New roommate on precautions

[JBMmom, MSN, NP]

Yesterday afternoon we had a new admission come in. The current resident in the room is alert and oriented, most of the time, very independent and a little angry/ paranoid about moving into long term care last summer. The new woman being admitted is supposed to move to our short term rehab wing today or tomorrow but there was a hold-up with an empty bed. She has VRE, and while the roommate was at dinner, the precaution cart and sign were put out. So, the roommate approaches me and says there's a stupid note on my door that says I need to see a nurse before I can go into my own room”. I told her that she shouldn't be concerned if she sees staff wearing gloves and gowns while providing care for her new roommate, there's no risk to her safety. Her response is Bull xxxx. You put someone sick in a room with an elderly person and expect me to be okay with it?!” This was the beginning of about an hour of swearing, tears and accusations. The resident said she would not be returning to the room and tomorrow she would have her daughter pick her up and never bring her back to a bunch of sneaky people that would do something like this to her when it's where she's supposed to live. Granted, she demands her daughter pick her up about once a week because there's some reason she's not staying anymore, but I have to say I can see why she's so upset. I can't give her the roommate's medical diagnoses, and even if I could I don't think I could really explain the transmission/ protection to her so that it would make her feel better. I had to leave before bedtime, but the supervisor was supposed to get in touch with our DNS to find out whether she could sleep in a different room last night. How do you think you would handle it when a resident comes upset because a roommate is on precautions? It has happened before a number of times, but I've never had complaints. If there's really no rationalizing with the person that it's not a danger, what else can you do? I really felt badly for the poor woman when I left last night, she was just sitting in a chair, looking very lost and asking where she could stay?

[silverbat]

In my opinion.... as an MDS/staffing coordinator, I would NEVER put the resident with VRE in a room with another resident. Your infection control nurse should be consulted prior to admitting anyone neediing precautions BEFORE they are admitted. If you do not have an Infection control nurse, then check with your DON before as well. the CDCis a good resource on this issue as well.

[casi, ASN, RN]

Nope wouldn't happen in my facility. If a patient has VRE the only roommate they can be paired with is another patient that has VRE.

[Red Kryptonite]

Your resident is perfectly right to be upset. Frankly I think your facility treated her terribly. Maybe since I'm not a nurse yet I'm naive or something, but it seems to me to be plain stupid to put someone on contact precautions in a room with someone who is not.

[JBMmom, MSN, NP]

Thank you for the responses, I felt the whole situation was a problem that really should have been avoided. I'll be interested to find out next week how they handled it after I left, but I think it should be something addressed for the whole facility. It definitely wasn't fair to the resident that was left crying, it really bothered me to leave with it unresolved.

[CapeCodMermaid, RN]

It's not the bubonic plague. More than half of our admissions come in with a diagnosis of VRE in the rectum...it's extremely hard to contract VRE from someone else. It's extremely hard to catch MRSA from someone who has it in the nares. It's not a huge deal. We keep our facility as home like as possible. People with CDiff are in a private room or cohorted but are not confined to their rooms.

We had one case of a roommate with MRSA in his penile discharge. His roommate refused to go into the room....really?? Keep your hands to yourselves and wash them often. I'm sure lots of us would test positive for MRSA in the nares and we are not public health hazards. I'd be more worried about hanging out with someone who wasn't vaccinated against the measles!

[JBMmom, MSN, NP]

Capecodmermaid, thanks, I was waiting for you to chime in! I guess my bigger concern was that while we could definitely keep the resident safe, we can't really reassure her of it. First, we can't share the medical information of the new roommate because of confidentiality issues, and second, the mental state of a resident should be a consideration when placing a few roommate. She already distrusts staff, so adding this to the mix definitely didn't help. Yes, VRE and MRSA are regular diagnoses at our place as well.