Advice please?

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I just got my RN last summer and just recently got my first permanent job on a rehab floor in a long term care facility. Yesterday a patient was sitting out by the nurses station. He asked for a bag of pretzels from the snack cart and I gave them to him. Well 20 minutes later he ended up choking on the pretzels and had to be sent out to the hospital. At the time his nurse had said he was on a regular diet. When rechecked today, we found he was actually supposed to be on a mechanical soft diet. My DON said that giving him pretzels is considered abuse.

What will come out of this?? I've never had anything like this happen before and I don't know what to expect.

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What State are you in? Have you looked into how your State defines "Abuse" and the State's policy on abuse allegations in healthcare? Might be a BoN position statement on it defining it too.

First of all patients have the right to self determination. If he wants a bag of pretzels, he can have a bag of pretzelsl. He is (I am assuming) an adult.

Even if it violates MD orders a patient/resident has the right to do whatever they want, you just have the obligation to ensure that they are informed and able to consent. Even confused patients under certain circumstances have the right to make their own decisions.

Our facility actually received a ding from the State Health and Human Services Survey team because a patient who was NPO requested popcorn or some silly thing and the Nurse did not give it to him.

Survey team said he has the right to self determine and the right to eat whatever he wants. It is up to the resident to make the decision if he is going to take the MD's/Nursing advice...and in reality that is all it is, advise.

They are our customers and that is their home, especially in LTC.

That being said there is some debate if we are obligated to enable unadvised behavior.

P.S. I HATE it when management throws around the term "abuse" or "negligence" without considerable thought and research into what the BoN's position statement is or the State's Revised Statutes say. If she thinks it was "abuse" did she file it with the State? Did she open an investigation? Did she send you home?

In Arizona at least an abuse allegation must be reported to the State within 24hrs and an official investigation opened. The suspect is to be sent home IMMEDIATELY pending the results of the investigation to protect other patients. If all that didn't happen then I don't want hear leadership throwing those terms around. It is not professional for Nursing leadership to throw around Class 6 Felony allegations lightly.

My advicde? Read your State's laws, start with the Revised Statutes. Then read the State's Health Dept or Health and Human Services Dept position on what abuse is and what steps are to be taken in the healthcare setting. Then read the BoN's position on it.

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Well, I'm sorry your in this situation. I learned the hard way once and gave an NPO patient water when I didn't know he was suppose to not have it. Well, he was NPO and sneaking around his nurse. I got chewed out by his nurse that I should have checked with her first. So my lesson learned.....anytime any pt that isn't mind ask me for something, I will make certain to hunt the nurse down before I give out anything, even ice.

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Specializes in home health, dialysis, others.

"His nurse said he was on a regular diet" Does she deny saying that now? You asked an appropriate person, and received what you thought was the correct answer. And anyone can choke on a pretzel.

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Specializes in PACU, OR.
"His nurse said he was on a regular diet" Does she deny saying that now? You asked an appropriate person, and received what you thought was the correct answer. And anyone can choke on a pretzel.

Absolutely right! If his nurse said it was ok, you should not be held responsible. Anyone can make a mistake, as she obviously did, but at least have the courage to own up to it afterwards!

To Asystole RN: seriously, "dinged" for refusing a NPO patient a bag of popcorn? What if said patient is scheduled for surgery within the following 6 hours? And don't your patients sign consent to treatment on admission? If such treatment includes staying NPO, then the patient has agreed to it and cannot hold you legally liable if you obey such orders! What process do you have to follow if the patient insists?

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Absolutely right! If his nurse said it was ok, you should not be held responsible. Anyone can make a mistake, as she obviously did, but at least have the courage to own up to it afterwards!

To Asystole RN: seriously, "dinged" for refusing a NPO patient a bag of popcorn? What if said patient is scheduled for surgery within the following 6 hours? And don't your patients sign consent to treatment on admission? If such treatment includes staying NPO, then the patient has agreed to it and cannot hold you legally liable if you obey such orders! What process do you have to follow if the patient insists?

LTC is a "whole 'nother kettle of fish" than the hospital.

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Specializes in PACU, OR.
LTC is a "whole 'nother kettle of fish" than the hospital.

Ok, I see what you mean; even so, any patient admitted for care in ANY facility must surely sign some form of consent-or be signed in by the person legally responsible for them. That means they place their own care in the hands of people suitably qualified to decide what kind of treatment is in the patient's best interests, whether it is a specific dietary regime or course of medication. What I'm reading here is, if a nurse gives in to the patient, she possibly endangers the patient and incurs the wrath of the MD; on the other hand, if she defies the MD's orders and gives the patient what he/she wants, she faces ?litigation?disciplinary procedure? I call that being between a rock and a hard place...

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So OK, did your NM simply mention that it could be considered abuse, or did you get written up? Big diff.

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To Asystole RN: seriously, "dinged" for refusing a NPO patient a bag of popcorn? What if said patient is scheduled for surgery within the following 6 hours? And don't your patients sign consent to treatment on admission? If such treatment includes staying NPO, then the patient has agreed to it and cannot hold you legally liable if you obey such orders! What process do you have to follow if the patient insists?

Yes they sign a consent to treat. Doesn't matter if they sign the consent, and scrubbed in the OR, the patient by Federal Law has the right to verbally say "Stop, I don't want this."

A person retains 100% rights to decide whatever their medical treatment. It is the Nurse's job to ensure that the patient is informed and able to consent to such decisions.

When the patient insists to go against order we have them sign a waiver and/or chart they made such a decision and the teaching we gave to the contrary.

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Ok, I see what you mean; even so, any patient admitted for care in ANY facility must surely sign some form of consent-or be signed in by the person legally responsible for them. That means they place their own care in the hands of people suitably qualified to decide what kind of treatment is in the patient's best interests, whether it is a specific dietary regime or course of medication. What I'm reading here is, if a nurse gives in to the patient, she possibly endangers the patient and incurs the wrath of the MD; on the other hand, if she defies the MD's orders and gives the patient what he/she wants, she faces ?litigation?disciplinary procedure? I call that being between a rock and a hard place...

The Nurse is not defying the MD's orders, the patient is, something he is 100% entitled to do so and as the patient's advocate we are 100% required to advocate for the patient's right.

Just because he signs a consent to treat, a DNR etc does not mean he has to stay by that decision. At anytime as the patient desires they can verbally negate any consent or agreement that they signed.

The patient is never at any moment required to do anything. 100% voluntary for the patient.

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Specializes in Geriatrics.

Did you chart that the Nurse in charge of that patient/resident/client gave consent to give him pretzels?? Is the Nurse accepting blame for giving consent without looking up his diet orders?? Did the DON/NM write you up? Did he/she write up the Nurse in charge?? If you charted it & the Nurse accepted her part in the choking then you are safe. If the Nurse is now denying her approval, or they wrote you up & not the Nurse then you have the right to fight the claim against you.

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I'm in PA. As of now I'm not really sure whats happening with this situation. And I didn't get written up. As far as I know the pt has been receiving a regular diet for some time now. The last order for mechanical soft was written in May. My NM had to report it to the state, but I do not think an incident report was written up by his nurse that night like it was supposed to be.

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