Advice on dealing with confused patients

[SubSippi]

I work on a tele floor, but lately I have been getting patients whose medical diagnosis is "Alzheimer's, waiting for placement." I'm a new nurse, so I'm not sure how common this is, but what has been happening is that a family suddenly decides that they are no longer going to care for their family member who has dementia, and brings them to our ER. The ER doc admits them, and then the nurses essentially become their babysitters until a spot opens up at a nursing home or whichever LTC facility is most appropriate for them. These patients hardly ever have any sort of medical illness (other than diabetes).

Best case scenario is they are pleasantly confused, won't stay in their rooms, try to take their gowns off in the hallway, poop in weird places, etc. Sometimes I try and get them back in their rooms, and I'll stay in there to do my charting. Sometimes I'll let them sit at the nurses station and give them some towels to fold or some other sort of project, which will generally keep them occupied for about 15 minutes.

The worst are the ones who accuse me of holding them hostage, and are constantly crying or yelling about something. Nothing will keep these patients occupied.

We can't put them in a roll belt or any other kind of restraints unless they are violent or are actually TRYING to leave the hospital, not just wandering. The doctors might have some anti-anxiety meds ordered PRN, and while that might (or might not) make them less anxious, it certainly doesn't keep them from getting up and wandering around. When I've asked for something stronger, I've been told that they don't sedate for "nurse convenience," and we can't get a one on one sitter unless the patient is suicidal.

The other nurses I work with pretty much just say we gotta deal with it and hope nothing bad happens. Since these patients pretty much need to be watched 24/7 I'm doing good just to give the meds to my other patients. This is frustrating when I have ventilated patients, or patients on insulin drips...and I'm having to chase someone's confused, but otherwise healthy, mama down the hallway before she busts up into someone's room, or wanders outside in the middle of the night.

Since restraints and extra sedation don't seem to be options, does ANYONE have any tips/advice on how to get these people to stay put or calm down? Or on how to convince their doctor that the 1mg PO Ativan q6h isn't really cutting it? I am at a loss, and they are driving me insane.

[hppygr8ful, ASN, RN, EMT-I]

I work on a tele floor, but lately I have been getting patients whose medical diagnosis is "Alzheimer's, waiting for placement." I'm a new nurse, so I'm not sure how common this is, but what has been happening is that a family suddenly decides that they are no longer going to care for their family member who has dementia, and brings them to our ER. The ER doc admits them, and then the nurses essentially become their babysitters until a spot opens up at a nursing home or whichever LTC facility is most appropriate for them. These patients hardly ever have any sort of medical illness (other than diabetes).

Best case scenario is they are pleasantly confused, won't stay in their rooms, try to take their gowns off in the hallway, poop in weird places, etc. Sometimes I try and get them back in their rooms, and I'll stay in there to do my charting. Sometimes I'll let them sit at the nurses station and give them some towels to fold or some other sort of project, which will generally keep them occupied for about 15 minutes.

The worst are the ones who accuse me of holding them hostage, and are constantly crying or yelling about something. Nothing will keep these patients occupied.

We can't put them in a roll belt or any other kind of restraints unless they are violent or are actually TRYING to leave the hospital, not just wandering. The doctors might have some anti-anxiety meds ordered PRN, and while that might (or might not) make them less anxious, it certainly doesn't keep them from getting up and wandering around. When I've asked for something stronger, I've been told that they don't sedate for "nurse convenience," and we can't get a one on one sitter unless the patient is suicidal.

The other nurses I work with pretty much just say we gotta deal with it and hope nothing bad happens. Since these patients pretty much need to be watched 24/7 I'm doing good just to give the meds to my other patients. This is frustrating when I have ventilated patients, or patients on insulin drips...and I'm having to chase someone's confused, but otherwise healthy, mama down the hallway before she busts up into someone's room, or wanders outside in the middle of the night.

Since restraints and extra sedation don't seem to be options, does ANYONE have any tips/advice on how to get these people to stay put or calm down? Or on how to convince their doctor that the 1mg PO Ativan q6h isn't really cutting it? I am at a loss, and they are driving me insane.

It's not just as simple as the families no longer wanting to care for them - Imagine a family going through what you just described 24/7/365 - it becomes quite exhausting and often dangerous for the elder involved. In home round the clock care runs around $20,000.00 a month I know because we tried it for a while with my mom. She kept calling the police on her caregiver stating there was a stranger in her home. The caregiver finally quit. Then mom got a hold of the car and drove it into a concrete pylon blocking a street fair. Had the pylon not been there we would have made the evening news and not in a good way. Putting people in restraints - even if they are confused and dangerous to themselves is actually a violation of their rights and doctors have to renew those orders and justify them every 24 hours. Assisted living will not take a patient with Alzheimer's (only with dx of mild to moderate cognitive impairment) and Medicare won't pay for memory care because they consider it custodial. We did finally get my mom into a Alzheimer's specialty center which is costing the family $8,000.00 to 410,00.00 a month but she has money left from my dad's estate which should cover her for the next 10 years or so if she lives that long. She also has low dose Seroguel which seems to manage her anxiety and confusion without completely gorking her. Reality Orientation is key. You have to meet the patient where they are as they will never meet you where you are. I would suggest doing some CEU on Alzheimer's and other dementias as well as drop by a memory care facility and see how it's done.

Best of luck

Hppy