Polite way to document over-involved family members?

[BiohazardBetty]

How do you document when a family member is waaay too involved or excessively demanding?? I want to keep it professional & not look like I'm name calling, but I want my charting to reflect the family members actions... Especially with families who seem particularly litigious.

As it stands, our computer charting makes it easy to chart if guests do not participate in care or if they are disruptive to the patient, but lots of times the guests aren't really disruptive... They're just sort of "Grey's Anatomy" nurses :/

Any advice is appreciated :)

[AOx1]

I would be very factual and use quotes. Ex- who is present, what are they doing (ex- writing things down in journal, demanding a change in care based on article they read, etc) as well as any education or intervention provided. Ex- "Pt. Wife at bedside. States that she read in Women's Magazine that morphine is abused. Wife seen moving PCA button out of pt's reach on two occasions. Reiterated need for post-operative pain relief and consequences of untreated pain on pt's overall health. Will continue to monitor pt. Pain levels and family's understanding of plan of care." If needed, document any follow up, such as switching delivery methods, calling security, etc. Notify risk management if needed.

[RunninOnCoffee]

Oh we have all had those. I had a wife that was determined to give her confused husband that just had a massive CVA with almost no swallow reflex a "small sip of diet coke" because he "wanted it." Mind you, he had just been extubated also. I caught her the first time, and the second time I caught her as she had the straw in his mouth and he choked about 2 seconds later. I just charted something along the lines of "observed pts wife at bedside attempting to give po fluids. Educated family in dangers of aspiration and need for NPO status" and would later add on "observed pts wife again attempting to give po fluids, reinforced education of risks of aspiration, pneumonia, and safety. MD notified of family noncompliance." We had trouble with that little angel the entire hospital stay on multiple different floors. Just chart to cya. As long as you just state the facts in a non biased tone you're covered.

[jadelpn, LPN, EMT-B]

And make sure that when you observe and document as indicated, that someone else knows this--including the MD. Meaning, your charge nurse, your nurse manager, your patient relations department, the social worker. If a family member has an issue ie: giving diet coke when patient is having swallowing issues, come back with a plan for speech/swallow to see patient, and charge nurse to go in and discuss, case manager/social work to talk about plan of care going forward.

Do not take the responsiblity on yourself--ie: "patient's wife states that patient is to be walked q hour. States that patient is 'getting weak' by 'inactivity' and that patient will 'end up an invalid that needs constant care'. Charge nurse notified to continue to review plan of care with patient's family. MD notified, PT notified to set up consult for family education. Social work and case managment notified to speak to patient and family on discharge planning."

Just make sure that however irritating a "request" is presented to you, or even a passive aggressive comment, that there is an answer by using your resources. Document to cover yourself, but have interventions listed as well.

[Esme12, ASN, BSN, RN]

keep it professional and objective. Just state the facts. wife/daughter/friend at bedside continued requests for water@ 1230(patient NPO), pillow@1245, pain med for patient @ 1300 (patient pain free medicated@1250) family encouraged to allow patient rest, educated family a fourth time about NPO status...manager/charge nurse notified.

[kakamegamama]

Sometimes, it would just be nice to kick those well meaning people out of the patient's room, wouldn't it? But then........

[ProgressiveActivist, BSN, RN]

I had a self described "ICU nurse" visitor constantly stimulate an intubated patient and untie the wrist restraints when I was out of the room.

I let management know that I would not be held responsible for a self extubation and wrote an incident report. I got permission to ask them to leave and with security present I firmly said "it's time for you to go." Made my day when they left.

[caliotter3]

I had a self described "ICU nurse" visitor constantly stimulate an intubated patient and untie the wrist restraints when I was out of the room.

I let management know that I would not be held responsible for a self extubation and wrote an incident report. I got permission to ask them to leave and with security present I firmly said "it's time for you to go." Made my day when they left.

Almost wish I could do this on a daily basis with my patient's parents. Unfortunately, this is home care and you can't make them go away from their own home.

[ProgressiveActivist, BSN, RN]

Back to the original topic. How to document the above incident:

" Spouse has used the call light 5 times in the past hour to request mouth care, turning, foley care and a back rub -all of which were already done, and despite repeated education on the plan of care demands constant interpretation any minute change in vent pressures and monitor waveforms. Restraints were untied when I was not in the room. Fi02 was turned to 100% by an unknown person. Spouse talks incessantly to pt and patting and squeezing his hand and arm to elicit a response. Attempts to educate on sedation and analgesia to no avail. Necessary to increase Precedex to 0.8mcg/kg/hr and fentanyl to 50 mcg/hr for a RASS -2 due tachycardia, agitation and attempts to self extubate.

Nursing administration and attending MD informed that spouses actions are detrimental as evidenced by the Ventilator changes untied restraints increased HR RR and level of agitation necessitating increased sedation and analgesia. I requested that a security guard or sitter be provided while the spouse is visiting to ensure the patient's safety or that this pt be on 1:1 ICU status. Awaiting a response.

[ProgressiveActivist, BSN, RN]

Make friends with risk management.

They want to know about the potentially litigious families and are very good at nipping these situations in the bud.

Document, document, document.

[addylpn]

This reminds me of the time a fam member wanted to look at their parent's actual meds in the med drawer. Wanted to compare them to the MAR and also wanted to dc the ones they thought were not needed because they had "researched" them. Same person in denial about parent's anxiety issues and prohibited any/all anti anxiety meds. The parent would have such severe panic attacks they would literally vomit.

Be kind to me

Or treat me mean

I'll make the most of it

I'm an extraordinary machine

[ProgressiveActivist, BSN, RN]

Depending on the severity of the situation, I would either ask to be reassigned and/or notify the Primary Care Physician and Agency administration and insist on an investigation by Child Protective Services.