Foley question

I am with you, I don't think there is a valid reason for putting a foley catheter in this patient.

It just adds another portal of entry for infection, may add to discomfort for the patient, is not helping the patient or the daughter.... ✅✅✅

I also agree with you. For all the reasons you and 4_Sq give. Skin intact and daughter is obviously taking good care of Mom. Your director needs to tell you what makes her think it would make it "easier" on the daughter to insert a foley the patient doesn't need and the daughter doesn't want. I would think forcing something like this on the daughter would cause distress in the daughter, not to mention the patient.

I fully support the daughter. How nice would it be at the end if this patients life she develop Ito-sepsis. I think your boss needs a little education on this one.

I agree that this is the decision of the daughter.

However, it is important to support the assessments and recommendations of our teammates.

You will be the ongoing case manager, so your relationship will be the strongest, but always keep in mind the relationship of the patient to the "team"...there must be trust across the board.

This is not to suggest that you did not support the ADONs assessment or recommendation, rather it is intended to highlight another facet of the discussion.

would it increase the billing rate??

No, hospice bills and is paid per diem

this is one of those cases where i am amenable to either/or.

catheterization is relatively non-invasive, considering the procedure is hopefully done one time only.

and even if it happens a couple more times, the benefit could outweigh its hindrance.

my only thought is that this pt's sacrum is reddened...

and depending on the reason why, a foley could prevent redness from macerating or spreading.

if it was me, i'd discuss the daughter's objections with your mgr and ask "what should we do"?

this keeps mgr in control and feeling respected.

as tewdles stated, you have an ongoing relationship with her.

inevitably, it's preferable to stay in an amicable relationship.

again, i say this only because i don't feel this is a battle worth fighting.

blessings to you and all involved.

leslie

Thanks for all the input! She has since passed, without a catheter:). The daughter was against it. For infection reasons and that the patient was very grabby and fidgety. Which makes complete sense. I would have supported it if she wanted it. But I supported her when she didn't but my director felt I should have pushed it more, but I saw no reason to.

The reddness was not do to incontinence, it was because she was failure to thrive, 80 lbs soaking wet:(. Bony and bed bound.

I hate to say it, but my now old boss was very " I am right, I've been doing hospice for so many years"

But as always, these are things that should be discussed in team, and was. And the medical director agreed.

I'm just greateful she died a peaceful death at home.

MomRN do we have the same boss? LOL. I have a director who has that whole I am right and you wrong and you will do everything my way attitude! Very frustrating some days! I have gone rounds with her on several occasions especially regarding admits that I did not feel were appropriate and been forced to admit anyway. Don't ever be afraid to stand your groundand advocate for your patients. I will never do anything that goes against a families wishes unless the patient is fully alert and still able to make their own decisions. A lot of what we do in hospice is about supporting the choices of family.

Are you insane Leslie! Foley cath are relatively non invasive! Let me put one in into your urethra! Then we see if it is non invasive!