Family Behavior during a code

[cm8816]

I work as a float RN at an acute rehab hospital. I have worked there for 7 years. Two days ago, I had an elderly patient who had had a stroke. He had multiple co-morbidities. The son was in the room. They had been admitted the prior day. In report that morning, I had been warned that family was very difficult. I found the son to be suspicious. He demanded I explain each medication and why I was giving it. He chose the meds to be given or held. I complied with his requests. My patient load was demanding. From 0630 until 1350, I never hit the restroom or took food or drink. We have Spectra-link phones. At 1350, I did go the restroom and then spent 15 minutes in the breakroom eating. Shortly after 1400, I finally sat down on the unit to chart (since I had not had a chance to chart all day). At 1425, I heard a shout from my patient's room. The son had come into the hall shouting, "I need help, he's turning blue". A tech ran in the room, hit the code button. I was in the room within one minute. As the room was filling with the code team and additional staff, the son kept shouting that "I kept calling the nurse and she would not come". The pt was in full arrest and a code was conducted with eventual ROSC (about 15 minutes in). He was transferred to ICU. I was so horrified by the son's false claims that I had a charge RN look at my phone, both missed calls and received calls. There were no calls from that room to me between the time I was last in there (noon meds) and the code. I also took pictures of the missed call and received call lists on my personal phone. This has made me very nervous. I have malpractice insurance. What steps should I take now?

[Here.I.Stand, BSN, RN]

You can call your carrier for advice, but it sounds like this guy doesn’t have a leg to stand on. He lied and you have the evidence

[cm8816]

Thank you.

[JKL33]

In the future, when you encounter individuals of this nature, it's wise to be a little proactive (maybe you were and I'll just put this out here for others).

People who demand what medications may be given and may not be given (and a variety of other very-stressed behaviors) are those who should receive intervention. (Primarily because they and the patient whose care they are negatively affecting deserve that, and secondarily because taking official steps to help them lays documentation groundwork should things escalate). They need things like social work, care conferences, etc. They need to be reported to administration formally, including appropriate neutral documentation of such in the chart. It's good that you didn't lose your cool earlier in the day, but these other things are steps that should be routinely taken in all such circumstances as well.

If an event/accusation happens like described in the OP, it may sound weird but these are not unreasonable things to report on incident reports as well. Categorize it under "care concern" (or whatever labeling your facility uses) and proceed to neutrally describe the facts, including the fact that your phone was reviewed by yourself and the charge nurse to ensure that it was working properly and that this phone check did not reveal any calls related to the patient.

Speak with management regarding the facts. Be the "first reporter" of the facts, anticipating that an incorrect or deceitful version of the facts likely will be forthcoming.

Be very careful with the photo you took on your own phone. Keep it in case it can be helpful, but right now it isn't necessary to try to defend yourself by telling important people that you have it. If they hear the words "took a picture" all bets are off.

Good luck.

[cm8816]

Thank you so much for this advice. I will follow it.

[Emergent, RN]

I hope you contacted the doctor regarding the meds not given, and did CYA charting.

[Horseshoe, BSN, RN]

If the son has medical POA, I think it's perfectly appropriate for him to want to know what each medication that his father is getting is and why he getting them. Giving this information is Nursing 101. As to refusing certain meds, you would want to know the rationale for this and educate accordingly. As refusal is a basic right of patients (and by extension, of the person with POA), you are mandated to accept it if they persist in the face of education. However, the physician absolutely should be notified and documentation of all of it should be done scrupulously to protect the patient's (and YOUR) interests.

As to the son lying, it's very fortunate that you have proof that his assertions are incorrect.

[canoehead, BSN, RN]

I would make an incident report of the situation and accusations, and make sure to get a witness to the read out of no calls from the room. Then I'd forget about it. You did nothing wrong.

[FolksBtrippin, BSN, RN]

Is it possible the son means that he called out "Help!" and not that he called your phone? His perception may be that no one answered him because he was distressed. Time passes differently for people experiencing a stressful event. Assume the best. Also understand that son is likely experiencing grief which may have contributed to his suspiciousness.

Obviously, you responded to the code appropriately.

As far as holding the meds, did you have documentation that son was the healthcare proxy? I would not have held the meds without that documentation or another good reason to hold the meds. I also would have educated about rationale for medication administration as PP said, and documented accordingly.

[Susie2310]

11 minutes ago, FolksBtrippin said:

Is it possible the son means that he called out "Help!" and not that he called your phone? His perception may be that no one answered him because he was distressed. Time passes differently for people experiencing a stressful event. Assume the best.

I agree with this.

[Susie2310]

9 hours ago, Horseshoe said:

If the son has medical POA, I think it's perfectly appropriate for him to want to know what each medication that his father is getting is and why he getting them. Giving this information is Nursing 101. As to refusing certain meds, you would want to know the rationale for this and educate accordingly. As refusal is a basic right of patients (and by extension, of the person with POA), you are mandated to accept it if they persist in the face of education. However, the physician absolutely should be notified and documentation of all of it should be done scrupulously to protect the patient's (and YOUR) interests.

This is correct. Also, patients' family members/POAs sometimes have good knowledge of the patient's medical history, current medical problems, medications, allergies, etc., and if given the opportunity to explain can offer good reasons for refusing certain medications.

[Susie2310]

16 minutes ago, Susie2310 said: