Need advice on reporting incident with relative

CHATSDALE · Mar 4, 2005

sometimes communications between shifts are not what you might wish...i am glad that your g'father did well...reporting may change the system they have in transfering info

i don't believe that anyone was at fault in this instance .. many times families do not want to see procedures .. some really want to be there for loved ones...this is personal decision and each should be respected

allele, LPN · Mar 4, 2005

I agree with Chatsdale that (unfortunately) communication between shifts is sometimes less than perfect, but that's the only part I can agree with. I do think there was fault with the RN. I won't even let a patient go down to the O.R. without the family seeing them off if they told me they wanted to be there. If no one on the previous shift tells me that the family wants to see the patient off, I ask the patient. In the OP post it's obvious the nurse couldn't ask the patient, but the rest of the family was there! They told her the time agreed upon was 0900 and the WIFE OF THE PATIENT had planned on being there!! I think it was irresponsible to extubate without the family there that wished to be there, especially because the patient wasn't expected to make it. (I'm very happy for you and your family that he did, by the way!). I'm not sure about reporting though. Maybe a letter to the administration?? I think that would be appropriate, and maybe request communication back to you letting you know what they planned to do about lack of communication among staff. Best of luck with this and I'll keep your grandparents in my prayers!

fabnurse · Mar 4, 2005

I have just started nursing school and only have a vague idea of how thing run in the ICU. I have a question about care my grandfather received there recently, but am not sure if it is reportable (I feel I should) and how to go about reporting it. I am pretty upset and am directing my feelings toward one nurse in particular, but am not sure if I am directing it in the right place.
My grandfather was in ICU on a ventilator. It was against his wishes to be put on it (another story), so they were taking him off. They told my grandmother to call the family because he was not expected to make it long after. The night before, the nurse on-duty told us what to expect the next morning...she said once everyone was there to let the waiting room attendant know and we would all be allowed to go back and visit for a bit. Then my grandmother or dad would be able to be in the room when they took it out if they wanted while the rest of us waited in a separate room. She asked what time everyone would be there the next day. My grandmother told her 9 am. The next morning we had all arrived and my grandmother was stuck in traffic. At 8:30 a nurse called to the waiting room and asked if the family was there. I told her no, my grandmother was not and we were not due to be there until 9...she says 'well, you didn't tell me that' and hangs up the phone. A few minutes before 9 my grandmother is pulling into the hospital finally and about the same time the nurse calls out again and says she needs the wife and one other relative in back there. My dad and uncle went since my GM was parking car and such. THEY HAD ALREADY TAKEN IT OUT!!! Did not tell us, they were going to do it or anything. Just called out after they had.
I cannot fathom why they would not wait for the wife to get there to do this or why they would not call out and say 'we are going to go ahead and do it now anyway, the rest of the family can come back and visit once more.' Fortunately he pulled through, but what if he had not.
I am really furious about this and don't know who to direct it at. Can anyone give me some insight as to what might have gone on there?
Thanks,
KB

Whoa the fact that he was put on a ventilator without consent is wrong. ICU rules might be different from a med/surg floor but if a patient refuses a treatment-and they do have that right-healthcare workers have to make sure they understand what their refusing and other options. With his condition, his options should be explained. If the ventilator was an option and he refused-he has that right according to the Patient's Bill of Rights. However, if his heart should stop or he should stop breathing without ventilator (breathing) and he doesn't want to be brought back to life....they should have told him about the DNR/DNI option as well. Do not resuscitate/Do not intubate. All of this should have been explained to your grandfather and grandmother. Of course, i'm happy that he is well. He didn't need the ventilator anyway. This situation is more like medical mismanagement NOT so much malpractice. You should talk to the Nurse Manager and your grandfather's doctor about how you feel. Your grandfather never gave any written or signed consent, nor did your grandmother it seems. Look, that's just wrong. People make mistakes, but as I've learned just being a student that just doesn't cut it. People have lost their licenses for lesser things. I'm about to graduate in June and I've cared for a vent patient. You'll learn that procedures just can't be performed without consent from patient, family, etc. It's a legal issue. For yourself, learn early to cover your *** with documentation on everything you do for your patient. They wanted to take it out because they realized there wasn't any consent to do it in the first place. I'm frankly a little surprised. But don't go postal on them...just speak to them professionally just in case you end up working there one day. Also, treat it as a learning experience for yourself too. But thank God your grandpa is ok. The nurse was rude most likely due to stress. I think they lacked a therapeutic touch with your family. That's key in nursing. Your family wasn't very supported and you should point that out as well. As busy as it gets on the floor...we always have to stop and console the family and patient-its part of the job. I hate to see people in anguish. So hope it works out and good luck with school!!!

