Legal elderly abuse

[Steve123]

A confused patient from a nursing home was admitted to hospital with skin lesion. According to the color and irregular form of the lesion it was obvious for doctors that it was skin cancer. The surgery was planned only in 4 days after admission. (Time was needed for pre op work-up and obtaining consent from the family. Vancomicyn IV and continuous IVF were started. Pt was pulling out saline locks all the time. Finally order for wrist restrains was obtained. Pt became even more confused because he couldn't go to restroom and couldn't understand how to use urinal d/t his baseline mental status. Then Vancomicyn through was elevated before the 4th dose. I expected the doctor to stop Vanco, instead he only reduced the dose. I asked the doctor,

-Why does the pt need Vanco?

- To his justify his admission to the hospital, - answered the doctor honestly.

Don't you think it is abuse to restrain patients o give them iv meds they do not need.

For nurses who do not work on surgical floors: standard of practice is 1 dose of antibiotics pre op, not half a week.

[Anna Flaxis, BSN, RN]

Hi Steve123,

At face value, this is a very disturbing story. Some questions I have are: Are you certain this patient has no indications for Vanco? Are you certain that the physician was being "honest" vs. making a sarcastic, jaded comment?

If the situation is exactly as you describe and there is nothing more to it, then I would have a couple of suggestions. You could take this up the chain of command and talk about your concerns, starting with your charge nurse and going up the chain from there as needed. Alternatively, you could skip that process if your work environment is such that you suspect that it will be futile and/or you fear retaliation, and make an anonymous report to risk management/the hospital's patient safety officer.

Good luck!

[Steve123]

Yes, I am sure, PT's WBC was normal, no fever, no puss around the lesion. No signs of infection. I have a lot of stories like that. I write a diary, it is just one story from my diary, some time I will publish them all.

[KatieMI, BSN, MSN, RN]

Need in IV hydration and preop workup justify inpatient admission.

If you take a closer look at medications elderly patients get, you'll find that almost every single person over age of 70 receives at least one medication with questionable indications or with any of them at all. Polypharmacy is a BIG problem among this population. There are no studies which would clearly ascertain benefits of life-long statins after age of 85, aricept/memantine for advanced dementia (MMSE

What you described is not a legal abuse per se and won't be qualified as such because it is all done for the patient's safety and care. It is entirely another question if the patient wanted that care and would be able to state that. That's why it is so critically important to have advanced directive.

I'd witnessed hundreds of times the "care and treatment" which was clearly nothing but legally applied torture, done entirely because the family wanted "everything to be done" doesn't matter what, even after all further care except palliative was proclaimed futile, as well as physicians encouraging families to continue their lunatic wishes in the name of "not stealing hope" in words and for the sake of all-mighty $$$$$ in fact.

[vanilla bean]

Yes, I am sure, PT's WBC was normal, no fever, no puss around the lesion. No signs of infection. I have a lot of stories like that. I write a diary, it is just one story from my diary, some time I will publish them all.

As a side note, and to save you some potential embarrassment when you publish your stories and release to the masses, it's *pus. More importantly, if you use the word as an adjective, it's *purulent. In my fledgling young RT career (with uneditable paper charting, no less) I learned this lesson the hard way.