Is this abuse how do I report?!

[KMarieD]

Please be gentle maybe I am wrong in assuming this is abuse.

I am currently working at a SNF/Rehab. This is my first nursing job as an LPN.

I have a patient who has dementia and has recently starting mental declining according to other nurses. I haven't been the nurse in 1 month for them. I came in on sunday and was informed they due to have IM Geodon Q4H. When i got report the nurse said they had been refusing the med.

When I went in to the room and offered the med, I tried to convincing but patient stated "I have the right to refuse, i don't want those shots"

This patient recognized me, had conversation with me. Some confusion was evident, but this would be baseline for them.

I documented as refusal. Well supervisor came to me and said they received a text from the administrator (no medical background) stating this patient was "not allowed to refuse" and I HAD TO GIVE IT.

I told the nurse that this patient has the right to refuse, they are not a harm to themselves or others and I would not be holding them down and forcing them this is not a psych facility.

To which response I got "To bad, its a med error if you don't give it, and you can hold them down and give it"

I refused so the supervisor took my keys from me and administered the med while the patient yelled and stated "this is my right to refuse, this is illegal"

Please tell me I wasn't wrong in refusing to give this med. I was absolutely devastated that a fellow nurse would not advocate for this patient when they were doing NOTHING. They got the med and were so sedated they wouldn't even eat or wake up.

Is this not considered a restraint? Abuse? What do I do?

[heron, ASN, RN]

Congrats!

Meanwhile, PLEASE drop a dime on these folks. The worst that can happen now is that the state will do an investigation. Forced medication without the required legal safeguards, if that's what's happening, needs to be stopped.

[KMarieD]

Patient refuses because they state 'I am not doing anything wrong. Its my right to refuse'

It was ordered because they had been stating 'I don't want help, please just leave me alone, no one in this place cares' dementia is worsening, they categorized it as 'behaviors'

Confused about what day it is, what month, meal times.

But isn't everyone else?

They lay in bed all day. They have no family to advocate, they have been alone for 10 years.

[Adele_Michal7, ASN, RN]

Everything Caliotter said.

[heron, ASN, RN]

I'm curious, why was the geodon prescribed? What you describe is not adequate grounds for forced medication. Geodon is an antipsychotic and you describe no psychotic symptoms, let alone symptoms that would call for forced medication. Does the resident have a history of dangerous delusions or command hallucinations that would make him/her an immediate danger to anyone? Does s/he make homocidal or suicidal threats? Is there any paperwork in the chart documenting legal proceedings or physician evaluation to justify forcing medication?

You did good. Even if the facility had all the i's dotted and t's crossed, you should have been given reasonable explanation, not a threat of getting written up for a med error. Call the state and let them sort it out. Good luck at the new job.

[KMarieD]

I'm curious, why was the geodon prescribed? What you describe is not adequate grounds for forced medication. Geodon is an antipsychotic and you describe no psychotic symptoms, let alone symptoms that would call for forced medication. Does the resident have a history of dangerous delusions or command hallucinations that would make him/her an immediate danger to anyone? Does s/he make homocidal or suicidal threats? Is there any paperwork in the chart documenting legal proceedings or physician evaluation to justify forcing medication?

You did good. Even if the facility had all the i's dotted and t's crossed, you should have been given reasonable explanation, not a threat of getting written up for a med error. Call the state and let them sort it out. Good luck at the new job.

I've sifted everywhere. Literally nothing to find the reasoning behind the geodon. Only remarks that any 92 year old person with dementia would say. No homicidal or suicidal things. Patient just gets really frustrated. But never lashes out.

This isn't the first instance I've had of this...meds being prescribed for outrageous things because the higher ups fabricate to the docs.

[VivaLasViejas, ASN, RN]

It doesn't sound to me that Geodon or any other antipsychotic is appropriate in this resident's case. These drugs raise the risk of death in elderly patients with dementia and should never be used in the absence of unmanageable symptoms, let alone forcibly. Frankly, I'd report it because there appears to be no one else to advocate for this resident. Let the authorities sort this out.

[Sun0408, ASN, RN]

Geodon q4!! Wow that's a lot. In my hospital is only given IM q12.

[blondy2061h, MSN, RN]

Like others have said, no legal advice allowed here, but I can tell you the practice at my facility. Meds can only be forced if a psychiatrist deems the patient incompetent to make informed decisions. Other than that, if they say refused, it's refused. The post you wrote does smell of abuse and I'm glad you're exploring your options.

[Pangea Reunited, ASN, RN]

Patient refuses because they state 'I am not doing anything wrong. Its my right to refuse'

It was ordered because they had been stating 'I don't want help, please just leave me alone, no one in this place cares' dementia is worsening, they categorized it as 'behaviors'

Confused about what day it is, what month, meal times.

But isn't everyone else?

They lay in bed all day. They have no family to advocate, they have been alone for 10 years.

Geodon sounds very extreme for that type of behavior. I really want to believe that there's more to it. It just doesn't make sense, otherwise ...but maybe you really do just work in a very strange place.

[MunoRN, RN]

This almost seems to straightforward to be an actual situation, but if what you're describing is correct then what's happening is assault, which is a mandatory reporting item in every state I'm aware of. More importantly though is the basic nursing ethics issue which should be considered just as important.

[Ruas61, BSN, RN]

After all of this reporting that you may be doing, I wouldn't want to remain working at this facility if I were you. Just to say, that a version of what you describe is not necessarily rare in LTC facilities. Most nurses either participate, or turn a blind eye, to what goes on. Just one reason why it is difficult to work in LTC.

EXCUSE YOU!

REALLY???

MOST NURSES EITHER PARTICIPATE, OR TURN A BLIND EYE, TO WHAT GOES ON.

How dare you make a sweeping derogatory generalization of us LTC nurses.

I have never done such a thing nor have I knowingly let something go on or turned a blind eye to something unethical. immoral or illegal.

I have always done my best for those under my care.

The majority of nurses I have worked with over years do not reflect your opinion.

Your words speak volumes but they are saying something you can't hear.

[Ruas61, BSN, RN]

To the original OP.

Yeah, it is reportable.

I would call the OHC.

Yeah, you best go job hunting because that place has issues and you will get caught in the cross fire.

Good luck.