Aggressive treatment?

Antibiotics to treat UTI's are comfort measures and not aggressive treatment. This is not the DON's call, it's the doctor's call in conjunction with the patient/family wishes. Get the doctor on the phone, explain the situation, and let him be the one to tell the DON to back off. You're not over reacting, and you've got to advocate for this patient.

Is the patient on hospice? If so, call the hospice nurse. I am sure she will echo what Ashley said. The DON is not the person who should be making the call about treatment...unless she also is the patient's family and the patient's MD :)

You also should check the advanced directive of the patient and talk to the family. It could be that the patient has expressed wishes that she not be treated for infections...and the DON might be aware of it and is basing her directive on that.

What ever is done, be sure to keep up with her pain and treat accordingly as an infection will add to any pain she already has.

Good luck and let us know what happens. And keep up the good work...advocating for your patients is at the core of nursing.

Yes, the patient is on hospice and since I am new to hospice and this company, I didn't no that I could order cipro without the DON's permission, although she would like me to think that I need her permission. I was informed yesterday by the on call nurse whom I will be replacing next weekend that since we have standing orders from the MD, we don't need the DON's permission. The DON stated that cipro is considered aggressive treatment since the pt is already receiving amoxicillan for another infection. To me and the other nurse, it sounds like a budget issue.

This company is having a difficult time retaining nurses and I'm beginning to see why. I just left another hospice company after 3 wks of training because the DON was not knowledgeable about how to treat the pt's conditions. This DON is up to date on how to treat conditions, but then tells me I can't do anything without the CM's permission. Keep in mind that the CM for this pt is also new to hospice care and has failed to make a scheduled visit to the pt because of the distance. I also found out yesterday that this CM removed a comfort kit from another pt's house. I'm trying to give her the benefit of the doubt by saying she has not been trained on how to dispose of expired meds, if that was the case.

Please pray for me.... I love hospice and will stay as long as possible for the patients' sake.

Is the patient symptomatic for UTI? If there is no pain, burning, itching etc. and the patient is already on an ABT, treatment not specifically for comfort (symptomatic UTI) may not be necssary. Overuse of ABTs may lead to C Diff which will be very much more distressing to the patient than an asymptomatic UTI. Just my:twocents: