Right Events, Wrong Times in Nurses Notes

[Jo Dirt]

I took over a private duty case this past weekend on a patient who came back from the hospital after two weeks (this agency has cared for her the last year). The patient is not stable and requires total around the clock care. I stayed 36 hrs. at this home and what a nightmare. First of all, while the patient was in the hospital several of her chemically dependent children stayed in her house while she was gone - not only had her food supply been cleaned out, all the narcotics (ativan, DCN and lortab) had been wiped out. So, I filled out an incident report with the agency.

This family has complained about this agency for a long time because they sometimes have trouble keeping the place staffed so I have no idea why the agency won't pull out, but anyway, this fits into what I'm about to say...no doctor's orders were faxed to the agency or patients home. The daughter who brought patient home and left patient in my care said patient had a lot of med changes (this patient is on so many meds it's pathetic). So I'm totally lost about what to do. I call the hospital and they talk to me like I'm pure trash.

They refuse to help. Then a visiting nurse from another home health agency comes in with the doctor's orders and says they had been told to take over, she looks through the chart and sees that the only agency approved to charge TennCare for this patient is the agency I work for...so there is nothing she can do. She won't give me a copy of the doctor's orders but she lets me see them before she leaves. I see there have been quite a few new med orders, for example, Accupril 40 mg BID had been changed to 10 mg QD! Novolin 70/30- 30 u Q am and 20 u Q pm had been changed to 20 u am and 10 u pm. The doctor had started her on digoxin and several other new meds but without an order what could I do? Between dealing with the family and the patient (who is very hard to care for) it was later that day before I call the hospital back to explain the situation. This time I get someone who is at least apologetic about not being able to help. She says the doctor authorized them to fax orders to a certain agency only (the agency that came and left when they found out they were not authorized to charge)...so as a last resort I call the doctor and levae a message with his answering service. He refused to call me but relayed a message through his answering service to tell me to continue with the pre hospitalization med orders until further notice.

This all happened over the weekend. The patient is doing so poorly Monday he says to bring her into the office. I just heard from a co worker this morning who went with the patient to the office that the doctor ripped into her, called her and the agency incompetent and useless, and basically made an ass out of himself in front of the patient, her family, and a nursing student. He also said furthermore he didn't appreciate "that nurse" calling him at 11 o'clock at night ("that nurse" was me). I didn't call him at 11 pm, it was about 8 in the evening.

When the family was complaining to the doctor at the hospital about the agency not being able to find nurses to come in when other nurses called out, the doctor had purposefully written the order out to a different agency.

This is where I am a little concerned. I did the best I could, but the I had to at one point even start the charting over because everything was so hectic and I was trying to fit it in to the narrative. I was looking through the narrative I had written and saw that I put the wrong time down when I notified the doctor...have it charted I called in the morning when I called in the evening.

I wish I had never gone to work at that case.

[Antikigirl, ASN, RN]

Are you an RN? I mean, heck...I don't pass a SINGLE medication without seeing an MD order at all ever ever! I don't understand why you were not allowed to see the MD orders considering you were this patients caregiver...that is in your role to be able to see (regardless if you are certified or licensed!).

This is a sad situation...just had one like it last week. The poor gent has prostate cancer and was taking so many pain meds...his two children (all in their 30's) took his meds for personal use..leaving him with none, and no caregiver or ability to even ambulate!!!!!!!!

Then the son came in on a meth high, beat the living tar out of his father for running out of meds! The patient barely made it!!!!!!! Crushed skull from a baseball bat! The children are being searched for...they skipped town fast!!!!

Then we came to find they stole all his personal information and assistance money leaving him with NOTHING!

He has no where to go, nothing left but the pain of his cancer that will slowly take his life.

Lo and behold...since the daughter was found, and had nothing to do with the beatings (didn't catch her on stealing...uhggggggg) she now has him at her place and trying to get money from the state because she is caretaking him.........OMG!!!!!!

This man will have no help, send in a nurse and I don't see it helping him any. I fear one day this sweet guy that has been through cancer then death, then h*ll, then betrayal, through pain, through getting everything taken from him....well, makes you sad to regret they saved him to hand him over to more h*ll...I am sure they will do this again, but get the job done if he ever runs out of meds again....

There are times when there is nothing you can do but accept that you did the best you could given the time you had. I got to know this man...helped him the best I could...and must trust in a power larger than me to take care of him...that is all I can do.

You did your best...give yourself credit for that. We aren't given only positives in life...but negatives too...we aren't living in a disney world environment where the little mermaid survives and marries the guy, or true loves surpasses death with a kiss, or the villan is caught...but, we do live in a world where what we do matters and helps, if in a small fraction...and that you have to learn to see and appreciate no matter the size of change...

Huggles...and you did great. Keep on being positive, it really does help everyone :).

[Jo Dirt]

There are times when there is nothing you can do but accept that you did the best you could given the time you had. I got to know this man...helped him the best I could...and must trust in a power larger than me to take care of him...that is all I can do.

You did your best...give yourself credit for that. We aren't given only positives in life...but negatives too...we aren't living in a disney world environment where the little mermaid survives and marries the guy, or true loves surpasses death with a kiss, or the villan is caught...but, we do live in a world where what we do matters and helps, if in a small fraction...and that you have to learn to see and appreciate no matter the size of change...

Huggles...and you did great. Keep on being positive, it really does help everyone :).

I just hope "they" see it that way. To heck with Disney World, I just hope I don't lose my license over this deal with writing the times down wrong.

We're talking about the kind of family who will sue you if they can.

Now I know why no one else wanted to work that case.

[Antikigirl, ASN, RN]

Hopefully your times are in the general ballpark and you should be fine. I have had to fudge every now and then when I get busy and can't chart...but I found a good way to chart that....I use the approx. sign...which is of course not on typeset..LOL. It is two sideways "S" one on top of eachother....

I know those types of families too well...I stressed too! But I can only do my best...anyone can sue me, or take my license even doing my best! I just learned to stick up for my actions, and realize that heck...if they want to sue I can't stop that...out of my hands like an earthquake...best to know and document as well as I can and well....I can't do much more than that!

If you are very concerned...which I feel you are...start up a journal TODAY....record anything you feel or remember now while it is still in there....that way if something comes up...you have at least a partial answer vs none. And I have heard that if you do this it can be used in your defense because you noted something that caused concern, and started a log to remember...that beats doing nothing and just hoping!

Nothing brings back the hands of time...but prepairing for what may happen isn't too bad as long as it doesn't become something that overtakes the time you have! Put in some time, but not too much.... There were a few times I was SURE a suit would happen and it didn't...so I used up valuable time I could have used helping my patients, family, friends, and well...me! LOL!

Good luck hon...I hope the best for you...I have been there in some respect, and I know the fear! But overcoming that fear for me was the BEST thing I ever did...simply accepting to put in my best and that is all I can do...well...that helps!

[ArizonaICU]

I just hope "they" see it that way. To heck with Disney World, I just hope I don't lose my license over this deal with writing the times down wrong.

We're talking about the kind of family who will sue you if they can.

Now I know why no one else wanted to work that case.

Write an addendum/ late entry to your charting. Get a legal nurse consultant to advise you if necessary.

[bookwormom]

I'm wondering what would happen if you called adult protective services-- about the meds and food being gone. Sounds like the patient in a bad situation. Is this just for the elderly?