i am a hospice nurse who is caring for a 56yr old woman with MS & Dementia. the pt is bedbound, malnourished, with pressure wounds to her left hip and buttock. in early september she was admitted to the hospital for replacement of a her PEG. the family revoked hospice services in order to have the PEG replaced. when the pt came home the family called to have her readmitted to hospice. 2 weeks later, when i found the other agency's folder under a pile of linen, i discovered the pt had also been admitted to home health for wound care and OT(forget for a moment that she cannot participate in therapy in any meaningful way). i notified my DON and contacted the home health agency for coordination of care. the home health nurse began making daily visits. at the time i began providing care the wounds were small to moderately sized, unstageable due to necrotic tissue and slough but responding well to santyl. i was told by my DON to defer wound care to home health. it made me very uncomfortable but i did. today i saw the wounds for the first time in several weeks. they are much worse. the hip wound is significantly larger with increased necrotic tissue. the buttock wound shows evidence of tunneling and there was purulent drainage on the bed pad. there is swelling around the wound. it appears to be infected. i discussed my concerns with the pt's daughter (she is disinterested on the best of days) and was told the home health nurse would be out this afternoon and she would tell her about it. i also reported it to my DON, her response once again was that the wounds are the home health's business and she does not want "to appear that we are looking over their shoulder."
my gut tells me this is BS. i believe that if i see a pt's condition deteriorating i am duty bound to report it. i also believe that if the family were to decide to take legal action, as a licensed person in the home i can be held responsible.
what do you say?