........or isn't Ambien 5 mg., Sonata 10 mg, and Rozerem (a new sleep medication) just a bit much to give a 90-something-year-old patient every night at bedtime?
Here's my concern. The patient in question is one of 43 residents in my assisted living facility, and she has a daughter who has literally controlled every aspect of her care for several years now. This apparently includes circumventing our medication administration system to obtain sleep medications for her mother that are left at the bedside, plus the Rozerem we give her every night. The resident herself has VERY poor vision, a fair amount of memory loss, and as far as I'm concerned she is not safe to have these things in her room. We give her her stool softeners and her heart medications because she supposedly is too demented to self-administer........but we're allowing her to have several varieties of sleeping pills??!!
The daughter---who is not a nurse, but a food-science professor at the university---pops the Sonata and the Ambien for her each night and puts them in a cup for her to take when she wants them, then staff delivers the Rozerem at 8 pm and that also gets left at the bedside. Not only do I fear what could happen if a couple nights' sleepers are 'forgotten' and then taken all at once, that's just WAY too much medication for a frail elderly woman. The Sonata alone would snow me, and I'm half this woman's age and twice her size (and I'll bet my liver and kidneys function a heck of a lot better in the bargain). I can just imagine the daughter going nuclear if Mom falls and breaks her hip, or accidentally OD's.........well, I'm sorry, but I don't want to be held responsible when something bad happens.
What's even more frustrating is, I had a talk with the daughter today, and she SO does not understand why I have issues with all of this. She thinks that because there is a doctor's order OK'ing the sleepers to be handled in this fashion, I shouldn't object. She doesn't get that the facility is legally responsible for her mother's care, or that as an RN, I MUST refuse to carry out an order that I believe to be inappropriate, or even that her mother is declining both cognitively and physically to the point where it's not safe to "do things the way we've always done them".
My administrator and I have drawn up a managed-risk agreement that essentially makes the daughter assume responsibility for any bad outcomes, but I still don't feel right about it.......I mean, it's partially about covering our behinds, but it's also about NOT giving in to what I feel is over-medication. I've been in geriatrics too long not to know what happens to frail elderly folks who take too much and too many meds, and even though both the resident and her daughter want all of this, I feel a responsibility to protect her from herself here.
I don't know, maybe I'm too conservative; I realize I've only been at this facility 8 months, and this daughter's iron-fisted control has apparently not been challenged during the three years the resident has been there. But I'm less worried about alienating her than I am about her mother's safety, and yes, our liability if something happens to her as a result of taking three different types of sleep medications. I know it's not a personal thing, and I don't take it personally, but I admit it does irritate me that the daughter seems to think she knows more than I do about meds, and she will do an end run around me and/or the system to get whatever she thinks her mother should have, whenever she thinks Mom should have it.
So..........am I wrong in thinking this is too much medication, and how can I make sure we are not held liable if and when things go sideways? I've faxed the NP who ordered the Sonata and Rozerem to find out if she's even aware that the resident is on Ambien; I suspect not, because she's seen the resident only once and I'm sure knows only what the daughter has told her. I've also documented all of this in the chart, and written up the managed risk agreement........beyond that, well, I'm hoping some of you will have some ideas.
It just goes to show ya, no matter how long you practice or how much you think you know, there's always more to learn! Thank you!
