Brainless People!

[mickeypat]

Need some advice on something.... I have a rezzie who smokes, is on oxygen continously, and has been told by MD that he is not medically stable to drive his vehicle, but still does. We have tried to explain to him that he is not to be doing this, he has been told repeatedly by the doc to not do this, also. We have even talked to law enforcement about it also, they told us that we need to have the MD sign a statement that he is not able to drive. Oh, by the way, he has 2 big O2 tanks in the back of his pick up. He did agree at one point in time to give us his keys, but he got them back somehow and won't give them back. This person likes to sign himself out, go get his money from the county and then go and gamble it away, and buy cigarettes. We have talked to our social service people, but not much is being done with it.

Also, he is going outside to smoke with his O2 on! Talk about a huge lawsuit waiting to happen! Hope I'm not there when he blows up the place.

My issue is this.... I won't put my name on his sign out sheet, because I feel that I'm giving him permission to go, but then I'm told I can't refuse to let him go, even tho I know he is not medically stable enough to be doing this.

Just need some advice and to vent. My license is not worth losing because of his stupidity!

[Jamie Dale]

Maybe he will put the cig down long enough to get an AMA paper signed.Maybe if your lucky...he'll leave the place after signing.I know it can be frustrating to deal with contrary patients. But our hands are tied in situations like this.

[santhony44, MSN, RN, NP]

I hate to be the one to tell you that it is indeed not blown out of proportion. Oxygen is one of three components required for a fire to take place; ignition, fuel, oxygen. I had a friend whose mother was a smoker wearing O2 who'd gone outside to smoke, where the concentrated O's could more easily dissipate, and ignited. It traveled the path and well....let's just say it was gruesome, the husband couldn't get to her quickly enough with a water hose and she did not make it. Ya, she learned from it...

I went to a hospital "fire school" over 20 years ago now and saw a demonstration I'll never forget. A hospital bed had been made up with linens and then saturated in oxygen- pretty much the way it would be if a patient on oxygen were in the bed.

They tossed a lit match onto the middle of the bed.

WHOOOSH!! The entire bed was up in flames instantly. There is no way a patient would have survived that.

The bed may not have "exploded" but the patient would have been just as dead.

[BSNtobe2009]

I've seen cannulas melted into someone's face when they were smoking with the O2 on... not a pretty site!

Ok...I just got a visual on this...

[Lovin' my job!]

This reminds me of a pt on a renal floor I worked on. On oxygen at 4 litres and determined to go out for a smoke. In a hospital that was now totally smoke free - including in your car in the parking lot. Go figure. Anyhow, we tried and tried to educate her on the dangers blah blah is all she heard. The one thing I'll always remember was her scottish accent when she said. "it's ok dear, I'm a force of nature" After speaking with the physician we agreed that she had to sign a sheet stating we were not held liable if anything were to happen. We physically stood in her way of the elevator until she signed that sheet. She did sign every time though. She was fiesty that's for sure.

[purplynn]

If you have exhausted all other avenues i.e. MD, administration, S.S, try the ombudsman for your state.

http://www.ltcombudsman.org/

1) I am only an LPN

LPN/LVN/RN/ASN/BSN/MSN/MBA/ARNP

=

NURSE

:wink2:

Don't sell yourself short!

[twotrees2]

Ok, you have a resident that is intractable, so you TRY to do what is necessary to get the MD to sign a statement banning him from driving. He already has voiced his opinion,get it in writing.That's all you need to solve the problem. Grow some guts, girl. How will you feel when this resident goes out to poker night and kills a family of five because of his hypoxia?

And how will your family feel when they are impoverished due to lawsuits you could have prevented by notifying the Ombudsmon and the State Board of your concerns?

You CAN refuse to let him go, as an RN, you have legal and justifiable powers as an expert to intervene if you feel necessary.

Just try answering this in a courtroom: "You knew the pt. had COPD, was dependant on oxygen,knew the resident physician had declared him unsafe to drive, but let him leave anyway".

My bet is that you would be on the hook for a million dollars.

not really - if the doc has not signed an order preventing him from going ( vs just a casual saying i wouldnt let him drive) there is nothing we can do excpet make them sign a waiver which would absolve staff of responsibility - just what i know from experience in where i work.

[twotrees2]

1) I am only an LPN. I have been told by the RN/Case Managers and Administration that Social Services is taking care of the problem. I can only document, voice my opinion and pray to God that no one is harmed in the meantime.

2.) We have been trying to get the MD to sign papers stating that this resident is not well enough to be driving, but he does not respond to our faxes or telephone calls to address the issue. For most of the docs we have, it seems as if the rezzies don't really matter to them anymore...

Like I have previously stated, my license is not worth losing for this facility and the docs, cause I "let" someone do something that is against medical advice.

