Silvercel vs. Doctors Orders

LadyFree28, BSN, LPN, RN · Feb 3, 2015

They can be perturbed all they want; until you have a conversation with the doctor, A&D will have to do or not do, since it needs something else since it's not healing; hope the doctor will order it or possibly Santyl or if needed, debrided to help promote healing.

Is there a wound doctor on the case?

NightNurseRN13 · Feb 3, 2015

No wound doctor on the case and communication with the doctor(s) is very poor considering they have no nursing during the day. I had to advocate big time for this patient to even get their pitting edema addressed, everyone kept over looking it. Since using A&D the scab has come off and the skin underneath is intact, but new blisters have started to form. Feels like a never ending cycle with this patient.

I've called the doctors at all hours of the night and they just ask for the patient to come in and be seen. The patient cancels 80% of their appointments last minute. I've warned them that they can be "fired" from a practice for having so many no-shows.

LadyFree28, BSN, LPN, RN · Feb 3, 2015

Sounds like this pt needs a TON of education. :no:

brillohead, ADN, RN · Feb 3, 2015

A client like this would have me asking my agency for a new assignment.

Brings to mind the scene from Jerry McGuire, "Help me help you!"

https://www.youtube.com/watch?v=AGt5f70K02Q

NightNurseRN13 · Feb 3, 2015

You have no idea! this same patient will take their inner cannula out and hold the tube in their unwashed hand while they take a paper towel and try to clean it. I've told them a million times to not do that and explained why and yet they still do it every single night.

No Stars In My Eyes · Feb 5, 2015

I worked Home Health for nine years and one of the hardest things to accept was that people are going to do what they are going to do the minute you walk out the door at the end of your visit.. You can 'educate' until you are blue in the face and it will make no difference for some patients. At times we would have to discharge, at which time another agency would pick them up, and so it went, on and on.

The thing is, and I'm sure you know this, you can't cure everyone's life. Sometimes recalcitrant stupidity is the worst 'disease'.

I had an old farmer one time who would remove the bandage and medication I'd placed on his foot ulcer, and apply some nasty unsanitary 'horse linament' because "it worked on the horses." Didn't make a lick of sense as the ulcer he had was not the kind of abrasion the horse had. Couldn't convince him of that though!

caliotter3 · Feb 5, 2015

I have found that with this type of client, if I wait to ask to be moved to another case because I am so in need of work, at some point in time the client will exert their right to get rid of me in a final show of superiority of will. Meanwhile the day to day discomfort of dealing with the passive aggressive tug of war is detrimental to both the patient and my own peace of mind. Better to put an end to it before they see just how needy you are for a paycheck and use that against you. Poor patient doesn't get the best care possible.

Gooselady, BSN, RN · Feb 6, 2015

My patients doctor instructed to use A&D ointment on a scab that won't seem to heal (due to uncontrolled pitting edema and diabetes), the patient wants me to use silvercel instead. Am I wrong for telling them I couldn't do that until I talked to the doctor? They seemed pretty perturbed with me.

This is an issue of diplomacy as much as it is anything.

In the home, the whole game has different rules. We can be 'the boss' when we work at the bedside in the hospital. Not in the home. The psychology is different. We have to be a lot more flexible both in our approach to treatment AND how we verbalize our intentions because 'home patients' are not our captive audience. They can throw you out, call your office and have you off the case and then you're out of work.

And I don't mean kow towing or hiney-kissing at all. Just sheer recognition that you are on their turf. It's a matter of human nature. Imagine a nurse coming into YOUR home and calling all the shots. There are so many ways around triggering upset, everyone who understands the basics can develop their own way :)

"Why don't I give your doctor a call and ask him about Silvercel, do you want me to do that?" and "My agency literally forbids me to give a pill or apply a salve that isn't backed up by a doctor's order, so let me give the doc a call and see what they have to say. I'll let you know as soon as I hear back".

"Why can't we just start using it? I have some in the basket over here."

Nurse (shrugs) "If the doctor had some good reason not to use it, then you'd be back to the A&D, every doc has an idea of what they want used. I'll give the doc a call right away and we'll get this settled."

This usually averts 'that look' (the squinty look like they smell something bad) and/or decreases perturbation (puts it smack on the doc who isn't there instead of you ).

NightNurseRN13 · Feb 7, 2015

Got an unna boot prescribed, thank God! This patient also for months has been upset with me because I wouldn't administer their insulin without an order. They finally got an order and I administered it for the first time (for this patient) and they seriously said "I really thought you just didn't know how to do it" *sigh*

caliotter3 · Feb 7, 2015

Got an unna boot prescribed, thank God! This patient also for months has been upset with me because I wouldn't administer their insulin without an order. They finally got an order and I administered it for the first time (for this patient) and they seriously said "I really thought you just didn't know how to do it" *sigh*

Good. Hopefully this truly is just a case of misunderstanding and not the client being swift of tongue. Maybe from here on out you will encounter more and more cooperation now that a log jam has been overcome.