MunoRN 46,184 Views
Joined Nov 18, '10 - from '.'.
MunoRN is a Critical Care.
She has '10' year(s) of experience.
Posts: 8,215 (70% Liked)
Personally, I would have handled it by reporting the actions of your nursing director to the BON as they were pretty clearly negligent, but then again I'm a trouble maker.
I'm not sure how that would benefit a physicians office since insurers already employ nurses who deal with prior authorizations. If a physician prescribes something that is not on a plan's formulary then staff employed by the insurer offer alternatives, so I'm not sure how dealing with prior authorizations outside of the insurers would in any way help a private practice physician.
If she preferred that the patient have a sitter, did she provide you with a sitter? Sometimes aggressive patients require both a sitter and restraints, I'm not sure what alternative plan she provided?
Assuming it's a true allergy and not a fairly normal and expected side effect or pseudoallergy symptom, an opiate from the semi-synthetic family (ie hydrocodone) could be tried since there's a decent chance the patient won't be cross reactive. Full synthetics like fentanyl would have the least chance of cross reactivity with a true codeine allergy. The mechanism in codeine that triggers a true reaction is not usually present in opiates that have a significantly different structure. It's the same premise as why someone can be allergic to shellfish but not meat in general, they can still eat chicken even though it's also a type of animal meat.
The bigger question, is the dose appropriate?
This is not QA, this is nosey. I doubt it would stand the true test to the letter.
Maybe not, but it IS tacky for the manager to be on her phone and flipping through papers during the visit. Also, the patient should be asked if it's OK for her to sit in while the nurse is working. Frankly, I don't know why she has made it her business to "observe" when she is clearly not in a clinical role.
Non-clinical is the key word. If she is the office manager why does she need to know about your vagina?
I find it a little hard to believe that the physicians behavior was tolerated as much as it was, if the patient was capable of making decisions, and at every opportunity had refused the surgery, then the physicians actions should be reported to the state.
I don't know where people are getting that this is a potential HIPAA violation, from the description it's the nurses direct supervisor, so whether she's a nurse or not her involvement in observing would clearly be allowed under HIPAA.
A Florida nursing home where 8 residents died in the aftermath of hurricane Irma when the facility lost air conditioning. The facility has been closed and it is considered a crime scene by police, the deaths are apparently being investigated as homicides with direct care nursing home staff potentially facing charges.
Fla. nursing home where eight died after Irma defends actions, says it called governor for help
I think there's some confusion about the steps the hospital has taken. The hospital hasn't banned all LEO's from the hospital, they now require LEOs to direct their requests to the house supervisor or an administrator rather than to direct care nurses, which is how it works at most of the facilities I've worked at.
There are some reports that suggest Officer Payne has received a lifetime trespass from the hospital, but that is pretty standard for anyone who physically attacks a staff member when in their 'right mind'.
Some of the reports also suggest that their have been additional, temporary measures placed on the SLC PD which is appropriate since the cause of the incident came from many levels of the department, not just one bad apple. This would be more problematic if the SLC PD was who the hospital relied on for law enforcement needs, but it's not, it's the U of U PD that has jurisdiction over the hospital.
There's not really any gray area here, assuming there wasn't information left out then the scenario includes a patient who is competent to make their own decision, in which case the POA doesn't come into play. And even if you for some reason ignored the patients refusal of a transfusion, the POA is required to make the decision the patient would make to the best of their knowledge, not what POA thinks the patient should do. While there are some fine points regarding POAs that vary by state, these basic requirements and definitions are common to every state.
If I came across a physician who did this I explain to them how POA's and patient decision making works, and probably report them to the facility's medical director, risk management, and their governing body.
There needs to be an assessment of the patient's competence to make medical decisions in order to answer your question. These are sometimes referred to as the 3 "magic questions" required to make your own decisions: Does the patient understand what we believe to wrong them, do they understand the purpose of the medication/test/procedure in question, and do they understand the risks of refusing this medication/test/procedure. They can be totally kooky, but so long as they meet these three criteria then they can refuse. If they can't meet these criteria, then that must be documented, and questions about tests/treatments/procedures/medications must be directed to a surrogate decision maker or in emergent situations medical necessity may be used.
I have seen situations where the solution is essentially 'lets wait until they can't refuse and then just do it', which is an illegal act.
I agree with you and should have been more clear that indeed, suicide is not "illegal." Just the same, the clarification probably should be that we stop people when we don't believe there has been an opportunity for evaluating their mental health status, or when we directly suspect/believe that their decision arose from an altering MH condition.
Not trying to nitpick your important clarification (which I do think it is).
Again, I do not think we can totally look to our treatment of patients with suicidal ideation to explain why some places do not honor DNRs of patients who have(presently) attempted suicide. But, it's possible that the concern is that the patient has not had the benefit of a MH evaluation, and that may be a fair assumption. I'd think that planned suicide where all the appropriate planning steps have been taken is not the usual situation where someone calls 911 after the fact...kwim?
Thank you for the discussion, Muno.
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