What to do when Nursing Home doesn't follow instructions?

  1. I've been on call all weekend. I have a patient in a nursing home 30 miles north of my home, he has a feeding tube and gets cyclic feedings. He is end stage dementia, only responds to vigorous tactile stimulation...

    I get a call from the answering service at 11:30pm, the nurse tells me that his feeding tube has been clogged "ALL DAY", I gave her several methods to unclog said feeding tube, she states "I tried to unclog it but his daughter was sitting there and I didn't want to be too vigorous." She THEN states that she called the patients DOCTOR this afternoon who stated if she was unable to unclog it, to "send him to his GI doctor in the morning so they can replace his tube."

    Now, my dilemma. Do I run my tired heinie out there NOW to save the hospice the cost of transporting a contracted dementia patient by riding 60 miles roundtrip to unclog a feeding tube when the nurse that is there can't follow my instructions?????????????????????????????????????? ?????????????????????????????????????????????

    I left specific instructions that once the patient was on hospice to contact
    us FIRST. and instead she contacted me LAST.

    I'm not running up there tonight, although it would be my regular rate plus mileage. I asked her WHY she didn't call me first because I could have taken
    care of that this morning, instead of worrying about it now.

    Well, NOW I can't sleep. I don't feel like I SHOULD drive out there, when there are nurses right there at the nursing home that can do the same thing.
    Frankly, if he had been getting his tube feedings on schedule, and getting the 200ml of free water every shift (and warm water flushes after his meds as is
    ordered), this wouldn't be happening.

    I have a IDT meeting in the morning, and I will discuss it with the director then. i'm not waking her up with this.

    This patient is only responsive to firm tactile stimulation, but with no access
    he couldn't get his lortab even if he needed it. Frankly, i'm just irritated.
    WHY couldn't she have called me this afternoon........................................

    What would you do?


  2. Visit AtlantaRN profile page

    About AtlantaRN

    Joined: Oct '98; Posts: 772; Likes: 293
    med/surg/hospice/home health RN
    Specialty: 13 year(s) of experience


  3. by   Liddle Noodnik
    Quote from AtlantaRN

    What would you do?


    I think giving them a little firm tactile stimulation might help...
  4. by   AtlantaRN
    AMEN, and pass the biscuits!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

    It's just too darned late to call my director, and we have an IDT meeting in 7.5 hours and i'm just too *issed off to sleep!!!!!!!

    I don't want the hospice charged for something that a nurse can remedy, and frankly the nursing home is FULL of NURSES and TECHS that can manually unclog that *amned tube. here I am 30 miles away and I'm supposed to rush over there NOW???? No way in "H E double hockey sticks....."

    I can go over after the IDT meeting.....

    Thank you for your input, I needed a laugh.

  5. by   Agnus
    Sheeesh! Is this the first time these nurse ever had to deal with a feeding tube? Sounds like they don't want to be bothered because this is a hospice pt. and hospice is "getting paid' to do it. They have no clue. I have seen this before. Pts neglected in SNFs BECAUSE they were hospice.

    I would register a concern with the facility DON about this.