Could I have done something differently?

[Iker]

Ok, I had a difficult patient this week. It's my first week off orientation and I wanted yalls opinion on if I handled it adequately. The patient was suppose to be discharged, but he and his sister objected and refused to leave. The patient said he wanted nothing through his IV, pain or nausea meds included. The morning shift discontinued all IV meds. He later complained of pain. I called be Doctor, who gave an order for a one time dose of something for pain. The sister was not satisfied with this. Wanted me to call the doctor and get something routine. I told her I already called the doctor and he ordered what he thought adequate. She was mad, called the nursing supervisor, and they eventually got an order for something routine. Did I do everything I could have? Was there something I could have done differently?

[quazar]

So he refused to leave the hospital even though he was being discharged? Whaaaaa? Did he just get to stay? Where I work, if the doc days you're ready to go, you either go or security will escort you out.

I had a patient refuse to go home for 4 days. She insisted SOMETHING was wrong. We did every test under the sun on her, most of them ungodly expensive. Nothing was wrong. She was medicaid. *shrug* It happens.

[Kooky Korky, BSN, RN]

I had a patient refuse to go home for 4 days. She insisted SOMETHING was wrong. We did every test under the sun on her, most of them ungodly expensive. Nothing was wrong. She was medicaid. *shrug* It happens.

Nothing was found. It doesn't mean nothing was wrong.

Medicaid has nothing to do with it.

OP, if you asked me what kind of pain control I wanted, I'd crack. What do you mean by that question? What does anyone want? They want relief from pain. All this modern day sophisticated mumbo jumbo about pain is maddening. Just get me relief.

What was done while the pt stayed in the hospital after "discharge"? Were the orders that were already in place continued? Did the doctor see him again? What did managers and administrators have to say? Etc.?

[JKL33]

edit.

[Iker]

Thank you all for the feedback :) I had two unruly patients that day and by the time this was going down I was pretty frazzled. Just wanted some constructive criticism. She later called switchboard and asked for the night hospitalists extension. She talked to him herself. She calls the nurses station, asked to speak to me, and told me to check my orders. He ordered some Tylenol for him. She called a couple more times telling me to check on her brother because he wouldn't answer his phone. He wouldn't answer his phone because he was sleeping. She wanted me to get him to call her back because she wanted to make sure "his pain was under control." Ugh I was over it by the end of my shift XD

[Iker]

They were seen by doctors, who told them there is nothing more we can do for them. All orders were continued, except for anything IV related. The patient wanted everything related to the IV discontinued. Otherwise they just stayed an extra two nights. No tests or treatments or new orders. Managers didn't say much. They were made aware that a patient was appealing to Medicare.

[K9lover, ASN, RN]

Medi-caid absolutely has something to do with it. With a 30% co-pay and endless out of pocket covered California I would need to be comatose for anyone to get me through the doors of an ER...

[quazar]

Nothing was found. It doesn't mean nothing was wrong.

Medicaid has nothing to do with it.

Nothing WAS wrong, actually. You weren't there. I was.

Medicaid is relevant to this conversation because another poster mentioned that medicaid would never tolerate or allow such a situation.

[K9lover, ASN, RN]

Refer them to therapy for never having developed past that childhood stage wherein siblings cannot get by without one anothers constant companionship/care/dependency and I only went through that due to having a twin.

[amoLucia]

Just reading this late - am wondering how old the pt was, did pt live alone, and was sister involved as primary caregiver???

I've had pts/family resist discharge because management of home care was daunting (or they were just lazy and enjoyed the "3 hots and a cot" environment).

In SNF, I'd be talking Medicare or Insurance - pts/family just don't want to go home, esp near a holiday. With the Medicaid pts, the opposite problem would occur - they'd be overextending on freq home visits (and you'd question the need for continuing care).

Am assuming the discharge planning folk were involved.

[morte, LPN, LVN]

Nothing WAS wrong, actually. You weren't there. I was.

Medicaid is relevant to this conversation because another poster mentioned that medicaid would never tolerate or allow such a situation.

again, nothing was found, does not mean nothing was wrong.