My sister was not taken care of in a nursing home

[Ginger45]

I feel really quilty about this because this is my specialty. My older sister, who is 55, has to have a hip replacement. We were in a really bad car accident when I was 15 and she was 25. It shattered her hip joint. She received a new one but that has been a very long time ago and it gave out. She was put into a nursing home last week to wait for her DR to return from vacation. I hated it because I live a long ways away. I am between jobs, and I don't have the money to go there. My sister has a long history of mental illness that includes a panic disorder. She has been on a high dose of Klonopin for years. She sees a psychiatrist regularly.

Apparently, they never even started her meds until yesterday and only started the antipsychotic. My mom said that she has been shaking for days. Also two nurses stood outside of her door and called her a "Drug addict." Yesterday, she suffered a Grandmal seizure and was sent to the ER. That was when my mom called me and I found out about the meds and the shaking. It was the lack of Klonopin that caused the seizure, and they gave it to her in the hospital. She will be staying in the hospital until her surgery. The hospital will not send her back to the nursing home now. I am very upset about this. I feel like I could have maybe prevented it had I called. I didn't though because of Hippa and you know how it is when a family member calls and throws their weight around. Also I did not know she was shaking, my mom never said anything about it or I would have picked up on that immediately. She did have a good nurse yesterday who noticed the shaking and tried to get the DR to give her something but he wouldn't.

Anyway, I am just venting here. Thanks for listening......

[Ginger45]

I had a message from the administrator in which he said that he had looked into the situation and it was not ordered when she was admitted. I had suspected that, however part of the admission process is to ask family members and the pt about routine medications. I was not impressed with his tone.

He went on and on about Hippa violations and did not address the fact that noone noticed she was having withdrawls. I know more about her then he does and because I understand Hippa regulations, I did not ask him for medical information. From his voice mail, I got the impression that he felt he was all clear. Never mind the nurses who called her a drug addict etc. Never mind she suffered withdrawls to the point of a grandmal seizure. Never mind that her husband and my mom asked what meds she was on. The ER figured it out quickly, they asked her husband what meds she was taking at home. Why did the nursing home not do that? I am really ****** now. I am considering getting an attorney and getting the records and the names of all the nurses who cared for her. If he is not going to investigate this then my only other alternative is to report it to the state and let them do it.

[SuesquatchRN, BSN, RN]

I applaud you for fighting for your sister, Ginger.

Good luck.

[withasmilelpn]

Ok, I am going to present another view. I was told by my ADON to not even consider administrating an antianxiety med or antipsychotic without having tried and documented all other avenues first. I have patients who are alert, oriented who have taken said meds for years. I know just where they will tell me to go, when I discuss alternatives with them. I have also sat next to the PA who refused to order all the meds a patient was on following admission from a behavioral, psych facility, because that was 'too much for her', even with my warnings of what I had reviewed in her copied chart. It took days of repeated calling by nursing staff about thie patient's subsequent violent, out of control behavior before she was returned to the recommended dosages by the Psychiatrist. I think that you might want to look at the policies of the facility first and then the ordering Doctor. Many Doctors won't order meds they are not comfortable with, or will change dosages, etc..

[Ginger45]

My sister does not have those kinds of behaviors. In a hospital setting she is very meek and afraid to ask for help. I do understand that some DR's feel uncomfortable but when they put her life at risk because they think she is receiving too much I have a problem with that. Taper the dose slowly if you think it too much but don't stop altogether.

[SuesquatchRN, BSN, RN]

I have a sister with schizophrenia. If someone decided that they needed her to lapse back into psychosis before giving her her Seroquel I'd have to go all Ginger on their hineys.

[CoffeeRTC, BSN, RN]

It's true, chatsdale, we do that sometimes. However, it's always a good idea to find out why the meds weren't ordered, why does the pt need them, etc. Epileptics need their seizure meds regardless of who puts what value judgement on them. Doctors get paid to answer the phone and give orders, whether they are grouchy about it or not. Even if I have a doc telling me up front, hey FYI this is probably an addict, I feel better if I've done the best job I can in advocating for the patient and calling him/her back if I think the patient presents with a need for something else. They don't all turn out to be addicts.

Yes....just because someone is on a high dose med and the state wants reductions and limits on them....it doesn't mean that the GRDs need to be done. All a doc needs to do is say no for xyz reason.

