Aggrevated LTC Nurse!

  1. Where do I even begin...

    We have one of our residents here in our SNF that was having misappropriated behaviors, so one of our new psych doctors, who seemed to be very crazy, put this resident on Lithium 150mg BID and Abilify 30mg HS (an extremely high dose of both medications considering the resident has never been on any scheduled psychotropics). This was like 1 month ago.... and we even notified his primary care doctor seeking permission to even start these medications, and of course our primary care doctor just agreed with the order since it was a psych consult.

    About two weeks ago several nurses including myself noticed some tardive dyskinesia. The Psych doctor that placed him on this medication was recently let go from our facility this weekend, so he didn't have a chance to correct the order from all our complaints we where given. So I called his primary care doctor and he told me that psych is the one who created the problem, so psych needs to handle it. This was very frustrating to me because tardive dyskinesia is no longer just a "psych" problem, but a medical problem and the primary care doctor refused to do anything about it so I was heated before I went home. Anyways, I wish there was some sort of magic potion we can give our primary care doctors that don't even come out and see our residents like the state regulations dictate they should..... I placed these medications on a 3 day nursing hold, (I know we are not suppose to stop Lithium cold turkey, but his levels where very low to begin with) but I didn't know what else to do.

    Needless to say, I consulted another psych group so I hope this issue gets resolved quickly before the tardive dyskinesia becomes perminent as the drug book suggests it will....

    Sorry, I'm just venting...
    Last edit by JTworoger on Mar 22, '11 : Reason: My Grammer is Poor... :(
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    About JTworoger

    Joined: May '10; Posts: 40; Likes: 45
    Medical Floor Nurse; from MO
    Specialty: 10 year(s) of experience in Long Term Care, Medical Surgical, ER


  3. by   Reigen
    This situation needs to addressed in several ways:

    First, the primary "refused" to treat his patient? Nursing thought this should have been addressed/treated and no new orders were obtain? A call to the Medical Director was in order to get this Patient help for this--- a trip to the ER for evaluation and treatment should have been asked for. If the nurse thought it was serious enough the nurse should have sent the Patient to the ER. If we remember "this is their home" anyone could have called 911/ EMS to transport.

    Second, I would inform the Administrator and the Medical Director of this physician's refusal to address your concerns about the symptoms and the patient's condition, and get a directive on what to do in the future if things like this crop up again.

    I am so sorry that the Patient has to suffer longer while the new Psych Team can come to see this Patient. I hope that the Patient can get the care needed.