False Documentation?

[RPN_2006]

I need advice.

I have a home health client who is 100+ years old, end stage renal failure, anuric, +++sediment in foley causing obstructions.

This man was getting cath irrigation c NS q week for months and I increased him to q2days when obstructions were becoming a problem. Even then he obstructed and so I increased him to daily irrigations..so far so good.

I am responsible to order all supplies for clients and when i saw this man on friday I took a count of supplies and put in an order for more NS and irrigation trays. There were three of each left...one for Sat, Sun, and Mon. I had Saturday off.

I saw this man today and began my visit by reading his chart entry for Saturday...all is good, VS stable, NS irrigation given...no prob.

Except when I began to gather supplies there were neatly stacked as I had left them, 3 trays and 3 bottles of NS.

We do carry minimal dressing supplies with us, but not irrigations trays, not as a rule, and who would drag them out of their car for no reason.

To further complicate matters, the nurse who made the visit is well respected in our practice. She precepts new students and new hires. Unfortunaley, she is always giving me the a** about something, always questioning the frequency of my visits, or the dressings I choose. She is snide when talking to me. I have considered why this may be but have come short of a satisfactory answer. Feedback from other members of the team and from patients themselves towards me has been good, but I digress...

What would you do? What should I do? I can never prove that the tx wasn't given, and the pt cannot say. Fortunately there was no harm to the pt and I did not have to replace his catheter once again.

I'm just fuming! :angryfire

[RPN_2006]

NRSKaren thank-you so much for those useful suggestions.

I had no idea about the silicone caths or the cranberry capsules with regards to blockages/crystallization. This is information I can DO something with.

I have documented all events. I will forward to supervisor.

[NRSKarenRN, BSN, RN]

Check out our Wound, Ostomy, and Continence for the stickied info.

Great article:

Incontinence Products and Devices for the Elderly

by

Diane K. Newman, MSN, RNC, CRNP, FAAN, is the Co-Director, Penn Center for Continence and Pelvic Health, University of Pennsylvania Medical Center, Division of Urology, Philadelphia, PA

Section 4 talkes about catheter types:

The large diameter of silicone catheters may prevent the formation of biofilms as they are more compatible with the lining of the urethra and do not allow build-up of protein and mucous

Order 100% silicone and see if it makes a difference

[CapeCodMermaid, RN]

If a patient has a treatment ordered and the nurse does not do the treatment that could be construed as neglect. Neglect of a patient is an event which is supposed to be reported to the Department of Public Health. I realize that everyone forgets now and then to finish all treatments, but if the whole reason for your visits to this gentleman's house is foley care, how could one forget? You should tell your supervisor what you have found. If there are negative consequences, you could be held liable as well for knowing and not reporting.

[RPN_2006]

Thank-you all for your useful and informative advice.

I have learned things with this experience to take forward.

My patient passed away last night.

May God rest his soul and bring peace to his family.

[caliotter3]

So sorry to hear of the family's loss and your loss also. It was clear that you cared very much for your patient. He is resting now.

If you think this other nurse is habitually lax, perhaps you can find a way to avoid working on the same case with her in the future. Save you more uneasiness.

[jnette, ASN, EMT-I]

Thank-you all for your useful and informative advice.

I have learned things with this experience to take forward.

My patient passed away last night.

May God rest his soul and bring peace to his family.

((((RPN_2006)))

I'm so very sorry about the loss of this dear patient.

[RPN_2006]

Thanks Jnette and Caloitter.

I did care very much for this patient. I feel a little lost each day not stopping in to see him. He is my first death, although I was not on shift thank goodness, so I did not have to pronounce. I am glad he is no longer suffering, and although it was an expected death, its taking me some time to come to terms with.

Thanks for the hugs.