pigletrn2009

I'm glad to hear that you have a policy. Is it under the Department of Medical Services, Laboratory, of Nursing? Any chance you have access to an electronic copy/PDF?

Well, under the sensitivity, that's what it said. Interesting link though. I'm not sure it's something the lab re-checked though, so it could have been a mistake.

I was thinking this, exactly. OTC things like Tylenol or Colace are a no-brainer if someone is complaining of a headache or constipation. Now, I'm in a nursing home, so these medications are part of our "house stock", so they're not even assigned to patient account numbers. The difference between giving someone 2 tabs of Tylenol 325 mg off of your cart supply and telling a co-worker to "go out to the drugstore and buy your own Tylenol" is just common professional courtesy. I would never advocate for anyone using floor stock or patient medications as common practice or their own personal pharmacy, but there's a difference between OTCs and things like Zofran and other non-narcotics.

Oh yeah and I guess the doc forgot, this resident was on Flagyl FIRST for c-diff and after completing 14 days, he became symptomatic again and THEN went on the Vanc.

I work in a nursing home/sub-acute rehab but I figured everyone could probably offer input or feedback. We just had a resident complete 2 rounds of ABT for c-diff. He completed a 14-day round of Flagyl and was still having loose stool. A C&S was obtained and send to the lab. The culture came back positive for c-diff antigen and toxin. The result was called into the MD and he started the resident on Vancomycin for 14 days. It seems that no one ever received or called in the sensitivity results to the MD. The resident just completed the course of PO Vanco QID x 14 days last week and is still having loose stool. By chance, we discovered the sensitivity from the stool obtained at the beginning of September for this resident. I called the MD with results, and of course the sensitivity said the c-diff was resistant to Vanc. The MD ordered to re-start the resident on Flagyl, with no specified stop date for treatment. Apparently I wasn't clear enough that the sensitivity had been obtained after he started the Vanc but not after he had completed it. No final C&S had been obtained after he completed the Vanc. The resident was restarted on Flagyl but when the MD discovered that even though he was resistent to the Vanc, he completed the course of ABT and got better, so we were just supposed to leave it at that, regardless of the sensitivity that came back after it had been ordered. The MD d/c'ed the Flagyl and there are no new orders at this point. No C&S, nothing. Apparently, it's common practice to not test stool after completing a course of ABT to see if the resident still has c-diff unless they're symptomatic, which he was, but that wasn't made 100% clear to the MD. Doc is now pitching a fit and things are going up the food chain to the DON and the Medical Director. Do any of y'all have a policy of re-testing stool after completing ABT for c-diff?