Problem facility giving poor care

[wonderbee, BSN, RN]

At one of the facilities assigned to me, I have a patient (only one thank God) who has been getting substandard care. He is currently general inpatient for wound care. Every day someone finds him with orders improperly carried out or in an unsanitary undignified state. We have discussd it in team and I have followed through with speaking to the facility DON. I have appealed directly to the staff. I have told them that we would do all the dressing changes, put a note on the chart and left a note above the bed. He was supposed to have a silver calcium alginate dressing left on for three days which I applied and appropriately dated and initialed with a sharpie with additional marking "do not change until 6/24". What did the staff do? They changed the dressing using silvadene cream. They couldn't find the order and claimed the pharmacy never sent silver calcium alginate because the order was never faxed. It's like a twilight zone episode. He's GIP for wound care for prissy's sake!

This poor man is such a gentleman but from a CVA slurs his words. He is very much aware of what is happening to him and is aware that his dementia is increasing. I have appealed to the staff directly. We have documented up the wazoo. My DON tells me I'm really powerless now and to save what's left of the angst for when we're really going to need it. On top of it all, I think my LPN thinks I'm losing it and that there never was a silver calcium alginate dressing at all and implied that on report. I tell you I'm fit to be tied.

Any ideas?

[leslie :-D]

if you're convinced these and your pt are receiving substandard care, the snf should have the number of the ombudsman, publicly displayed on the wall.

give them a call.

that's exactly what they are there for.

best wishes.

leslie

[Hospice Nurse LPN, BSN, RN]

I agree with Leslie. Good luck to you.

[Allow Mystery]

Dear RNKittyKat,

My empathy is with you, my experience with LTC's may be best described, using one of your references, trudging in quicksand through the twilight zone.

Your DON is wise, pick your battles with these people or they will drive you crazy:monkeydance:. I usually defer to the facility's wound care nurse for patient's wound care. This saves time and cost, and allows them the control they need. Each week, I will get an updated report/document from the wound care nurse, with measurements, and

include this with my notes for our records.

One last thought , I always call the family/PCG with report after visiting patient in LTC. If I believe that the patient is not getting proper

care, I tell the family/PCG, and suggest they contact LTC's administration; administration is usually more responsive to the family/PCG concerns. Also, I try to attend the quarterly staffing on all

of my LTC patients. Best wishes, you're a wonderful advocate.

[a21chdchic]

6-26-2007

I am so sorry for what you are experiencing. I am in a very similar situation. I frequently write 3 medication errors a day in the same facility and frequently the same patient. I write the errors for Hospice Documentation, and give a copy to the person in the LTC facility who documents errors, I have arranged for Inservices on medications/documentation, treatments, I personally assess wounds on a weekly basis, I document all findings in a professional manner.

I have not found an Ombdsman to be effective, however the State Agencies can and will investigate and require changes to be made in a fair manner and they give the facility adequate time to make the changes. State agencies have the power to close down facilities if the problems are significant, and your Board of Nursing is also a resource if there are particular people that continue to repeat the 'negligent' acts. Obviously, our BON ar every powerful. Depending upon the severity of the situation, and only you know how bad the situation is, desparate situations call for desparate measures.

Ana

[bethin]

I would call family and let them know what is going on. Regardless of what they say I would call the state's ombudsman. If he's receiving substandard care then others probably are too.

Could he be transferred to another facility?

I've worked with hospice nurses while on my hospital's LTC unit and you guys are the best!! You are how the rest of us should be. Such patience, never raise your voice. You are great!

[leslie :-D]

i suggested contacting the ombudsman because it would be a timelier response.

if your ombudsman is ineffective, then i would contact the state.

it just might take awhile for them to investigate and present their findings.

leslie

[wonderbee, BSN, RN]

Many useful ideas and support here. The son is aware of the problems. We have a policy of calling after each visit. At least we try to.

I have come to trust my DON's judgment. I am however just a finger on the button away from calling the ombudsman. The situation has calmed down for now and we are finding him better cared for on our visits.