When patient requests something to do that is not on the plan of care.

  1. We are seeing a patient for IDDM who is recently put on dialysis. We are not doing anything related to her End Stage Renal Disease/dialysis but yesterday I went to see her and she had missed her dialysis and requested me to change the dressing on her permacath which was clearly soiled and very loose. What should a nurse do in this situation? I thought agencies get cited even if a home health aide does ROM exercises if it is not ordered.
    Please help. Thanks.
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    About Sana2007

    Joined: Apr '09; Posts: 29; Likes: 3


  3. by   Kymmi
    Would it be possible for you to write a order from the MD to change the dressing on the permacath then you'd be covered by getting a order and adding it to the POC then making the dressing change prn in the orders and on the POC so that if it happens again you'd be covered but if it is ordered prn instead of routine you would not have to plan visits or change it if she had it changed at diaylsis.
    Its been awhile since I've done home health but that would have been what I would have done many years ago so Im not sure how the regs have changed since then.
  4. by   caliotter3
    Take steps to obtain the appropriate order and change the dressing.
  5. by   SnarfGirl
    I would not leave the patient with a soiled dressing. I would change it and write a PRN order for sure. I've gone as far as calling the PCP from the home and getting a verbal for stuff like that, and then let them know I'll send it over written - then just document well.
  6. by   berube
    i would of called the dialysis center, from my experience they are very particular that we do not touch their dsgs,,,i would of told them the situation and gone from there.
  7. by   KateRN1
    As a former dialysis nurse and current home health RN, I agree with berube. Call the dialysis center and ask them what you should do, then get MD orders, if needed.
  8. by   SnarfGirl
    Thank you Berube - I will keep that in mind if I run into that situation again!
  9. by   corky1272RN
    I am a dialysis nurse and have previously given a patient or two a roll of paper tape to use in case it is coming off. I don't want the drsg dirty, but even more don't want the dressing coming off.
  10. by   NurseKitten
    Another dialysis nurse here: Don't touch the dressing. The patient can go to their dialysis center on their "off" day and get it changed. That access is that patient's lifeline, and if something happens to it, you are liable. Going to the dialysis clinic on the off day can also give them a chance to assess them for fluid gain, and if they're OK to wait until the next day for treatment. They can run them for an hour and pull off a couple of liters, if need be.

    Also, by changing the dressing, you are reinforcing bad behavior. They don't get to miss dialysis. It is not an option. If they have chosen dialysis as their renal replacement option, they need to understand that they need to be there, 2 or 3 times a week, as their nephrologist prescribes.

    Just IMHO. I've had patients who thought they could pull that before, and the studies bear it out time and time again: it's just not good for them in the long run. Missed dialysis time exponentially increases morbidity and mortality.