Is this neglect

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Specializes in Occupational, rehab.

We have a sever dialysis patient at our long term care facility. He is new. He is on a fluid restriction of 1600 a day which he gets with his meals and fluids he gets with his medication. He will demand water I have educated the CNA's that I manage to not give him water. I also would not allow a cup in his room because if one is in there he will go to the sink and fill it up. I know I could not take a cup of water out of his hand if he should do that but is it neglect to not give him a cup of ice. all of our other patients get a cup of ice 3 times a day. I am not concerned about the ice melting and him drinking that but I am concerned about him using the cup and we really would have no record of how much water he has drank. but is it neglect? I worry that if something did happen then my license is on the line . they would say you knew he was on a fluid restriction yet you allowed a cup to be in the room knowing he would use it. What would you all do in this situation. the nurses where I work are divided on this.

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It depends on his level of orientation. People do have the right to be non-compliant.

This is a question for the super, and whomever care plans for him.

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Specializes in LTC.

i would give him the ice cup but remove it from the room after about 15 minutes or so. make sure you document on it thats very important. I would also confirm with the supervisor of what your plan is. At least your making an attempt to keep him hydrated.

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Specializes in Mother-Baby, Rehab, Hospice, Memory Care.

Is he alert and oriented and able to make his own decisions? Does he have a POA? I would say the bigger issue is that he's being denied the right to make his own decisions if in fact he is deemed able to.

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Specializes in Family Nurse Practitioner.

No it is not neglect

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Specializes in Telemetry & Obs.

I, too, am in the camp of if he's A&O he has the right to be non-compliant. I know how very frustrating it is for staff, but he is an adult and can make choices...including bad ones.

That is IF HE IS A&O.

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Specializes in Community Health, Med-Surg, Home Health.
i would give him the ice cup but remove it from the room after about 15 minutes or so. make sure you document on it thats very important. I would also confirm with the supervisor of what your plan is. At least your making an attempt to keep him hydrated.

This may be hard to maintain...especially in nursing homes. I think that I would speak to the powers that be to alert them, ask their input and make sure that I document his behavior , esp. if he is a/o x3.

I, too, am in the camp of if he's A&O he has the right to be non-compliant. I know how very frustrating it is for staff, but he is an adult and can make choices...including bad ones.

That is IF HE IS A&O.

I agree with this...I'd document the teaching, the instructions to staff, who was alerted that is over me and patient's behavior.

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Specializes in Maternal - Child Health.

I wonder if part of the problem may be that he feels helpless to quench his thirst between meals.

Would it be possible to schedule a meeting with the patient/family, nursing and dietary? Perhaps his mealtime fluids could be cut back just enough to allow him to keep a small bottle of water with him during the day, with the agreement (if he is capable of cooperating) that he won't refill it. Or perhaps a pouch-type container (like Capri Sun) that can't be refilled.

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Specializes in ACLS.

If I was in that situation I would find out if there was any kind of way that I could get him an ice tray with pop sticks. Maybe toss in a mint leaf if available. This way he could have a 1oz. ice pops between meals.

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Explain, teaching and document it!

Otherwise, ask him to sign the AMA (Against Medical Advice)!

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Specializes in LTC, Memory loss, PDN.

I agree with Jolie. This needs to be a team effort and the patient and, or POA or healthcare proxy are part of the team. All the steps and efforts taken to adress this situation need to be documented and this issue needs to be adressed on the POC. I know we have a duty to protect the patient, but I can't help thinking how terrible it must be to be denied water. How about serving ice chips in a cup with holes in the bottom until a more workable solution can be found.

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Specializes in LTC, Urgent Care.

Has this resident's doctor been notified? Maybe it's possible to increase the fluid restriction a little bit. At the very least, the doc should be made aware of his non-compliance.

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