Resident dies and nurse is to blame

[fairyluv]

We had a resident die recently and he was a very brittle diabetic, on a continuous tube feeding and a full code. (thankfully he was not on my hall). This res. blood sugar would sky rocket so high the CBG machine could not even read it. When he would get his insulin he would drop down into the 30's. The Dr. had been called numerous times regarding his insulin dosage, so that was changing daily, I don't know how high a dose or what long acting he was getting, I just know he was very brittle.

For about 4 days this man would refuse his insulin, he was alert and oriented and therefore was able to refuse, he did not want his insulin for fear of bottoming out. the nurse on dayshift would chart that he refused his insulin at 8am and noon. But she never charted that she called the doc, the evening nurse only gave him insulin at 5pm, and res refused insulin at 9pm, the nurse never charted this nor called the doc. The night shift nurse comes in and the res requested his blood sugar be take, the ,machine would not read it, the nurse called the dr and told him about the blood sugar being to high to read, and that the res had also been refusing his insulin for the last few days. the doctor said that was his right if he didn't want the insulin then we can't give it to him. so he didn't give her any new orders or even tell her to give insulin.

Later that night during the CNA rounds they found him unresponsive without resp or pulse. so the nurse started CPR and called EMS. and did all the necessary steps that she was suppose to do. The nurse was off for the next 2 days after that, when she came back to work, she worked her shift and when her shift was over, she was called to the office and put on suspension pending the investigation into this guys death. The DON asked her why she didn't give the insulin, the nurse told her she didnt have an order for it, and the DON told her she should have given it anyway.

So now she is on suspension and will probably not be coming back. I think it's wrong for them to suspend her when she did everything she was suppose to do, she charted that she called the doc, told him that res had refused insulin on previous shift, and that his CBG was extremely high, doc gave no order to give insulin because res would refuse it. So the nurse gets in trouble for not giving insulin to the res. How is she to blame ??

[TheCommuter, BSN, RN]

How is she to blame ??

Workplace politics seem to be playing out like a game of musical chairs where this particular nurse had the seat taken from under her because she was one of the last licensed staff members to have contact with the resident.

In the nasty game of workplace politics, management will cover their bases by looking for the convenient scapegoat (read: the floor nurse with relatively little power).

[fairyluv]

that is just scary.

[sallyrnrrt, ADN, RN]

mgt. is wrong, the night shift nurse is correct

[CoffeeRTC, BSN, RN]

But...did she chart all of that? After a few refusals a refusal of care form could be done. If he was A & O, he signs it.

[fairyluv]

But...did she chart all of that? After a few refusals a refusal of care form could be done. If he was A & O, he signs it.

Dayshift nurse charted the refusal, evening shift nurse did not, night shift nurse charted that he refused insulin on previous 2 shifts and had been for several days and also called the doc, which neither dayshift nurse nor evening nurse did. night shift nurse does not give insulin. residents are asleep and night shift nurse does not have to do AC cbg's. I have never heard of a refusal of care form, I don't even know if we have one at our facility.

[Meriwhen, ASN, BSN, MSN, RN]

I sincerely hope that the nurse has malpractice insurance and/or has contacted an attorney. Not saying that she's in the wrong, but she needs someone to look out for her and her interests in all of this. It damn well won't be this facility.

[CapeCodMermaid, RN]

I've never heard of a 'refusal of care' form either. We simply document in the chart/EMAR that the resident refused meds. We always explain and document the risks to the patient of refusing the meds and/or care. People are not prisoners and are allowed to refuse and make bad decisions. IF there was no order for insulin, the nurse could have had her license revoked for giving medications without an order. I'll bet there is more to this story than we know.

[kcdunlap]

The fact that the Doctors orders for insulin regiments made the patient bottom out when he took insulin no wonder the patient refused. The constant rollercoaster of blood sugars very horrible feeling. I hope the nurse has a good lawyer because if she documented properly she should not be held responsible. It is improper knowledge of treating this patients diabetes that caused this problem for the patient and made the patient terrified of taking their insulin which in turn made the patient go into DKA and die.

[DalekRN]

DON asked her why she didn't give the insulin the nurse told her she didnt have an order for it, and the DON told her she should have given it anyway.[/quote']

Wouldn't that be battery??

[2011RN]

Shouldn't the nurse have requested that the doctor give her orders for insulin and then approached the patient about taking the insulin to see if they would take it or refuse it? After all a refusal on one shift or even days of refusal does not mean that the patient would have refused that one time if offered the insulin. I think the nurse certainly should have pushed the doctor for some kind of insulin order and if the doctor refused to order the insulin then she should have documented that.

[sallyrnrrt, ADN, RN]

I've never heard of a 'refusal of care' form either. We simply document in the chart/EMAR that the resident refused meds. We always explain and document the risks to the patient of refusing the meds and/or care. People are not prisoners and are allowed to refuse and make bad decisions. IF there was no order for insulin, the nurse could have had her license revoked for giving medications without an order. I'll bet there is more to this story than we know.

and careplan " the all get out " on it