elkpark · Mar 5, 2005

You (or anyone who is unhappy with the care they or a loved received in any hospital) can contact the hospital and ask what their procedure is for filing a grievance. The hospital is required (by CMS as well as, usually, state law) to have a process for investigating and resolving complaints/grievances, including notifying you in writing of the outcome of the investigation.

You can also complain to your state agency that regulates hospitals -- the name is different in every state :) , but it's usually a division of the state Dept. of Health and Human Services (or whatever that's called in your state). There is usually an 800 number for complaints. They will investigate your concerns and determine whether the hospital violated any of the state or Federal rules it is obligated to follow.

Hospitals usually prefer that you complain to them first if you have a problem, and give them a chance to resolve your concerns before you go to the state, but you are not obligated to do so.

apaisRN, RN, CRNA · Mar 6, 2005

In general we don't allow family to be present for extubations in the ICU. If you were promised, it should have happened, but no one was harmed. I understand your anger and don't know what to tell you, but it was a misunderstanding.

Fabnurse, are you a nurse yet? Sounds like you have a lot to learn about living wills and patients' wishes. It's not nearly as clear-cut as you make out.

mattsmom81 · Mar 6, 2005

I agree with you 100% apaisRN. The OP's anger shows the extent of the tunnel vision and entitlement of today's patients and families, unfortunately.

Most frustrating to me however, is the nurses here who would criticize another nurse without even knowing the whole story, Shame on those of you who did.

God what I wouldn't give for a little bit of solidarity...what doctor would ever criticize another doctor simply based on what they read on a BB??

And in general I disagree with the idea that ICU is a 'reality TV' show for families to watch. ICU is a hectic place where lives are being saved, lifesaving procedures in progress, crisis being averted. Timing events for families presence cannot always be at the top of the list, nor guaranteed.

I am an ICU nurse by the way so I know what goes on in the real world of ICU.

The day shift ICU nurse likely never got the 9 am message or else other things were going on, (think codes;dying) other people's schedules to consider (doctors, RT's, etc) so the timeframe got offschedule a bit.. FOR GOOD REASON more than likely.

But yes I'm sure the OP will write a scathing letter because she did not get her way.

Student nurses should be especially thoughtful ...you are creating your own future !

Supporting the extreme customer service attitudes out there guarantee you will be dealing with worse soon enough. When you're out there dealing with crisis, trying to prioritize, and family members are throwing tantrums, remember this thread.

'Burger King' mentality has gone too far when hospitals support it...particularly in ICU.

JMHO.

ktwlpn, LPN · Mar 6, 2005

I agree with you 100% apaisRN. The OP's anger shows the extent of the tunnel vision and entitlement of today's patients and families, unfortunately.
Most frustrating to me however, is the nurses here who would criticize another nurse without even knowing the whole story, Shame on those of you who did.
.

