Need help please, pt not allowed to have meds and not safe to live alone...

Mulan · Dec 4, 2006

Can you report the son for elder abuse? Is there adult protective services? Sounds like abuse to me, if he won't fill the scripts. Does the son not want the parent to be spending the money on the meds?

Home Health Columnist / Guide · Dec 4, 2006

Report to

a. Discharging facility doctor and discharge planning staff

b. Protective service if can't get hold of son tomorrow to get meds straightened out.

c. MSW eval re med management and family counciling

d. Notify supervisor

e. Call to pts pharmacy--see if they know of any issues.

f. Needs visit tomorrow for followup and speak with pt what SHE wants and needs.

DutchgirlRN, ASN, RN · Dec 4, 2006

Thanks Karen. I know the issue is that he's afraid the parent will abuse the meds because that's what the pt went in the hospital for in the first place. Overdose, accidental. However this patient does have legit pain, I feel this pt cannot handle his/her own medication management and shouldn't be living alone. After I posted I thought about the MSW too and think that's where I'll begin today. The son fills the medication box on a weekly basis. I will suggest that he comes over twice a week to replace the patch as well. I have already scheduled a PRN visit for today with another nurse, need another opinion, maybe I'm not seeing it in perspective but I think I am. Thanks, I'll let you know what happens.

cookie102 · Dec 5, 2006

i'd get your MSW in there ASAP, see that patient daily for a few days

CardioTrans, BSN, RN · Dec 5, 2006

Report to
a. Discharging facility doctor and discharge planning staff
b. Protective service if can't get hold of son tomorrow to get meds straightened out.
c. MSW eval re med management and family counciling
d. Notify supervisor
e. Call to pts pharmacy--see if they know of any issues.
f. Needs visit tomorrow for followup and speak with pt what SHE wants and needs.

All of this, plus.......

When you speak to the son, you need to make sure that he is aware that home health cant continue to come in daily or sit with her. Unless she has a different policy outside of Medicare or if he is willing to pay for a private sitter through another agency.

He also needs to know that the discharging MD may sign the original 60 day orders, but in order to recert her if needed, then she will HAVE to have a PCP.

Is the patient able to get out of the house if it caught on fire??? Major safety issue if not and she may be able to be removed from the house. Is there any possibility that the son may allow her to move in with him? Or have some pre-planned arrangements for long term placement somewhere???

DutchgirlRN, ASN, RN · Dec 9, 2006

The pt has been discharged. The MSW was able to find out that the pt had been put out of several good assisted living facilities. On a return visit this pt showed me his/her stash of Lortab, MS, and Dilaudid each from a different doctor and filled from a different pharmacy all within the past 2 days! I feel this pt has legitimate pain but is abusing and also that the fact that he/she showed me the stash tells me she/he is reaching out for help. This pt is a huge liability to the agency. On O2 and caught smoking as well!

augigi, CNS · Dec 10, 2006

Did not see OP's most recent update post.

DutchgirlRN, ASN, RN · Dec 11, 2006

First of all, sounds like the son has a serious knowledge deficit about pain management. Why wouldn't you try talking with him to explain that people with pain rarely if ever get "addicted" to pain meds prescribed by their physician?

You're missing the point completely. This patient is visiting multiple doctors, getting multipe narcotic prescriptions and taking multiple narcotics. All this after being discharge from rehab only 2 days ago.

Otherwise, if the patient was competent, I would get them to call their pharmacist and fax the script for them!

While this patient is competent she/he is an addict and she/he is acting irresponsibly. Although I feel compassion for this pt. I will not enable him/her to feed their addiction.

FYI: In the US scripts for narcotics cannot be faxed or called in.

augigi, CNS · Dec 11, 2006

You're missing the point completely. This patient is visiting multiple doctors, getting multipe narcotic prescriptions and taking multiple narcotics. All this after being discharge from rehab only 2 days ago.
While this patient is competent she/he is an addict and she/he is acting irresponsibly. Although I feel compassion for this pt. I will not enable him/her to feed their addiction.
FYI: In the US scripts for narcotics cannot be faxed or called in.

Actually, I missed the OP's last post, which you'd have to admit changed the situation considerably from the first one....!

But thanks for setting me straight :rolleyes:

Jo Dirt · Dec 17, 2006

I wouldn't be so quick to jump on the phone with APS, especially since this patient is of sound mind and the son is not the POA.

Likely, considering her history, he probably thought he was avoiding giving the patient the opportunity to overmedicate him/herself. I know that some people are appalled at the thought of taking any kind of medication (I've even seen doctors who will avoid prescribing any medication at all costs) and he may feel these meds would just be facilitating a way for her(?) to resume addiction.

I just think that in a lot of cases people are chomping at the bits when in doubt to call social services and I just don't believe that is a good practice and can cause unnecessary trouble and grief for everyone involved. Maybe the son is ignorant about the meds? and it sounds like he may have had legitimate reason to be concerned about addiction. I would talk to him first and find out what is going on.