Ginger...you know the routine and you know what should have or could have been done. Sounds like sloppy nursing and dropping the ball.

I'm not a sue happy person, but I would go after them.

[rn undisclosed name]

Ok, I am going to present another view. I was told by my ADON to not even consider administrating an antianxiety med or antipsychotic without having tried and documented all other avenues first. I have patients who are alert, oriented who have taken said meds for years. I know just where they will tell me to go, when I discuss alternatives with them. I have also sat next to the PA who refused to order all the meds a patient was on following admission from a behavioral, psych facility, because that was 'too much for her', even with my warnings of what I had reviewed in her copied chart. It took days of repeated calling by nursing staff about thie patient's subsequent violent, out of control behavior before she was returned to the recommended dosages by the Psychiatrist. I think that you might want to look at the policies of the facility first and then the ordering Doctor. Many Doctors won't order meds they are not comfortable with, or will change dosages, etc..

Sorry I don't agree with this viewpoint. If they would have looked at her medical hx they would have clearly seen why she was getting this med. This is not someone who is without an extensive psych history. If a pt is tolerating a med then I have a hard time seeing how it is too much for that person. Yes to start them out on a high dose is most likely too much but if you are getting the appropriate response from the patient on those medications, well, then it is not too much. Isn't this why we monitor patients and their responses to medication?

Ginger that is awful what happened to your sister. You have every right to go after them. Hope everything turns out well for her.

[Ginger45]

I want to thank all of you for your kind responses. It has helped me alot. Now I know what it is like to be on the other side of the fence. My Grandmother died of a blood clot. The nurses described her as whiny and didn't check it out. By the time she died her whole leg was blue. I was only 13. I knew nothing about what should or should not be done. I will never forget it though because something did not seem right to me. My mother never made an issue of it. I guess that is why I am the way I am. I am that way even if they aren't family. I know that mistakes happen. If he had done an investigation, found out who the nurses were that didn't notice the withdrawls and talked about her outside of her room and done something with them. Also found out why the klonopin was never picked up. Heck, they were giving her her risperdal. I would be satisfied. I wanted him to take the initiative and fix it for others. My sister will never be in a nursing home again. I don't care if she has to come here.

Update: She was transferred to UAMS yesterday for her surgery. Her husband went with her. Poor guy, he is terrified to leave her alone. She is about 2 hours from me so I will go up to see her this weekend. I am glad that they are doing the surgery there. It is one of the best hospitals in the country for that sort of thing. Oh and the nursing home sent a big flower arrangment. I have a kind of dysfunctional family. But we do all pull together and all is forgotten when there is a crisis. My mom can be really mad at me but when she or anyone else in my family is ill, I am the first one she calls. All is forgotten. Family is Family.

Thanks again everyone, your love and support has meant alot.

[withasmilelpn]

Sorry I don't agree with this viewpoint. If they would have looked at her medical hx they would have clearly seen why she was getting this med. This is not someone who is without an extensive psych history. If a pt is tolerating a med then I have a hard time seeing how it is too much for that person. Yes to start them out on a high dose is most likely too much but if you are getting the appropriate response from the patient on those medications, well, then it is not too much. Isn't this why we monitor patients and their responses to medication?

Ginger that is awful what happened to your sister. You have every right to go after them. Hope everything turns out well for her.

No offense, but you guys are missing my point. It is not why she is on it, I totally agree that it was inappropriate to stop her meds. It is up to the PA, NP or MD to order the meds. Period. Nurses can advocate for their patients and trust me I do! What I was pointing out though that I had documented proof that this patient was on appropriate therapy. She had spent an extensive stay at the behavioral unit where the MD there is known for his less is more theory. All this and the PA still made the (wrong) decision to cut her meds. If your sister did not have adequate documentation to support her meds, or the MD was uncomfortable, or recently had a lot of pharmacy reviews recommending cuts, was having a bad day, didn't care... on and on you get the picture. That is why when I disagree with a physicians choices I document exactly what I did and said. I also don't hesitate to get the family involved if need be. (Of course I am not sure whether you were the contact person, sometimes the level of involvement and knowledge they have influences decisions like these.)

[blueheaven]

TRUE TRUE ZIM! Sorry gang...but if some of her caregivers thought she was an addict there's no way in hell she was going to get her meds even if she spoke up for it. Talk to the nursing home ombudsman in that area about that situation and possibly talk to an attorney.