Complaints about Patient Complaints

[nursekelly217]

I work in an inpatient detox... wondering if anyone in similiar could share how pt complaints (about staff, tx etc) are handled. Our facility has "grievances" that the pts are given when they cannot be redirected. My problem is this: the powers that be seem to think that a pt c/o about ANYTHING is a valid grievance. For example, if a staff member calls a pt "a good for nothing junky," that is, obviously, a valid c/o and should be written up. However, if a nurse holds a medication because said pt's BP is, say, 80/50 (and therefore the dose cannot legally be given, which is besides the point!) and the pt does not like missing such medication (and what drug addict does?), this is also considered a valid c/o and warrants a write up too. At this point, the write up will be investigated and addressed by the mgr (who thinks this part is a huge waste of time, when it is so obviously a safety issue and not mistreatment) and then filed in the staff-members employment file. Even if holding the dose meant I was doing my job. This happens A LOT and nurses get the brunt of the c/o by patients who often get very explosive towards us. And it ends up in OUR personnel files. Does this seem wrong to anyone else?

[TitaniaSidhe]

Occasionally where I work this also happens however the means I have found to protect myself is documentation in the patient record. When dealing with addicts, who often times have such wonderful personality disorders, it is always best to very clearly document everything, quote what exactly they said to you & how you responded, why you held a medication & if needed get another co-worker to countersign the note. Yes it is a pia & time consuming but if the advocates are so moronic they can't seem to understand things without such overly simplistic explaination, then give it to them & protect yourself.

Ex: Patient approached undersigned at 10AM at nurses station & demanded prn clonodine for withdrawl symptoms. Upon visual exam no withdrawl symptoms were evidenced, ie; abd cramps, chills, vomiting, diarrhea. Vital signs were as follows: BP 90/50 pulse 74 resp 20, unlabored & temp 97.6, orally. Patient counseled that prn clonodine would not be administered at this time as BP is too low & administration of this medication could be harmful. Patient responded with, "^*$(_^%%$&h! You just don't wanna give me anything that could help me. I feel like... & you love seeing me suffer you mean, ugly ....!!! I am gonna report you for this! You always do it & I know you just don't like me!" Patient then stormed off muttering more obscenities under his breath. Phoned MD on call & reported situation. No further medication was ordered for this patient at this time. Advised MD to please come to unit to speak with patient regarding treatment options as soon as possible. MD will be coming to see this patient during rounds within the hour. Will continue to monitor for signs & symptoms of withdrawl as well as continue to provided emotional support & threaputic environment.

You know never let it be said you were not compassionate while being cursed out but your local crack head

[Thunderwolf, MSN, RN]

You have my total empathy.

My past heroin users were just as warm and fuzzy :chuckle

[nursekelly217]

Thanks for the support... I think I just needed to vent. In the 18 months I've been there, have not had an official c/o against me... but occasionally get burnt out and pretty infuriated sometimes by how much abuse we take from clients... nothing like being called a $%&(@( the day after you give them Narcan after finding them blue in the lobby on admission!

[elkpark]

Been there, done that, empathize 100% ... However, please also be aware that CMS (Medicare/Medicaid) rules/regs require facilities to have a process in place for the prompt investigation and resolution of all complaints (whether legit or not :)), and your state licensing agency probably has v. similar state rules. The CMS rules are even v. specific about the complainant receiving written notification of the outcome of the investigation, and what that notification must include. The administration doesn't have to resolve complaints in favor of the client, of course, but they do have to investigate.

If someone complained to CMS or your state licensing agency that they had complained and nothing was done about it, and if your facility administration couldn't prove to the investigators that they had a policy/process for internal investigation of complaints and were following it, the facility would be in trouble with CMS and/or the state. I used to be a psych surveyor for my state and the Feds, and we did many complaint investigations where we were pretty sure up front that the original complaint was a bunch of hooey (it's amazing how clearly BPD comes across even over the 'phone :chuckle) -- but, if the facililty hadn't taken it seriously and investigated it, we had to cite them.

I understand completely that this is v. frustrating in your type of setting and client population (since I've been there myself), but it's just a routine part of being a healthcare provider these days. Best wishes!