Need help please, pt not allowed to have meds and not safe to live alone...

  1. I did a SOC on an elderly person who has had multiple serious surgeries. The pt was crying in pain when I got there. The hosp had placed a Fentanyl patch 3 days ago and it had worn off. I asked where scripts were? The pt said the son did not fill it because he didn't want pt to become addicted. Prior to this last hospitalization the pt was on pain pills. Also on the DC summary was an antidepressant and a mild sedative for sleep. The son didn't fill these either for the same reason. This son is not a POA, the pt is responsible for themself. The son has been OOT. I am going to call him tomorrow. I cannot believe what he has done. Am I correct he has no business with holding these meds? The pt currently does not have a PCP. The son fired the current Dr and has not arranged for a new one yet. Supposedly going to a Dr. on Wed but doesn't know who. This pt is in their right mind. I feel so bad about it. IMO this pt should not be living alone. great difficulty w/ambulation and ADL's. How would you handle this situation?
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  2. 10 Comments

  3. by   Mulan
    Can you report the son for elder abuse? Is there adult protective services? Sounds like abuse to me, if he won't fill the scripts. Does the son not want the parent to be spending the money on the meds?
  4. by   NRSKarenRN
    Report to
    a. Discharging facility doctor and discharge planning staff
    b. Protective service if can't get hold of son tomorrow to get meds straightened out.
    c. MSW eval re med management and family counciling
    d. Notify supervisor
    e. Call to pts pharmacy--see if they know of any issues.
    f. Needs visit tomorrow for followup and speak with pt what SHE wants and needs.
  5. by   DutchgirlRN
    Thanks Karen. I know the issue is that he's afraid the parent will abuse the meds because that's what the pt went in the hospital for in the first place. Overdose, accidental. However this patient does have legit pain, I feel this pt cannot handle his/her own medication management and shouldn't be living alone. After I posted I thought about the MSW too and think that's where I'll begin today. The son fills the medication box on a weekly basis. I will suggest that he comes over twice a week to replace the patch as well. I have already scheduled a PRN visit for today with another nurse, need another opinion, maybe I'm not seeing it in perspective but I think I am. Thanks, I'll let you know what happens.
  6. by   cookie102
    i'd get your MSW in there ASAP, see that patient daily for a few days
  7. by   CardioTrans
    Quote from NRSKarenRN
    Report to
    a. Discharging facility doctor and discharge planning staff
    b. Protective service if can't get hold of son tomorrow to get meds straightened out.
    c. MSW eval re med management and family counciling
    d. Notify supervisor
    e. Call to pts pharmacy--see if they know of any issues.
    f. Needs visit tomorrow for followup and speak with pt what SHE wants and needs.
    All of this, plus.......

    When you speak to the son, you need to make sure that he is aware that home health cant continue to come in daily or sit with her. Unless she has a different policy outside of Medicare or if he is willing to pay for a private sitter through another agency.

    He also needs to know that the discharging MD may sign the original 60 day orders, but in order to recert her if needed, then she will HAVE to have a PCP.

    Is the patient able to get out of the house if it caught on fire??? Major safety issue if not and she may be able to be removed from the house. Is there any possibility that the son may allow her to move in with him? Or have some pre-planned arrangements for long term placement somewhere???
  8. by   DutchgirlRN
    The pt has been discharged. The MSW was able to find out that the pt had been put out of several good assisted living facilities. On a return visit this pt showed me his/her stash of Lortab, MS, and Dilaudid each from a different doctor and filled from a different pharmacy all within the past 2 days! I feel this pt has legitimate pain but is abusing and also that the fact that he/she showed me the stash tells me she/he is reaching out for help. This pt is a huge liability to the agency. On O2 and caught smoking as well!
  9. by   augigi
    Did not see OP's most recent update post.
    Last edit by augigi on Dec 11, '06 : Reason: DutchgirlRN done tole me I was wrong!
  10. by   DutchgirlRN
    Quote from augigi
    First of all, sounds like the son has a serious knowledge deficit about pain management. Why wouldn't you try talking with him to explain that people with pain rarely if ever get "addicted" to pain meds prescribed by their physician?
    You're missing the point completely. This patient is visiting multiple doctors, getting multipe narcotic prescriptions and taking multiple narcotics. All this after being discharge from rehab only 2 days ago.

    Otherwise, if the patient was competent, I would get them to call their pharmacist and fax the script for them!
    While this patient is competent she/he is an addict and she/he is acting irresponsibly. Although I feel compassion for this pt. I will not enable him/her to feed their addiction.

    FYI: In the US scripts for narcotics cannot be faxed or called in.
  11. by   augigi
    Quote from DutchgirlRN
    You're missing the point completely. This patient is visiting multiple doctors, getting multipe narcotic prescriptions and taking multiple narcotics. All this after being discharge from rehab only 2 days ago.

    While this patient is competent she/he is an addict and she/he is acting irresponsibly. Although I feel compassion for this pt. I will not enable him/her to feed their addiction.

    FYI: In the US scripts for narcotics cannot be faxed or called in.
    Actually, I missed the OP's last post, which you'd have to admit changed the situation considerably from the first one....!

    But thanks for setting me straight
    Last edit by augigi on Dec 12, '06
  12. by   Jo Dirt
    I wouldn't be so quick to jump on the phone with APS, especially since this patient is of sound mind and the son is not the POA.
    Likely, considering her history, he probably thought he was avoiding giving the patient the opportunity to overmedicate him/herself. I know that some people are appalled at the thought of taking any kind of medication (I've even seen doctors who will avoid prescribing any medication at all costs) and he may feel these meds would just be facilitating a way for her(?) to resume addiction.
    I just think that in a lot of cases people are chomping at the bits when in doubt to call social services and I just don't believe that is a good practice and can cause unnecessary trouble and grief for everyone involved. Maybe the son is ignorant about the meds? and it sounds like he may have had legitimate reason to be concerned about addiction. I would talk to him first and find out what is going on.

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