To answer the question on the big O2 tanks, no they are not secured down, they are only held in place with bungee straps and after what I saw yesterday, they are not very stable!!! The way they are sitting, it looks as if they are pointed straight at my house!

one - id have to say please dont say you are "only an LPN " you are a nurse - and your residents are your residents - yes you have higher ups but we all have our brains to do or refuse what we know is wrong - we can not refuse a resident that is not deemed incompetent - fax the physician and keep a copy for your records of that fax to prove you faxed them with date and relative info. call the doc if you do not hear back - document in the chart every attempt and lack of response by the physician. you could refuse to work with this resident until the issue at hand is remedied however if it were me id not worry about it, as so far it seems you have no legal obligation to prevent him and thus can not be sued if something should happen. seems more of a moral decison and concern than a legal one at this point. good luck and keep us posted. just my 2 cents.

[twotrees2]

Yes, we have asked the MD to sign these papers, but he hasn't...This doc has a tendancy to take forever to do anything! We have also talked to his case worker and she keeps saying that he has rights to do this. I agree, he does have rights, but not the right to go out and kill someone just to feed his habit!

I also wonder to if he is doing this because he does have a death wish. I have a hard time with people who have mental illnesses and knowing how to deal with them!

And I also worry because I think that whoever gets hurt if something happens and they come back at the home, and I have to testify in court, how do I answer the questions.....like a previous poster stated... when I know he isn't to be driving. Alot of guilt for me, a chance of losing my license....

perhaps the doc feels he should not be driving, but has no legal basis to prevent him - if he sees ok ( with or without glasses ) hearing ok ( even if has to be with aides) and he is alert and oriented x3 - there is no competence issues - my grandfather can barely move his left leg - can barley get it in his big ole car - stil drives i dont like it, nothing i can do - he sees ok with glasses has his right mind etc. even if one is a bit confused at times unless it is documented religiously and brought out - it does not help. rememeber if it isnt charted it isnt so . so watch and document every episode that points to his inability to drive ( without putting your personal view that he should not be driving) and keep charting it till something can be done. as for the guilt there is nothing anyone but you can do to help with that - sometimes i just sit back and say there IS nothing i can do so i CANT help and that can help keep the guilt at bay ( though it does not stop it completelly )

[twotrees2]

1) I am only an LPN. I have been told by the RN/Case Managers and Administration that Social Services is taking care of the problem. I can only document, voice my opinion and pray to God that no one is harmed in the meantime.

2.) We have been trying to get the MD to sign papers stating that this resident is not well enough to be driving, but he does not respond to our faxes or telephone calls to address the issue. For most of the docs we have, it seems as if the rezzies don't really matter to them anymore...

Like I have previously stated, my license is not worth losing for this facility and the docs, cause I "let" someone do something that is against medical advice.

To answer the question on the big O2 tanks, no they are not secured down, they are only held in place with bungee straps and after what I saw yesterday, they are not very stable!!! The way they are sitting, it looks as if they are pointed straight at my house![/quote

How about notifying the state trooper's office? Send the report in writing with a cc. to your motor vehicles department. They will then be obligated to investigate the situation.

we are not agreeing they shoudl be going against medical advice if we get the wroitten AMA form signed which shoudl always be signed anytime you fgeel they are doing something that is against medical advice - however - it is not "against medical advice" if there is no ORDER stating he can NOT do it -

[twotrees2]

I hate to be the one to tell you that it is indeed not blown out of proportion. Oxygen is one of three components required for a fire to take place; ignition, fuel, oxygen. I had a friend whose mother was a smoker wearing O2 who'd gone outside to smoke, where the concentrated O's could more easily dissipate, and ignited. It traveled the path and well....let's just say it was gruesome, the husband couldn't get to her quickly enough with a water hose and she did not make it. Ya, she learned from it...

As far as the OP's concerns, I think the best you can do is to document, document, document. Documenting that you advised the patient of the safety issues, the risks involved and that he refused to comply and has checked himself out to smoke while wearing O2 against advice as well as not signing him out as the documentation will both document that he's gone, that he's doing so against medical advice and also releases you of the concerns of restraining him against his will (not allowing him to do as he chooses regardless of whether or not he should)...you might want to have someone witness and cosign just for extra security.

in our facilty the portable tanks are to be left at the desk if they go ut to smoke - if they can not go without o2 they can not go out period. we do not have anyone with large tanks for thier vehicles so dont know about that - but if it is the facilities o2 ( vs if it is his own supply ) then you shoudl be able to get a rule that the o2 stays inside. just a thought.

[twotrees2]

another idea- to prevent anyone from leaving and us not knowing it and or giving to those who are ORDERED by docs to not get any - we keep ALL cigs at the station - they have to ask us for them and we have to go out and light them ans they are also not allowed lighters in the facility. as of late we have even went to specific times for cigs - if they do not get there they have to have a family member or friend to take them out as we have so many smokers its just impossible to accommodate everyone and get our work done. these are facility policies and residents and families must agree to keep or be placed there. just some more ideas.

[dauschundlover]

I guess I would start with whether or not this person is competent to make decisions for himself. If he is I would then investigate the policies regarding oxygen and smoking. You could always question the need for the oxygen. What are his O2 sats? Is he short of breath? If so when and for how long?Depending on the answer to these questions I would approach the MD and the need for the O2.

Don't let anybody fool you, oxygen is dangerous. It's what is need to fuel a fire and just like mentioned in other responses those tanks if not handled correctly can act like projectiles. Good Luck.