"I want him extubated NOW...I dont care if he's not ready"

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Specializes in CVICU, CCU, MICU, SICU, Transplant.

So here is my new horror story from my unit:

We have this CRAZY family member (the POA), who has barely enough medical knowledge to make her dangerous...we all know the type :)

Background: patient is in severe heart failure, pulmonary edema, intubated on high peep/Fio2, inotropes, awful Swan #'s, not a candidate for LVAD or transplant. We are just trying to stabilize and dry him out, basically.

The POA is aware of this, doesnt care, but wants him extubated bc she read "somewhere" that being on a vent can cause VAP, etc. Ugh.

Here is her list of "demands":

1. That we turn off his sedation, skip weaning, and just immediately extubate (bc of the risk of VAP). She has come into our unit in the middle of the night (thank you, open visitation!) and tried this several times in a row. She doesnt listen to reason from the nurses or MD's (she demands to speak with the MD's at 4 am on the phone btw).

2. After trying to get #1 and failing, she changed #1 to: "well if you have to reintubate him, then thats ok I guess, but I want his ET tube changed out. I think there's some bacteria growing on it":banghead:

3. When we DO extubate him (not like we are going to in his present condition), she wants us to d/c the sedation, then immediately attempt to stand this 350 lb patient up on his feet, wean him standing up in that position hooked to the ventilator, and then d/c the ET tube....all bc she says "at home, he has to be in a high position to breathe". LOL:yeah:

4. She demands to read his chart/lab values/look at his chest xray every day... ok I know she is the POA, but there is still a formal process to view PHI at my hospital, and she hasnt gone through it :nono:

The other day, a nurse caught her smuggling out a urine sample from the patient's foley bag!! When she was stopped and asked what the _____ she was doing, she replied "Dont you worry about it, mind your business." Presumably, she wants to get his urine analyzed somewhere else...who the heck knows for what. It is unreal the kinds of things she has done/demanded.

The whole situation has gotten completely out of hand. Numerous incident reports have been filed, but nothing has been done. My manager seems to be turning a blind eye. We all believe she is setting up to sue (but doubt anything will become of it d/t her crazy behavior--- I mean, obtaining a urine specimen and putting it in her purse?? OMG). The nurses that care for this pt are charting to a "t", noting all her actions, RN responses/actions, and charting the constant phone calls to the MD and unit manger. Every time she comes in, the nurses watch the IV pumps and ventilator like hawks to make sure she doesnt do something really stupid and harm the pt, but they cant police her 24/7.

My question is: what will it take to get this lady REMOVED FROM THE HOSPITAL ?!! Press Ganey can take a leap off a cliff!!

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Specializes in Med-Surg.

My jaw dropped further and further to the ground as I read this list of "demands", especially #3, is this woman absolutely out of her mind?!? And smuggling a urine sample to get it tested elsewhere? EWWWW!!

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Ewwww - and she sounds paranoid/psychotic.

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Specializes in Trauma, Teaching.

Sounds like a call to Adult Protective Services is in order. POA or not, the patient's wellbeing comes first, and her responsibility to look out for him properly.

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Again, I would also make a call to the senior partner of the law firm who represents the hospital. I would give him/her a detailed report on the goings on in the hospital.

I guarantee that they will be very interested in what has been going on.

Lindarn, RN, BSN, CCRN

Spokane, Washington

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Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.
So here is my new horror story from my unit:

We have this CRAZY family member (the POA), who has barely enough medical knowledge to make her dangerous...we all know the type :)

Background: patient is in severe heart failure, pulmonary edema, intubated on high peep/Fio2, inotropes, awful Swan #'s, not a candidate for LVAD or transplant. We are just trying to stabilize and dry him out, basically.

The POA is aware of this, doesnt care, but wants him extubated bc she read "somewhere" that being on a vent can cause VAP, etc. Ugh.

Here is her list of "demands":

1. That we turn off his sedation, skip weaning, and just immediately extubate (bc of the risk of VAP). She has come into our unit in the middle of the night (thank you, open visitation!) and tried this several times in a row. She doesnt listen to reason from the nurses or MD's (she demands to speak with the MD's at 4 am on the phone btw).

2. After trying to get #1 and failing, she changed #1 to: "well if you have to reintubate him, then thats ok I guess, but I want his ET tube changed out. I think there's some bacteria growing on it":banghead:

3. When we DO extubate him (not like we are going to in his present condition), she wants us to d/c the sedation, then immediately attempt to stand this 350 lb patient up on his feet, wean him standing up in that position hooked to the ventilator, and then d/c the ET tube....all bc she says "at home, he has to be in a high position to breathe". LOL:yeah:

4. She demands to read his chart/lab values/look at his chest xray every day... ok I know she is the POA, but there is still a formal process to view PHI at my hospital, and she hasnt gone through it :nono:

The other day, a nurse caught her smuggling out a urine sample from the patient's foley bag!! When she was stopped and asked what the _____ she was doing, she replied "Dont you worry about it, mind your business." Presumably, she wants to get his urine analyzed somewhere else...who the heck knows for what. It is unreal the kinds of things she has done/demanded.

The whole situation has gotten completely out of hand. Numerous incident reports have been filed, but nothing has been done. My manager seems to be turning a blind eye. We all believe she is setting up to sue (but doubt anything will become of it d/t her crazy behavior--- I mean, obtaining a urine specimen and putting it in her purse?? OMG). The nurses that care for this pt are charting to a "t", noting all her actions, RN responses/actions, and charting the constant phone calls to the MD and unit manger. Every time she comes in, the nurses watch the IV pumps and ventilator like hawks to make sure she doesnt do something really stupid and harm the pt, but they cant police her 24/7.

My question is: what will it take to get this lady REMOVED FROM THE HOSPITAL ?!! Press Ganey can take a leap off a cliff!!

#3-Is she kidding, as well my jaw dropped of my face!!!:banghead::lol2::nono::nurse:

And is it possible we can put this psychopath on a 96 to behavioral health that should put a twist in her panties!!!:yeah:

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Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

what she gonna smuggle next her own blood sample and sputum samples and abg's, shes nutttttsss!!! and a call does need to be put in to social services asap!!!

my:redbeathe goes out to all the nurses, md's, and the pt. that has to deal with this nuttt!:nurse:rod rn

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Specializes in Cardiac Telemetry, ED.

Is Risk Management involved?

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Since it's obvious that your NM isn't doing anything to help with this situation, a call to your risk manager, social services and unit case manager are in order. The situation has been allowed to go on too long and for the patient's benefit needs to stop.

Gotta hate the ratings loving media out there stirring crap up amongst the masses with 1/2 truths (MRSA, VAP etc etc ad nauseum).

BTW, any crazy family members start messing with my ventilators or IV Pumps gets an immediate eviction notice. Only interns get a break, the first time I catch em trying to mess with my IVs they catch a small amount of flack from me...second time...I write em up and go to the attending.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Family meeting with attending + all the above bluehaven suggests indicated to deal with myriad issues presented, answering POA questions/allay concerns and present united front.

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Specializes in Hospital Education Coordinator.

go up the chain of command to cover yourself, but make sure risk management is involved. I agree that adult protective services should be called, and you don't need anyone's permission to do that.

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You may also consider calling in the ethics committee at your facility. Ethics committees can offer good input when there are conflicts between the various factions involved. They may be able to help sort out wants and needs, ideal vs. practical, irrational fears vs. legitimate concerns.

I wish you--and the patient--well.

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