Refusal of Care - page 2
by *4!#6 2,306 Views | 10 Comments
I am a new nurse. I want to run something by everyone to see how they feel about some difficult subject matter. Recently I encountered a patient who is AAOx3, new admission, and doctor puts them on a fluid restriction. The... Read More
- 0Jul 11, '12 by mortehow can this happen? The order may not do much good, if any. But till it is proven, how can the board take a lic over this? I hate to say it, I am wondering if that nurse had more going on with the board than this one thing.Quote from MunoRNThe only Nurse I've known personally to lose her license, lost it for this very reason. She had a bed-bound patient with a 1L fluid restriction ordered for CHF, the patient was A&O and was refusing the treatment, as is their right. The patient requested water, which he was not able to obtain himself, and the Nurse refused to get him any beyond his fluid restriction citing the order and the she had to follow the order. The patient filed a formal complaint and the BON pulled her license. When she left my Hospital she was also facing potential criminal charges of abuse of a dependent adult, rumor was that those charges were eventually dropped with plea bargain.
As a result of this incident we were required to review our review our patient refusal policies and review them with staff which also included a review of our fluid restriction policies. It was surprising how little evidence there is to support PO fluid restrictions in the case of HF. In multiple studies, patients had the same amount of time on IV lasix, same morbidity/mortality, and the same length of stay with or without a fluid restriction. Plus, patients on a PO fluid restriction actually had a much higher 30-day hospital re-admission rate (likely due to the fact that diuretics and ARB's were not titrated to the patient's actual PO intake). So in the end, this Nurse lost her license defending an MD order that really doesn't serve much purpose anyway.