Hello all, I've had a lot of questions answered on this website and I decided to make an account to try and get this one answered. A patient who io have been seeing daily needed a fistula above his rectum packed daily. This patient was very difficult and refused care at least 3 times in seven days. Well a week later he goes and sees his PCP. I come back the next day and inquire about what went on during the PCP appointment. He told me the PCP said to leave the wound alone because it was shrinking. So I ask him if I can take a look at the wound. He refused. I tell him I won't touch the wound I just want to look. He refuses still. So I take his vitals and watch him take his meds and leave. I try to call the PCP to verify but no answer. I try again two days later (on Sat) and there is still no answer. Well this morning I finally got a hold of a nurse that tells me the PCP wanted the wound packed for another week! Then covered for 2 more weeks. So basically the Pt tells me something which is not what the Doc told him. It took me 4 days to verify the orders and e patient has not been seen since the day he refused my care. Am I in trouble? Do I need to self report to the board about this. I really did try my best to confirm those orders. PS I'm a pretty new grad. Doing HH for about three months now.
Jan 14, '13
This is not 'patient abandonment'. If the doc knows the situation, that is, if you have notified the doc's office every time the patient has refused care, then this patient has not been abandoned.
Ask the doc to fax a copy of the most current orders to your office. And ask the patient why he is refusing to have the dressing changed. Tell your supervisor that you will call this pt before going out to make the visit, and ask the patient whether or not he will allow the dressing to be changed. Explain to the pt that you cannot keep coming out if he won't let you carry out the doc's orders. If the pt continues to refuse, contact the doc and make sure you speak to him.
Abandonment occurs when YOU refuse to carry out orders or make appropriate visits. And where is your supervisor during all of this????
In nearly 39 years of nursing I have never heard of someone 'self-reporting' pt abandonment. So don't even consider this.
Jan 14, '13
Thank you for your insight merlee. I guess my next question now is am I at fault for not being able to confirm those orders. Or if anything happened to the wound between the patients refusal to tomorrow when I see him am I liable. I feel terrible I left the patient without care that the doc ordered.
Jan 14, '13
You didn't leave the patient without care, the patient refused the care, misrepresented the orders to you, and the MD did not provide you with new written or verbal orders for ongoing care after the office visit.
I wonder also, where is your supervisor in all of this?
Jan 15, '13
The doctor's office should be faxing new orders for wound treatment if they change or calling to give you a verbal order. This is not patient abandonment. The patient refused care and you notified the MD.
Jan 15, '13
I would chart refused wound care. This would also mean non-compliance and
be cause for discharge.
Jan 16, '13
Please there is no need to report this to the BRN. If every nurse reported when a patient was non compliant ,difficult or refuses care and they took action for this there would not be any of us left to provide any care.
Also remember that a patient should sign a consent and admission papers that clearly should state the patient's rights and responsibilities. In home care those responsibilities can get very specific such as answering the phone and being available for care. A patient that is repeatedly difficult even after taking action such as an written contract is often terminated from care. May agencies will give the patient some time to secure further care but not all do that.
You did not abandon this patient. You accepted the assingment and tried to provide the ordered care and the patient refused 3 out of 7 visits then he misrepresented what the MD said. In addition the MD has a responsibility to call or fax any order changes and needs to respond to your calls and faxes. On your end please document all attempts to provide care and all attempts to obtain orders from the MD. Next go up the chain of command and report the situation to management. Your agency can then decide if they will keep the patient on service and deal with it or discharge the patient. The patient does have the right to refuse care and this also needs to be reported to the MD and documented.
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