Went to do a SOC today and the patient's house was not only a home that was tough to walk in due to the hoarding (which doesn't bother me. I've been in several hoarders homes), and realized within a minute that the place was infested. Every chair I tried to find to sit on had multiple bugs ( bed bugs, fleas, etc...) crawling on them. The floors had bugs on them. The walls, bed, everything. I was there to do a wound dressing change and noted a dead bed bug on the abdominal dressing. I was, to say the least, disgusted.
I completed the SOC, left, and called my company immediately to alert them of the situation. I said I didn't feel comfortable going back to do the daily wound changes unless they take care of the infestation ( I did try offer to call pest control and the pt refused. I offered to get them numbers of different pest places and the pt refused stating he sprays) . At first my director stated we still needed to provide the dressing changes. I called the LPN who would be splitting the days with me and she is justifiably refusing. I alerted the DON and she said she'll put the pt on hold. Which is good, but now I'm concerned. The pt does actually need someone to do his dressing changes.
QUESTIONS:
1-Is it right of me to refuse to go until the situation has been resolved, or is this what I should expect doing Home visits? (I'm new at the home visits) If I should still go, has anyone dealt with this and what precautions did you take?
2-Should I call the department of health? If I do that, will they assess and fumigate for free or will the pt be charged? I want to get the okay from the pt first, but doubt that will happen if he has to pay. (he'll probably refuse either way) If they won't fumigate for free, is there a way to get it done without the pt having to pay?
The house is probably going to be condemned if the DOH goes out there. The pt lives with 2 brothers. I would undoubtedly be ruining their lives. However, the Bedbugs ARE TRYING TO GET INTO HIS WOUND. (a very large abdominal (dehisced) wound).
ANY info, suggestions, opinions will be appreciated.
Specializes in NICU, PICU, Transport, L&D, Hospice.
That is a very sad situation. I would call the MD and see if there could be a consult to a wound clinic perhaps for his dressing changes??
I have been in homes that are horribly filthy and that is uncomfortable but not infested as yours. However, the case I refused was one where there was a shotgun behind the door and playboy/girl magazines on the coffee table!
When I visit homes with weapons visible I ask the patient or family member to put them away. The company likely has a safety policy which addresses weapons and pets, and you can use that to require the pt/family to comply lest they risk appropriate discharge from service. Given that weapons and dogs are EXTREMELY common in homes here in AK, it is commonplace to encounter them. The vast majority of clients respond nicely to the request to secure weapons and pets in my experience.
I would not be put off by the reading/viewing materials of the household and would probably just put my bag on top of them. But that is just me...crotchety old nurse dude.
I had a discussion about this topic with one my coworkers. I'm sorry but I do not care how badly someone needs care, if I cannot use a proper bag technique due to filth and bugs then I'm not starting the patient. I do not think we, as home health nurses, should have to "take just what you need" and worry about what bug fell into our pocket b/c homes are infested.
Specializes in NICU, PICU, Transport, L&D, Hospice.
I had a discussion about this topic with one my coworkers. I'm sorry but I do not care how badly someone needs care if I cannot use a proper bag technique due to filth and bugs then I'm not starting the patient. I do not think we, as home health nurses, should have to "take just what you need" and worry about what bug fell into our pocket b/c homes are infested.[/quote']
Why can't you utilize proper bag technique? Is there no where for you to set your supplies on a clean cloth provided by you? Some of the homes I visit don't have running water or flush toilets although we don't have much in the way of cockroach infestations here.
I cannot guarantee that the cat won't climb into my bag while I am working. Or that the dog won't pee on my boots by the door.
I simply accept my patients where and as they are and then help them to set and achieve meaningful and obtainable health goals.
Are you certain that you want to visit poor sick people in their homes for a living?
To RN-DC: I disagree with most of the comments to your question. I have done home health for several years in inner city an suburbs, have done psych, hospice and cardiac home care. Hoarders are no problem for home health nurses. Drugs, guns, dogs, etc. are not a problem. Bringing disease and bugs home to my family is a problem. I have been the lucky recipient of fleas, scabies, crabs, bedbugs. My PPD now shows positive, cxr negative. Been mugged and got through an attempted carjack. Been chased by dogs and wild turkeys. My husband died suddenly and I still have a child to raise, I have decided I will not take any more chances with my health and life. Only you can decide what you will tolerate. Risking your health is NOT a requirement for any nursing job.
Specializes in ICU/CCU, Home Health, Case Management.