We REALLY only know the OP's side of the story and as nurses we all know there was way more involved-Just the fact that the g-father "was put on a ventilator against his wishes" attests to the turmoil the OP and her family were going through.....I feel that the OP and rest of the family does have to take some responsibilty here-I don't mean to offend but my g-mother would NOT have been driving there alone to stand beside my g-father at what was was expected to be his last breath...And how fortunate to have the chance to be surrounded by loved ones at that time-most people don't get to "schedule" their demise....BUt My Lord----arriving LATE? I think I would have picked up my g-mom at about 5 am to make sure she got there.Someone should have met her at the entrance and parked the car for her while someone else scurried her to the unit........The night my gramdmother died I watched my aunt get into her car and instead of putting it into reverse she floored it straight ahead into the landscaping around the hospital door---grief can do that to you....The OP's feelings of anger are maybe a bit misdirected but are part of dealing with the trauma....I imagine she is angry at the people responsible for putting her g-dad on the vent "against his wishes" As we know advance directives are not recognized as legally binging documents in all states and the g-mother probably gave permission without the rest of the family present...That kind of thing happens between couples frequently and even though you don't agree you have to accept and support your loved one's decisions..Hopefully something good will come of all of this-the family needs to get together and discuss their wishes in a frank manner....Also we can all take something away from the OP's experience and try to handle our patients and loved ones with a little extra compassion.No one knows what else was going on in that unit at that time-we all need to be reminded that it does not matter to the pt and s.o.'s ..they only cared about their loved one and that's ok,too...Doesn't matter if your loved one is 9,29 or 99-you are still experiencing a loss.....To the OP-give yourself some time to sort through what happened and talk with your loved ones....by all means do write a letter to the nurse manager of that unit..Hold onto if for a few months-read it again and then decide if you should floow through...Your preception of the events may be very different down the road....

kbclary4 · Mar 8, 2005

The fact that he was put on without his permission is a complete non-issue here. My grandmother was completely at fault here as she and his doctor (not present at the time) knew his wishes and for whatever reason did not follow them. The reason I mentioned it was that after the fact, she calmed down and thought about it and asked that he be taken off. I only mentioned it to tell why it was being removed.

None of us wanted to be in the room when they removed it. That is just what the nurse on duty that night told us was an option. What I had issue with was the fact that the nurse on duty that morning knew the wife was not there and that we had been told the night before that it would happen at 9 am and did not wait for that time OR AT LEAST call the waiting room to let us know it would have to be taken out regardless of time or whether the wife was there. She called two times and easily could have said we were given incorrect information the night before or something. All we wanted was to spend a few moments with him before it was removed. We had dealt with this particular nurse several time throughout the stay in ICU and she was never even so much as friendly. All of the other nurses he had were at least that even when it was hectic. A few of them went out of their way to be nice to him and the family.

As for my grandmother being late...She was not driving alone and was stuck in traffic for almost two hours. The other realtives that were there lived close to the hospital or spent the night in the ICU waiting room.

I think MattsMoms post was a bit harsh and you are obviously bitter about something. Nobody threw a tantrum, we haven't even said anything to anyone and may not. The whole reason for the post was to get some insight into what might have gone on. As I said I only have a vague idea about the ICU. I was upset and confused about what happened, but not irrational. I wanted to know if this was something to report (and if so how) or if there was some explanation I had not thought of. Not be berated and made out to be some hot-tempered idiot who complains about everything that does not go their way. I think you need a vacation.

We REALLY only know the OP's side of the story and as nurses we all know there was way more involved-Just the fact that the g-father "was put on a ventilator against his wishes" attests to the turmoil the OP and her family were going through.....I feel that the OP and rest of the family does have to take some responsibilty here-I don't mean to offend but my g-mother would NOT have been driving there alone to stand beside my g-father at what was was expected to be his last breath...And how fortunate to have the chance to be surrounded by loved ones at that time-most people don't get to "schedule" their demise....BUt My Lord----arriving LATE? I think I would have picked up my g-mom at about 5 am to make sure she got there.Someone should have met her at the entrance and parked the car for her while someone else scurried her to the unit........The night my gramdmother died I watched my aunt get into her car and instead of putting it into reverse she floored it straight ahead into the landscaping around the hospital door---grief can do that to you....The OP's feelings of anger are maybe a bit misdirected but are part of dealing with the trauma....I imagine she is angry at the people responsible for putting her g-dad on the vent "against his wishes" As we know advance directives are not recognized as legally binging documents in all states and the g-mother probably gave permission without the rest of the family present...That kind of thing happens between couples frequently and even though you don't agree you have to accept and support your loved one's decisions..Hopefully something good will come of all of this-the family needs to get together and discuss their wishes in a frank manner....Also we can all take something away from the OP's experience and try to handle our patients and loved ones with a little extra compassion.No one knows what else was going on in that unit at that time-we all need to be reminded that it does not matter to the pt and s.o.'s ..they only cared about their loved one and that's ok,too...Doesn't matter if your loved one is 9,29 or 99-you are still experiencing a loss.....To the OP-give yourself some time to sort through what happened and talk with your loved ones....by all means do write a letter to the nurse manager of that unit..Hold onto if for a few months-read it again and then decide if you should floow through...Your preception of the events may be very different down the road....

