Patient complaint to charge: pt refused test but states that it was done?

[newnurse2014]

Hello all!

Basically I'm a little worried, I started this job back in November, I've worked at several different hospitals in all different areas (cardiac, psych, OB), but this is OB and Newborn at one of the largest hospitals in my area. I have NEVER had so many people complain on me before!! I am not used to this at all, even in psych my patients loved me. I'm a very relaxed person and can get along with anyone (I thought!) This is very long winded but I feel like there are some details that need to be known to understand whats going on.

I had a patient who was leaving AMA with their baby. We have to do certain tests before the babies can leave but it's typically done after the baby is 24 hours old. This baby was NOT 24 hours old yet but I was told we still needed to do it anyway. So I told the parents what it was for and why we do it and explained to them that even though I was doing it now, it would still have to be repeated correctly after 24 hours of life with their pediatrician, gave them the slip of paper with the information on it to give to their pediatrician. These patients were a home delivery and didn't want to be in the hospital in the first place, no separation from baby, no vaccines, no bath, etc. So while I'm doing the heelstick, Dad is hovering over me and baby, who is screaming and NOT bleeding enough for what we needed. I stuck the baby twice and explained that I didn't believe that would be enough for the lab and that they would have to get it redone. The parents both said it was okay and that they were ready to leave. So I charted that they refused it to be done because they didn't want me to continue. They were given their papers and about an hour later, walked out to go home. I realized after they were gone that I didn't get the paper back from them that they were supposed to give to their doctor.

I received a call from my charge nurse on Friday, approximately 3 weeks later, saying that the mom called up there and wanted to know why the results weren't in. She told my charge nurse that I stuck the baby 4 times and that it took me 30 minutes and I completed the test (which is not true.) When my charge nurse told her what I charted, the woman was upset. They definitely weren't the most sound of mind people, but I don't know who they really are and I'm worried that they're going to try to take this up the chain of command.

Looking back I realized that I charted incorrectly because I simply put "mother refused" instead of something along the lines of, "test attempted, mother refused after second heel stick." So now I'm worried that I'm going to get in trouble with work about it.

Has anyone experienced anything like this? Where they didn't chart something exactly correct and got in trouble for it at work? Or had a patient try to get you in trouble for something along those lines? I know that I'm being silly and my anxiety is getting the best of me but I can't get it off my mind!! If you've had something like this happen, what did your job do about it?

[psu_213, BSN, RN]

I'm sure there was an instance I should have charted more details on a patient refusal, but did not because I did not have enough time. I don't remember ever getting in trouble for it, but I'm sure, at some point, I did not chart enough.

Hopefully your charge will look at the situation and realize how unreasonable this family is most issues. Before anyone gets upset--I can understand why they don't want their baby stuck repeatedly--I'm talking about the other issues (no bath, no vaccines , etc). Plus, if you usually do a good job, this should make her more likely to have your back in this.

[newnurse2014]

I'm sure there was an instance I should have charted more details on a patient refusal, but did not because I did not have enough time. I don't remember ever getting in trouble for it, but I'm sure, at some point, I did not chart enough.

Hopefully your charge will look at the situation and realize how unreasonable this family is most issues. Before anyone gets upset--I can understand why they don't want their baby stuck repeatedly--I'm talking about the other issues (no bath, no vaccines , etc). Plus, if you usually do a good job, this should make her more likely to have your back in this.

Thank you so much! I've worked with this charge nurse before at my last hospital and she definitely knows that this isn't a normal situation for me and that the patient is a "little" weird. She told me that she does have to pass it along to the unit manager though, because it was such a large complaint. I've never been in trouble/written up before so I'm thinking that maybe I'll get either fussed at (next time, you need to..) or given a warning or write up. I guess only time will tell I work night shift, too, so it's not like I can easily go talk to her on my lunch break.

[AnnieOaklyRN, BSN, RN, EMT-P]

I think you should take this as a learning opportunity.

I think if I was in that situation I would have involved the charge nurse and she may have been able to talk more sense into the parents, or tel them she would try. I know the parents didn't sounds very reasonable, but it would have been worth the try and you would have had a second person as a witness that they refused, especially assuming it was the mandated testing you were doing.

Also I think it is good you documented that the parent refused, but I would go into more detail and include that you were having trouble getting blood, any interventions you did to help like a heel warmer, and the conversation with the parents and education you provided about the benefits of getting the tests and the risks of refusing. That way you would have had documentation with regards to you communicating that you would not be able to do the test. When documenting about something a patient is refusing, or in this case a parent on behalf of the patient you need to add that they were of a sound mind, you explained what your were doing and why (or what you wanted to do and why), the benefits of the intervention, the risk of not performing that intervention, and that they verbalized understanding of that information and still refused.

They sound a little nutty so I can see how it would have been a difficulty situation, but always use your resources.

Annie

[Double-Helix, BSN, RN]

You stated that the testing was going to have to be repeated anyway because it was done before the child was 24 hours old. So regardless of whether you obtained enough blood at the time of your attempt, the test was going to have to be done again, is that correct? In that case, I would have refused the initial testing as well, especially after multiple attempts.

Also, from the way you described your conversation with the parents, my understanding would have been that you weren't sure that you had gotten enough blood but we're going to attempt to send the test anyway. Perhaps that was the mother's understanding.

