so, not homebound) I go Tuesday. She won't let me in until the Young & the Restless is over. Her legs have massive drsgs on them that someone had written on in sharpie "7/10 change 7/14" It is now 7/22. I attempted in every way possible to get to those wounds. She told me if I touched her she would sue me. She is suppose to be following up with the wound care clinic but says she has no idea about any of that. I call my manager and the doctor. No answer from Doc. Thursday I attempt again, agreeing to come after TY&TR. As I press the button to her apartment from the street, no answer. The manager lets me in. As I am signing in my cell rings and it's her and man is she ******. She is out getting coffee and will not be home. I leave. 20 minutes later my phone rings again, she is now home she says. I say, I can't I'll try again tomorrow. I call manager and state that I am going to d/c, I called wound care clinic, they didn't have her in system, call her doc, he hasn't seen in her in 2 years but "Let me know if I can help in any way"

I am very concerned about her legs, but waaayyyy too busy to mess around with this. Obviously those wounds are going to be an awful site, but if she won't allow help or go get help what can I do? Just d/c?? I know, document, document, document.

Please advice me!

[SuesquatchRN, BSN, RN]

What can you do with a woman who would rather let her gangrenous wounds rot than interrupt her soap watching?

[BlueRidgeHomeRN]

document, discharge for non-compliance and non-homebound, notify doc, and move on..don't waste time or energy on this one.

[annaedRN, RN]

Agree with BlueRidgeHomeRN. I have discharged for less grief than that! Just document, make MD aware and move on to your next HH adventure!

[Tash4nvyblues, RN]

You have definitely gone above and beyond what you should have had to. Where I work, we deal with similar situations where we are contracted by the hospital to attend to wound dressings, often similar to your case. We have an unwritten policy of once, twice your out. If they are uncontactable or uncooperative for 2 days, on the second day that we are supposed to have admitted them we automatically discharge them. We contact the hospital and let them know the situation and they are happy for us to discharge them. We don't have the resources to keep attempting to help these people, and we do have to put some of the responsibility of the clients health, back on the client.

I don't think I have to tell you, make sure you document absolutely everything you have done for this person, so they have no comeback if they choose to take it further.

It sounds to me, she will be an amputee before long what a shame:sniff:

[nurseby07]

I agree with all of you, just d/c but my manager says to hold on to her for a bit and try again. I'm going to just d/c.

And another thing... we were told not to use the verbage 'non-compliant' because in court it would make us look like we were using medical language that the pt wouldn't understand! How much clearer do I have to be than, "If you don't let me change that dressing you stand a great chance of losing your leg"??

[SuesquatchRN, BSN, RN]

You can't be clearer but document exactly what you said and exactly what she replied.

[BlueRidgeHomeRN]

i agree with all of you, just d/c but my manager says to hold on to her for a bit and try again. i'm going to just d/c.

and another thing... we were told not to use the verbage 'non-compliant' because in court it would make us look like we were using medical language that the pt wouldn't understand! total bs!!how much clearer do i have to be than, "if you don't let me change that dressing you stand a great chance of losing your leg"??

i also use, "after extensive verbal and written education on risks and side effects of choosing to do/not do xyz, pt states "get out of my house, you stupid *&%*+". md notified by fax, fax arrival confirmed with susii cue, ma. pt refuses to sign notification of discharge from hha.

[tencat]

Oh, boy, do I hear you! I work hospice, but we have those patients who are not 'home' when you want to visit and who don't let you do what needs to be done, or will not follow suggestions such as 'change a feces filled brief' then blame you because the patient has a UTI. I just d/cd one like that, thank the maker! D/c and move on.

[NRSKarenRN, BSN, RN]

Agree with the above advice given.

Only other thing to add is:

a. Notify referral source of all attempts to revisit patient and outcome.

b. Three way call from office with Mgr -have witness to patient conversation not allowing you into home, nor having dressings changed, life indangerment concerns.

c. Fax Notification to referring Dr of discharge too

so when she ends up back in the hospital all your ducks covered.

We have three "not home, not found after mutiple calls", door knocker note left re driveby visit attempted then discharged. Second referral post rehsopitalization, not home again after admit visit then client listed as "referral clearance" in computer and we won't accept back a third time.