Yes, you can refuse to see patient if you are per diem. Seeing that the DON placed pt. on hold-is she attempting to problem solve the case. I agree a SW needs to go in, the MD needs to be called and yes-this pt. is an elder at risk d/t open wounds with insects in wound. Your agency should report this patient. Are there family members? I say he should go back to hospital and then to SNF-for wound care and state will possibly fumigate his house. I had a pt. whose home was infested, she had PICC line and bugs were crawling all over IV equipment, etc. I called MD, told him what was happening (I saw her two times), he said send her back to ER, so they can send her to SNF. I hope this helps!
I hope the MD intervened by calling the ER to speak to someone regarding discharge to nursing home, otherwise, that move would have been in vain. Good idea though, as long as you receive those instructions from the MD. I would then document that the MD instructed me to send patient to the ER.
Specializes in ICU/CCU, Home Health, Case Management.
Hi-yes, I did call MD-and he said he was going to call ER. I documented properly in EMR, including who and when each person was notified, including patient and her brother, who were in agreement with the plan to send her to hospital and that she probably will go to SNF. She might have stayed at hospital for IV antis, not sure.
Check with your state BON. If you feel you can't give safe and effective care then you can refuse any assignment. In addition you may very well have a duty legally to report neglect and abuse. He lives with others and this situation could very well fall under those headings. As far as going in and not taking any critters with you when you leave, you would have to disrobe before getting in your car or risk infesting it with bed bugs.
If I walk into a home to do a SOC and the place is visibly infected I am leaving. I will first call my manager and alert her and then call the referring MD and let him know we are not going to open the case until the situation in resolved. My company will offer assistance to clean up and if the pt refuse we would not take he case. The patient can either be referred to a different company by the MD or visit the MD for care.
Specializes in Cardiac/Telemetry, Hospice, Home Health.
I could not refuse providing care to my patient whose home is infested. In hospice, because I have been willing to just deal with it, was able to get a patient out of truly deplorable conditions and into a safe clean place where she was able to die in dignity. In home health I have a patient who is dear to my heart, yet she has roaches all over her home, even in the daytime. She is worth every bit of my discomfort. I hate roaches. I am terrified of them. But I make sure I don't sit on the furniture and I never bring my bag in. I have even managed to arrange to bring a hard chair in from the front porch on the pretense that it allows me to sit closer to my patient, and not hurt their feelings by never sitting down. Heck, bring in a small portable stool if you have to. I realize we all have limits and boundaries and I respect that. But nursing does call for us to step out of our comfort zone.
To RN-DC: I disagree with most of the comments to your question. I have done home health for several years in inner city an suburbs, have done psych, hospice and cardiac home care. Hoarders are no problem for home health nurses. Drugs, guns, dogs, etc. are not a problem. Bringing disease and bugs home to my family is a problem. I have been the lucky recipient of fleas, scabies, crabs, bedbugs. My PPD now shows positive, cxr negative. Been mugged and got through an attempted carjack. Been chased by dogs and wild turkeys. My husband died suddenly and I still have a child to raise, I have decided I will not take any more chances with my health and life. Only you can decide what you will tolerate. Risking your health is NOT a requirement for any nursing job.
This sounds horrible Maura. I'm so sorry you've been through all of that.
Thanks to all of you for your comments, suggestions, and opinions. Update on the original situation:
I had a change of heart over night after reading some of the comments and speaking with some other fellow nurses. I did tell my company I could do the dressing change a few days a week. But they had already found an amazing LPN that needed a case and was willing to to 7 days a week for the pt. I still go to the pt's home for supervisor visits, and if the LPN needs a day off (which isn't often due to the frequency now down to 3 days a week).
I did call APS several times. They stated it was a coding issue and I needed to speak with that department before they could do anything. I called the coding department. They couldn't do anything unless there was a court order and a Social worker had assessed the place. The pt isn't approved for social work (I can't figure this one out) until there is a need assessed by APS. I don't understand why it is so hard to get APS involved. I've had to call CPS before, and they are right on top of issues. The last time I went to the pt's home, the home was in worse shape, still tons of bugs, and a new horrible odor through out the home. The LPN, wound care nurse, and I could barely stand the stench. I don't know what to do from here since I am basically at a stand still. I have, of course, discussed all of this with my company.
toomuchbaloney
15,857 Posts
When I visit homes with weapons visible I ask the patient or family member to put them away. The company likely has a safety policy which addresses weapons and pets, and you can use that to require the pt/family to comply lest they risk appropriate discharge from service. Given that weapons and dogs are EXTREMELY common in homes here in AK, it is commonplace to encounter them. The vast majority of clients respond nicely to the request to secure weapons and pets in my experience.
I would not be put off by the reading/viewing materials of the household and would probably just put my bag on top of them. But that is just me...crotchety old nurse dude.