BackInTheGame

We d/c unused pain meds too and our DON is the only person who has the authority to destroy d/c'd meds with the facility supervisor as witness. What gets me fired up is a doc who d/c's pain meds that ARE being used on a regular basis. Had a pt once who's pain assessment was always in the 8-10 range with Lortab taking it down to maybe a 3 and Ultram only taking it to a 5-6. The doc decided that the pt couldn't possibly be in that much pain and d/c'd the Lortab and Ultram and left us with nothing but Tylenol q6h. This is also the same doc who told me that the liver problems I have (non-alcohol steratohepatitis) can't possibly cause pain either. Hmmmmm guess who is no longer my doc.. lol. The pt has asked repeatedly to see the doc face to face but all the doc does is come in, review the chart... which btw has qshift pain assessments and documentation of pain meds and effectiveness... and then quick as a flash is gone from the unit. The doc even admitted once to our DON that she didn't like her job... ok that's fine, but why take it out on patients who are dependent on her for care?? I just don't get it.

I personally would wonder why the aide is so adamant about you not asking the RN about it. I agree with so much that has been said here and one can never overemphasize the need to DOCUMENT DOCUMENT DOCUMENT!! Maybe you could say something to the RN quietly. You're leaving anyway so maybe say hey is there any advice you could give about my performance or in areas where I could improve... I dunno.. something along those lines.

You said it happened to two others. Any times where she said that and it turned out not to be true? The way I see it, if she's 100% accurate, then cross your fingers and get ready for a lot of congratulations. Yes, I think that sometimes people, and not just the elderly, have a kind of "instinct" when it comes to things like that. Best of luck to you!!

The woman to whom I was referring demanded to get up out of bed. She wasn't forced, nor is any patient in the facility forced to get up or sit up all day. According to her, she wasn't raised to lay around in bed all day and as long as she had her say, she'd get up every morning. She also had severe kyphosis and was unable to sit up straight. Laying in bed was uncomfortable for her and sitting up and leaning was how she preferred to be.

We have floor mats for fall prone residents when they're in bed. They're like larger versions of kindergarten mats so they fold up in thirds to make getting to the bed a lot easier... some times.

Ok this is going to sound horrible but there are times where I miss restraints. Not for my convenience but sometimes, they are needed for patient safety. We have a ZERO restraint policy and we get yelled at just for putting both siderails up on a bed. We've been able to reword some things, like lap buddy's being an assistive device (they're listed as restraints at our facility). One doc thought it was used to restrain someone until he saw the resident without it and realized that she constantly leaned forward in her chair and it really was necessary not only for her safety, but also for her comfort. Without it she leaned across her overbed table all day. I miss the days of being able to use a soft vest for someone in a chair. Instead we've become experts at the one second sprint across the unit to catch someone who thinks they can still stand unassisted. Had to send a pt to the ER the other night because her mind refuses to wrap around the fact that she needs help transferring. I agree that restraints, as a whole, should be avoided at all costs but sometimes they truly are necessary.

Yeah, it's the same here. Multiple med passes even though we try to standardize times, there's always those who need meds at "odd times". On my unit a full house is 35 patients. On my 3-11 shift, I'm the only licensed staff so med orders aren't an issue but they do have a similar problem on day shift. Usually there is a charge nurse plus one other LPN. Usually she's really good about putting orders in the MAR when the med nurse is in a pt's room. But for me, I don't mind someone interrupting me to add med orders or change existing ones. I'd rather be interrupted than have a med error. I also agree that there are times, especially when the floor is extremely busy and the orders directly impact that particular med pass, it's ok to delegate. Seems to me that if you hand the task off, it's no longer your error although I can see why your DON is saying it is. I guess the rationale is that YOU are the charge nurse, therefore you should have some kind of psychic power or ability to enter someones mind and MAKE them do the orders, and obviously your DON must think your transmitter's broken. Sorry, poor attempt at humor. What I want to know is, how do you deal with the fact that most of the time, when you step up to the med cart, families and patients come out of the woodwork with all kinds of questions, comments, and requests. I've tried everything I can to tactfully convey that when I'm at the med cart, I really need to give the meds my full attention but to no avail. Any suggestions?