Nurse Ratched, RN · Mar 8, 2005

PLEASE, everyone! Refrain from personal attacks. Kindly address the situation, not other posters.

ktwlpn, LPN · Mar 8, 2005

The fact that he was put on without his permission is a complete non-issue here. My grandmother was completely at fault here as she and his doctor (not present at the time) knew his wishes and for whatever reason did not follow them. The reason I mentioned it was that after the fact, she calmed down and thought about it and asked that he be taken off. I only mentioned it to tell why it was being removed.
None of us wanted to be in the room when they removed it. That is just what the nurse on duty that night told us was an option. What I had issue with was the fact that the nurse on duty that morning knew the wife was not there and that we had been told the night before that it would happen at 9 am and did not wait for that time OR AT LEAST call the waiting room to let us know it would have to be taken out regardless of time or whether the wife was there. She called two times and easily could have said we were given incorrect information the night before or something. All we wanted was to spend a few moments with him before it was removed. We had dealt with this particular nurse several time throughout the stay in ICU and she was never even so much as friendly. All of the other nurses he had were at least that even when it was hectic. A few of them went out of their way to be nice to him and the family.
As for my grandmother being late...She was not driving alone and was stuck in traffic for almost two hours. The other realtives that were there lived close to the hospital or spent the night in the ICU waiting room.
I think MattsMoms post was a bit harsh and you are obviously bitter about something. Nobody threw a tantrum, we haven't even said anything to anyone and may not. The whole reason for the post was to get some insight into what might have gone on. As I said I only have a vague idea about the ICU. I was upset and confused about what happened, but not irrational. I wanted to know if this was something to report (and if so how) or if there was some explanation I had not thought of. Not be berated and made out to be some hot-tempered idiot who complains about everything that does not go their way. I think you need a vacation.

You post clears up some of the confusion-but I still am missing something...The staff believed no-one wanted to be with him when he was taken off the ventilator and you state that this was this was correct.They thought no-one wanted to be in the room so they went ahead and extubated him? That does sound reasonable to me..They did not clearly understand that everyone wanted to spend the minutes prior to the extubation with him-they assumed since no one wanted to be there during the procedure it was ok to go ahead and do it.....I think your family was done a diss-service and should have been given the opportunity to say goodbye prior...I think a letter to the nurse manager is appropriate in this instance-I would want to know if they have an extubation protocol...That's a good idea-a great deal of teaching is involved-I see no reason why these particulars can't be part of the plan of care-This is something social services should have determined and communicated to nursing -mho....But there was no harm done as your g-father did survive....As for a particular nurse "not being friendly"-that is really OK,too--we have to be competent for sure but I don't think we have to win any personality contests..Warm fuzzies are nice but not much good in a crisis .... A seasoned nurse like mattsmom has dealt with things you can not imagine-check back with us in a few yrs.You are NOT going to believe how some people act...

caroladybelle, BSN, RN · Mar 8, 2005

As far as I know, in most places that I have worked, the extubation is done by RT/MD/resident. At very least they generally must be present. An MD usually is nearby to sign the death certificate.

As such, the nurse can argue till the cows come home. Beyond throwing his/her body over the patient...which result in a firing of said nurse, very little will delay the procedure. They have necessary jobs to perform that cannot wait for every single family member to show up, sad but true.

As nurses, frequently we have little control....despite what we hear in platitudes of the ivory towers of Nursing school, and despite misconceptions bred by bad TV.

And whether the nurse was nice matters little or not. Whenever, a patient is in a sad situation, someone ends being the scapegoat for the pain that the loved ones feel. If a nurse tells the hard truth, frequently they are not "a nice nurse".

The complaint should be with whomever physically extubated the patient and even then, it needs to recognize the limitations of the situation.

Nurses get metaphorically beaten up over enough situations beyond their control. It is why there is shortage, and burnout.

Does anyone really believe that we enjoy terminal extubations and would deliberately or neglectfully maltreat the family during such a situation? Laying this all at the nurse's doorstep is not appropriate.