LTC resident telling a fib

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Specializes in neuro/ortho med surge 4.

Hi all,

I am a new RN in a LTC facility. I have been off of orientation for a month now and it has been going OK. There is so much to learn with the paperwork and being a nurse but each day I make progress.

On Thursday evening I went in to one of my resident's room and gave her the coffee brandy sombrero she has every evening (she is allowed this). This was around 7:45 in the evening. Her roomate was lying on her bed watching her TV. I glanced over at her on my way out to dispense meds to my other residents. This resident ( I will call her Jane) did not complain of any distress or pain and looked fine. Jane has had a lot of arthritis pain in her knees and now had a gel ordered that relieved her pain a great deal and in the past had not been sleeping well because of this pain. When I went back into this room at approximately 9:30 PM to give Jane her meds she was fine and was acting like she normally does. She took her meds and I spread some of the gel on her knees to prevent pain. Jane is able to make her needs known but is sometimes confused. She will ask for pain medications and rings appropriately for help. She is alert and oriented X 2-3.

The next day (Friday) when I went in to work I was told Jane had been admitted to the hospital. When doing rounds she was found SOB with sats in the 60's and with oxygen her sats were brought up to 80 percent. I was told she had CHF. She did not have a prior history of CHF but she is 82 years old. I was upset and cried when I heard this. I could not believe it when only 3.5 hrs earlier she was not exhibiting SOB and did not complain of feeling unwell. I worked on a telemetry unit for 2 years as a nursing assistant while in school so I definitely know when someone is having SOB. Plus it is pretty obvious.

The nursing supervisor pulled me aside last night and asked me what happened. I told her she did not have SOB or any indication or C/O feeling poorly. I told her I could not believe she had been admitted to the hospital for this and how I had commented to nursing colleagues about this also. Jane is now saying that she told the nurse at 8 PM that she had SOB and that the nurse put the head of the bed up and told her she would be OK. I am upset that this woman said that. It makes me look incompetent- especially as a new nurse. It may have been one of the aides that told her this but generally my assistants tell me right away when one of the resident's are having a problem. How should I handle this? Can I be sued for negligence? I have always gotten along quite well with this resident and she thanked me profusely for getting her the Gel for her knees as this took a lot of advocation for the patient.

Thanks for any replies,

Heather

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Specializes in Cath Lab, OR, CPHN/SN, ER.

I always like to put "denies any other complaints or needs" in my written notes. Not sure how much it will cover me legally, but if it's true, I put it!

Since she is confused at times, and if you did good documentation, you should be fine. Was the roommate aware of what happened? Is she with it enough to vouch for you?

A lot of the little ol' ladies also think any female wearing scrubs is a nurse, whether it is the nurse, the aide, or housekeeping. Half of them think my husband (a nurse) is a doctor!

Other possibility- flash pulmonary edema. Happens very quickly, and it would explain why she suddenly had problems later.

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Specializes in Nursing Home ,Dementia Care,Neurology..

When you rubbed on the gel was the head of her bed up then? As another poster said,maybe someone else was in there.

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Specializes in ICU.

Most of the time "Jane" probably doesn't even remember what you say to her or what you do. She probably doesn't know the difference between an aid or a nurse, and though she smiles at you when you come in the room, she probably doesn't remember any of the specifics of your last encounter.

You're not going to be sued. You're not going to be in trouble. She would have had flash pulmonary edema regardless and would have gone to the hospital regardless.

Just remember, when you say something is so, it is so. When you write it in an assessment, it happened. If she wasn't short of breath when you last saw her, she wasn't short of breath when you last saw her. I don't care if you get fired, you never back off of what you said was so. We are nurses, our word is gold. And that's that.

If a patient gets tylenol when she has a fever of 100 and not 101.5, and if you document that the tylenol was for a headache, that's what it was for. Their temp is irrelevant. If you charted it was for a headache, it was for a headache. It is so, therefore you charted it; you charted it, therefore it is so.

I hope you see where I am going with this.

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Specializes in neuro/ortho med surge 4.
I always like to put "denies any other complaints or needs" in my written notes. Not sure how much it will cover me legally, but if it's true, I put it!

Since she is confused at times, and if you did good documentation, you should be fine. Was the roommate aware of what happened? Is she with it enough to vouch for you?

A lot of the little ol' ladies also think any female wearing scrubs is a nurse, whether it is the nurse, the aide, or housekeeping. Half of them think my husband (a nurse) is a doctor!

Other possibility- flash pulmonary edema. Happens very quickly, and it would explain why she suddenly had problems later.

Thank you for the reply. I have 20 residents and only document when there is a "problem" with the resident. She was acting fine and had no complaints so there was no reason to document. Her room mate is with it enough but I don't know how much she would remember. The roommate was asking the day shift nurse what happened and if it was serious so I think she would know there wasn't a problem earlier in the evening.

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{{{sistasoul}}}

I knew immediately that you didn't document on her. I've worked LTC and we only document "by exception" because one coulnd't possibly chart on every patient every night.

Nothing will happen to you, and you didn't do anything wrong.

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Specializes in ED, ICU, Heme/Onc.

There was a lot of time from 9:30p to when "Jane" was brought to the hospital. Plenty of time for her to have contact with another staff member who raised the head of her bed. If she has periods of confusion when she isn't feeling ill, or hypoxic, then she certainly isn't going to be a good historian when asked what happened.

I don't think she intentionally lied to your boss. If anything, we are authority figures to patients of that generation and the poor lady probably thought that *she* was the one who did something wrong!

Stand by your assessment. If you didn't see anything wrong, and the patient didn't tell you something was wrong, then nothing was wrong.

Take Care,

Blee

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Specializes in Community Health, Med-Surg, Home Health.

You say that the patient is alert and oriented X 2-3, which, to me, means that sometimes, she is with it, other times, she is not. If the job is not blaming you, then, please don't blame yourself. Even if the job is blaming you, you can only say what you saw, and if it was nothing, there was nothing at that time to report. I also suspect, as others, that it was probably a CNA or another staff member that she was confused about.

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Specializes in Cardiac Telemetry, ED.

Our facility policy is to chart by exception as well, but many nurses, myself included, do not adhere to this. With only four patients, it only takes a moment to chart "No c/o pain, SOB, dizziness. No requests at this time. Will continue to monitor." or something to that effect. I can see how, in LTC with however many residents you have, that this is not at all efficient or doable.

I agree with the others though, that since she is known at baseline to have changes in her mentation, this means she is a poor historian and you really shouldn't worry yourself too much. You told the nursing supervisor your account of events, and if she trusts your nursing judgment, she will stand behind you.

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Specializes in Management, Emergency, Psych, Med Surg.

From what it sounds like, you met the standard of care for this pt. These types of patients can take a turn quickly. You should not worry about this event. These things happen and we all feel bad but you can only deal with what you know. Working in a LTC facility is very hard work. I admire your ability to deal with all you have to deal with in your work. Diane

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I also agree with what everyone else has said. There is no way that you can chart on all of your residents. You did do a LTC assessment on this resident. Even tho you didn't do a head to toe..you were looking at her and listening to her while doing your med pass and treatment. I'm sure the MDS should reflect her level of orientatation too. Don't beat yourself up!!!!

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