Anyone have a lot of experience with these in the LTC setting. Any info or policies for dealing with these.
Jul 6, '03
This upsets me. People needing Dobutamine need to have the staffing and resources of a hospital.
An RN who can assess the patient very often must be assigned to that patient.
Seems like a telemetry patient to me. Is it for heart failure? Diurectic therapy and frequent laboratory tests are just part of the data that must be evaluated often.
Jul 7, '03
Well this is the thing..this man should be on hospice... he's a DNR has heart and renal failure, chronic pain (not sure from what) 80 yr old man... is extremely SOB cant maintain a sat above 84-86, yesterday emesis all day, no po intake, (a few sips of h2o), taking vicodin q 4 hr, 3 lb wt gain in 12 hrs, got compazine, ativan and was trying for a roxinal order, and xray of abd ordered, he has an ileus now.... still has dobuatamine runining, daughter at bedside, doesn't want him sent to hosp, but wants us do do everything we can at nursing home.... We have one RN and one LPN for 50 pts. trying to get vitals done on him q 4 was like pulling teeth... trying to tell the DON and ADM that this type of Pt (dobutamine drip) is not appropriate in our facility. Just wandering if any other SNF have had drips like this before....
Jul 7, '03
This pt needs to be in hospital or hospice. He takes up too much of your time, and all he will really get is comfort measures. He is end stage heart failure, and will only last a few more days at most. It is not fair to him or your other pts to keep him in LTC, you are not set up for that. Good luck.
Jul 8, '03
Get your social worker, and Medical Director involved. This is a little beyond skilled nursing in a LTC setting. This resident should be on an inpatient hospice unit. I take it he is using his skilled benefit. A lot of times families don't want residents sent out d/t the additional cost that incurs. The resident have the right of using their hospice benefits, if he waves his/her Medicare A benefits Hospice is the better route at this time for this residnt.They will work at controlling any pain, end stage issues that he may have at this point.
Have your social worker call a family meeting with all the interdisciplinary team and present this option to them.
Jul 8, '03
Sounds like this patient with a DNR order is ready for comfort measures only. A NGT to low continuous wall suction should make him feel much better and stop the nausea. Sounds like the dobutamine drip is past it's usefulness at this point. Definately monitor on telemetry I have seen many ectopies with dobutamine. Sounds like he is ready for a morphine drip instead. Poor patient, hope you can find a way to make his last days comfortable.
Jul 10, '03
Thanks for the input all. I havent been in to work for a few days hopfully our social worker has done something by now.. Hey BadBird, Im from Pittsburgh too!
Jul 10, '03
I work in an ECF that is part of an acute-care hospital. We have policies that strictly forbid certain medications to be given out of the acute care setting and that includes dobutamine. I've NEVER heard of it being given in a nursing home before. I think I would refuse to hang it unless I was given adequate staff to monitor the patient well. I'd seriously question this practice.
Sounds like this poor guy is on his way out, so the question by now is probably academic, but really, I'd be sure to push this issue so it doesn't happen again.
Jul 17, '03
I work in LTC and we have a resident who gets Dobutamine. The resident is on another unit and it is done during the day so I am really not sure how they monitor it being given. I do know that there are several forms that are filled out with diffrent assessment data for 24 hours (during and after) . I have never worked the hall, so I am not sure what goes with it. However I do think LTC will continue to see sicker patients with greater needs. It seems like we get more acute patients every year. Of course we do not have more staff.
Jul 27, '03
I have to tell my story of administration of Dobutamine drip outside the cardiac unit setting.... I work for Hospice and we had a physician who wanted us to administer it in the home as the patient was beyond tolerating the ride to the center in the ambulance to recieve the drug at the cardiac clinic.... Reluctantly, and with lots of conversations with my administrator and our attorney, I administered the drug... after having the family sign their life away to prevent a lawsuit...
Anyway, to make a long story short... I administered the drug... Left the home 30 minutes after the drug was through infusing and verifying that his vitals were WNL..... the patient died 10 minutes after I left.....
Based on this patient's general overall instability, I feel it was just this person's time to go... however, I will always wonder...
That's not to say I wouldn't give it again, because I would... I will just always wonder if the cardiac lab could have picked up on something that I didn't...
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