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

Nurses General Nursing

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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!!

I'm sure TiredMD would feel differently if he were the one being constantly called at 4am to pacify her.

I see an unplanned extuabtion in this pts future-I think a sitter is a wise idea.

Anyone who steals urine out of a foley (which interferes with my I/Os among other things), just shows that she's willing to cross any line to reach her 'agenda'--this is what makes her dangerous.

Our first responsibility as nurses is to protect the patient. She needs to be watched like a hawk.

I totally agree with idea of a sitter. A big huge built like a linebacker one.

I disagree with TiredMD because this woman is going beyond demanding and she is acting irrationally to the point she may endanger the pt. I hope everything turns out O.K. with the pt.

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

Thanks to all who replied. Just wanted to update/clarify.

First, (thankfully), I havent taken care of this pt myself...just been around when some of the fireworks went off.

Apparently, risk management was notified (d/t the numerous incident reports that were filed). From what i understand, there wasnt a whole lot done on their part (or so I'm told). Therefore, the solution of an angry staff that feels abandoned...keep on drowning risk management with incident reports, and document document document! lol

Social work/case management is involved, but to what extent, I dont know.

So far she hasn't tried to physically tamper with any machines, pumps, or the vent. When ever she comes in, the staff makes it a priority to monitor the room and her actions. Our IV pumps have a key pad locking mechanism that we have engaged in this pt's room (think in order to actually make changes to the pump you have to push an obscure button located in the back).

**very recent update**

So just yesterday... the pt was doing better, was extubated (the correct way!) and did fine. He was PROMPTLY transferred to the tele floor. My heart goes out to the floor nurses who have inherited all this drama.

Funny part: we got an email from our UM who said, "the sister of Patient X wanted to thank all of you for taking such good care of her family member." :chuckle:chuckle:chuckle Is this lady bipolar??!!! Just the other day we were on her hit list!! Did someone get through to her? Was all this the by-product of her stress with having a loved one in critical condition? Did she start taking her meds again? Did my staff start a collection to hire a guy to pull out her nose hair? Who knows. As quickly as it began, it ended.

Specializes in ICU.
Thanks to all who replied. Just wanted to update/clarify.

First, (thankfully), I havent taken care of this pt myself...just been around when some of the fireworks went off.

Apparently, risk management was notified (d/t the numerous incident reports that were filed). From what i understand, there wasnt a whole lot done on their part (or so I'm told). Therefore, the solution of an angry staff that feels abandoned...keep on drowning risk management with incident reports, and document document document! lol

Social work/case management is involved, but to what extent, I dont know.

So far she hasn't tried to physically tamper with any machines, pumps, or the vent. When ever she comes in, the staff makes it a priority to monitor the room and her actions. Our IV pumps have a key pad locking mechanism that we have engaged in this pt's room (think in order to actually make changes to the pump you have to push an obscure button located in the back).

**very recent update**

So just yesterday... the pt was doing better, was extubated (the correct way!) and did fine. He was PROMPTLY transferred to the tele floor. My heart goes out to the floor nurses who have inherited all this drama.

Funny part: we got an email from our UM who said, "the sister of Patient X wanted to thank all of you for taking such good care of her family member." :chuckle:chuckle:chuckle Is this lady bipolar??!!! Just the other day we were on her hit list!! Did someone get through to her? Was all this the by-product of her stress with having a loved one in critical condition? Did she start taking her meds again? Did my staff start a collection to hire a guy to pull out her nose hair? Who knows. As quickly as it began, it ended.

It always makes me laugh when 1 to 1 care is not enough, they still want more, more and yet more. Then pt transfererred to step down ward where they are one of many. Family soon realise just how good ICU care was.

By the way what is POA? Don't know that term, I'm a British Nurse.

Thanks

......................... My heart goes out to the floor nurses who have inherited all this drama..........

I predict that if one of the floor nurses is a member here, there will be another thread about this woman.

TiredMD, I doubt you'll get flamed. This seems like mostly a vent thread with a call for some ideas on how to handle the situation.

In that case: I would coat the foley bag and tube in a layer of vaseline, so that the next time she tries to steal a urine sample, she'll get it all over her hands. When she asks you about it, get really excited and go, "Oh my God! What is that?! You should go get checked out in the ER right away!"

Specializes in neuro, ICU/CCU, tropical medicine.
In that case: I would coat the foley bag and tube in a layer of vaseline, so that the next time she tries to steal a urine sample, she'll get it all over her hands. When she asks you about it, get really excited and go, "Oh my God! What is that?! You should go get checked out in the ER right away!"

LOL!

Not Vaseline - XY jelly - with a little green dye in it.

I personally think she seems to be too mentally unstable to be a POA. Especially trying to smuggle a urine sample out...who knows what she could do with it.

Is the hospital social worker involved? If the hospital is afraid that she is capable of tampering with tubes, etc...then doesn't that meet the criteria of "a harm to herself or others"?

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

Anyone who steals urine out of a foley (which interferes with my I/Os among other things), just shows that she's willing to cross any line to reach her 'agenda'--this is what makes her dangerous.

Our first responsibility as nurses is to protect the patient. She needs to be watched like a hawk.

I agree with this wholeheartedly. The POA not only caused an error in I&O recording on a patient with fluid volume overload (especially if this patient's UOP was being recorded hourly and affecting any medication that would given based on that output), but possibly put the patient at risk for an infection by collecting the urine without proper training.

Specializes in Emergency & Trauma/Adult ICU.
In that case: I would coat the foley bag and tube in a layer of vaseline, so that the next time she tries to steal a urine sample, she'll get it all over her hands. When she asks you about it, get really excited and go, "Oh my God! What is that?! You should go get checked out in the ER right away!"

Cute, except I work in the ER where she's sure to show up ... :rolleyes:

Specializes in Corrections, Cardiac, Hospice.

By the way what is POA? Don't know that term, I'm a British Nurse.

Thanks

POA-Power of Attorney(for legal and financial matters), also can be seen as DPOA Durable Power of Attorney (for decisions in medical)

It is a legal document stating that if something happens to you that you can no longer make decisions that person can make them for you.

Hope that helps!

Cute, except I work in the ER where she's sure to show up ... :rolleyes:

And you will make her wait a minimum of 6-12hrs, which will keep her away from the ICU and make everyone upstairs happy.

Think of it as "taking one for the team". ;)

Specializes in ICU/CVICU/Stepdown.

Most places I have been when the family or POA is causing a disturbance in the units.....they get the quick escort out of the unit and if it happens more than once then they are asked to leave the facility. Yeah I think that everyone has it right....risk management and social work to see if the patient can get a state guardian ad lidum (i think that is how you spell it). They are appointed by the state and act in the interest of the patient when it is deemed that the POA is not acting in the best interest of the patient.

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