I agree. When a person is admitted for "comfort measures", then give them COMFORT, whether it be narcs or not. We have families not wanting us to put family members on oxygen because they consider it "life support", but when we explain that it's a comfort measure, to help them breath easier and allieve anxiety, they usually agree with us that it's ok. Why should people be so against narcs when it's so obvious that they're needed? If only they could see through the eyes of the patient.

NOT counting narcs??? Never heard that one before. We have a doc that refuses to believe that her patients have pain. We fight tooth and nail and toe to toe with her over this issue. She won't even let us give Ultram without a fight and actually went through the unit one day d/c'ing every pain med on her pts. Unfortunately she is in my doc's practice and occasionally I end up having to see her. She tries to tell me that the NASH I have doesn't cause pain. Yeah right.. let me give it to her for a while and see how SHE feels. Sighhhhh.. I agree though, if a person is nearing end of life.. give them whatever is necessary to ease any discomfort they may have. What's it going to hurt? One kind of funny thing though (not ha ha funny but still... ). Had a pt.. end stage cancer.. refused pain meds because as she put it "I don't want to be one of those junkie people". God love 'em.

Last time State showed up on our doorstep, it was because of a family complaint... later proved to be totally unfounded. One of the RN's was getting a census sheet for shift change and someone came up and asked if we had daily census and staffing sheets and asked how many residents we had and all kinds of pointed questions. Well, the RN looked this person over from head to toe and said "And you are????" Yep, that's right... busted a State surveyor for NOT wearing identification!!! Yay score one for our side.. lol. Well that set the tone for the rest of the survey. Showed them that we paid attention (ok so it was only that one time but still.... LOL) and that we were pretty good at not being intimidated... well... at not SHOWING it at least.

Oh and one more VERY important thing.... DOCUMENT, DOCUMENT, DOCUMENT!!! If the person is verbally abusive to staff or others, quote every word... even the four letter ones.

Oh God love the sundowner's because sometimes it's hard for the rest of us to. As far as #1 "problem child" goes, I agree with a lot of these suggestions. Had one like this, major league blow ups around 8pm. Luckily his doctor happened to be on the floor at the time and actually got in there with the rest of us to wrestle him back in his chair (it eventually took six of us!). She ordered a STAT one time Haldol order and then sat down with all of us to get our suggestions. He ended up being put on several meds but none of them worked well or worked for more than 2 or 3 doses. Now though, he's declined to the point of being bedridden and just doesn't have it in him anymore to get agitated. I told the others though, watch out when he does go off again because that's not going to be a good sign. As for #2... if all medical roads lead to nothing majorly wrong, then it could be anxiety related. Had one similar and after the doc put her on 0.5 of Ativan every evening, things drastically improved. She's happier and we all get a bit of a break. The dose wasn't enough to sedate thank goodness, but it was enough to calm her. Best of luck.

I agree with you on "report books". Ours simply contains the census sheets with our notations that are passed along in report. We use the census sheets rather than a kardex. As a matter of fact, we don't even use a kardex. On our Rehab and Recovery unit, the census sheets are used to give report and then shredded. A lot of the nurses keep their own "report books" and make sure they're locked up at all times. Most of them do this to avoid having to say "HUH??" if our DON comes to them and asks about something that happened months before. Good idea actually. They also use their books for charting purposes and make sure that the factual information is in the nurse's notes. Other than that, they keep notes on feelings, attitudes at the time, the floor census, and staffing for that particular time. Some facilities strongly discourage this practice but I, for one, think it makes sense in the long run.

oh yeah i definitely agree. give me a floor with good aides and i am one happy camper. luckily i'm on a unit like that now. the two "regulars" are top notch and when they're there i know that it will be a good evening. that's why i know tonight will be good because i know that one of them will be there and our "fill in" is a-ok too. never be afraid to say i don't know and never hesitate to ask for help. i started out as an aide and nothing made me feel more unappreciated then when an lpn or rn felt "too good" to ask an aide for help. i'm not saying that that is what anyone here is doing... i'm just saying that sometimes, that's how it's percieved.

i just realized that it sounded as if i was unconcerned with the death.. i wasn't. the supervisor was handling the details and making the calls and the room was filled with family and staff who were close to the woman. i'd leave the room occasionally, give out a few meds to keep from getting too far behind (i have a 35 resident unit to care for), and then i'd go back to see if the family or supervisor needed anything. it's just that after re-reading my post, it sounded a bit calloused to me. mental note... preview first... then post.