I agree that you should have documented that the test was attempted but you were not able to obtain sufficient sample. What the parents actually refused was repeated attempts at obtaining the lab, not testing altogether. Since it appears that you only attempted the initial testing to fulfill a hospital policy, not completing the test didn't have any implications for the patient, so hopefully you can take this as a lesson learned and nothing more comes of it.

[KatieMI, BSN, MSN, RN]

1). Some hospitals, and some units within hospitals, normally have more demanding clientelle than others. For the future reference, think twice before accepting a job in a place which makes "customer service" its brand name and part of image. And, of course, OB/L&D always was, and is, and will be the place with the near max possible concentration of "unhappy customers" (as well as "happy" and "satisfied" ones).

2). Again for the future reference: "required" tests (as far as I can understand, phenylketonuria and congenital hypothyroidism screens) are useless if done before 24 hours after birth due to high incidence of false positives.

3). That's why the old maxim "if it is not documented, then it is not done" has a grain of truth in it. Not only the number of pokes but inability to obtain the sample, the fact of not sending the said sample due to above and the reaction of parents - all must be documented, the latter verbatum, and brought to your manager's attention the same day. Then there would be no questions to you.

4). The fact that the your manager couldn't manage one "just a little weird" "customer" totally by herself without making her staff member (you) uncomfortably and scared speaks quite a lot about her leadership abilities - or rather lack of them. Think about it :)

[newnurse2014]

Thank you all so much for your input! This has definitely been a learning experience, for sure. I've never been in a situation where I felt like I didn't chart enough, but that was definitely a different night, our night shift nurses barely know how to perform a discharge and no one knew how to do an AMA either (we very rarely see that.) And of course this all started as soon as I got on shift so I was super behind. Then right after they walked out of the door I was told I would be getting another mom and baby to replace them, so I tried to get my charting done quickly and minimized. I was so worried about preparing for what was coming that it didn't even cross my mind to document the attempt. I definitely won't be taking that route in the future!!

[ruby_jane, BSN, RN]

Thank you all so much for your input! This has definitely been a learning experience, for sure. I've never been in a situation where I felt like I didn't chart enough, but that was definitely a different night, our night shift nurses barely know how to perform a discharge and no one knew how to do an AMA either (we very rarely see that.) And of course this all started as soon as I got on shift so I was super behind. Then right after they walked out of the door I was told I would be getting another mom and baby to replace them, so I tried to get my charting done quickly and minimized. I was so worried about preparing for what was coming that it didn't even cross my mind to document the attempt. I definitely won't be taking that route in the future!!

Documentation should reflect, as much as possible, the full picture. Be easy on yourself. Now that you've seen it/done it, you'll do better next time, right?

[newnurse2014]

Thanks again for all of your input everyone!! This has been a huge learning experience and it's still ongoing. Received a call from my manager yesterday regarding the situation and then she called me a second time today and this time asked me to email her a statement. When I asked what kind of statement I was told, "paint a picture because, and don't freak out about this, but I have to send it to legal." I asked her if the patient was pushing legal and she said yes. She also said that after speaking with several others who encountered the patient, including the OB and pediatrician who had to agree to the AMA, that it is clear that the woman is "crazy" and "pushing this as far as it will go." But her complaint hasn't been against anyone but me. I for sure, 100% see my errors and will never make this stupid mistake again. My manager told me to not worry about it because every one's account of the patient has been consistent but I'm worried about what happens if the patient does push it further. What if she wants a settlement or takes me to court? I have no idea how these things work v.v Please send good vibes. I have NEVER had anything like this happen and all of my patients usually love me :'( 3 I'm the sole provider for my family, my husband has been out of work for a year and I don't know what I would do if I lost my job or worse my license. I don't know if it would go that far but I'm pretty shaken up.

[K+MgSO4, BSN]

First of all your boss can't tell you if the pt is persuing other people in her complaint. However it sounds like you are being well supported by your team, OB, paediatric doc and your boss. Make your statement as brief as possible with ONLY facts no assumptions of her being nuttier than a fruitcake.

Take it one step at a time. Sit down with hubby and work out where you can make cutbacks etc if you are worried. Make sure your PII is valid.

Panicking about the situation is not going to change it.

[Double-Helix, BSN, RN]

I would strongly advise against posting any details on this forum or anywhere online if there is potential this may go to litigation. If you don't have your own malpractice insurance, this would be an excellent time to get one- before any official action is taken against you.

I agree with K+, be factual and objective. Don't write "I did X because I thought Y." Simply say, "I did X". If you need to include what the parents said to you, do so without interpreting their tone or mood. I'm sincerely hoping that this goes nowhere and you can put it behind you. Best wishes.

[JKL33]

I wouldn't be surprised if what this family is complaining and pushing about is something to do with their bill; not helped by disappointments and a need to regain control when a birth doesn't go the way people planned. They didn't want to be there. A hospital scene was not part of their perfect plan. It also wouldn't surprise me to hear that they have gripes about more than just the situation you (OP) were part of. They obvioulsy were not in agreement with medically recommended care. In some situations (possibly this one) it almost seems like people's own decisions are making them anxious and they take it out all the more on anyone who doesn't agree with them (in this case the medical establishment). They seem kind of like they're flailing (my word for pathetic/desperate attempts to spread misery).

I am sure their complaint(s) are being duly investigated as all complaints are, and there's a good chance your statement is simply a routine part of that process.

Legal? What are their damages? If legal is involved it could be simply to provide an opinion on whether any of the bill needs to be comped.

Stay calm.