I got into a disagreement with the SLP that was assigned to my patient and I need some advice and feedback so I know how to move forward.
Patient was an adult that fell out of a tree and face planted on concrete. Bilateral skull fractures and extensive TBI. Patient came to us from the ICU with restraints due to patient behavior. Pt was restless and agitated, moving around in bed to the point of throwing herself over the side rails and slamming her head into the side rails. We place seizure pads on the bed to protect her head. She was also pulling at her lines. The RN's before my shift were giving .5mg dilaudid, 1mg Ativan, and 2 mg of haldol approximately every four hours to keep the Pt calm and from thrashing in bed and pulling at lines. She received the last dose at 0338 and I resumed care at 0730. Patient would be calm for 5-10 mins at a time and restless/agitate the rest of the time.
SLP walked up to me at the nurse's station and asked "why are we giving her dialaudid, haldol, and Ativan all at the same time. I explained the reasoning and SLP says we are over medicating the Patient. She followed the question asking why the patient needed the PICC and the Foley if she was pulling on it. Very annoyed and upset, I replied with "I don't know, I'm not a Dr." And left it at that. Now I understand I could have handled that part better, but I was offended that she would question my judgement.
SLP went to the provider and told him that nursing was over medicating the patient and told the provider that the patient dos not need the lines anymore and that they should be removed. Provider agreed and discontinued the lines and the meds. That night all meds had to be added back on by the night hospitalist because they couldn't keep the patient in bed and the patient ended up in 5 point restraints.
The next day, the patient was restless and thrashing around all morning so I decided to give the haldol. The SLP happened to be in the room when I was giving it. She asked me why we were giving the medication and the patient happened to be calm for that 5-6 mins. I told her I was giving it because it was ordered. SLP went to the provider and accused me of unnecessarily sedating the patient and that the patient was not a harm to herself and didn't need the medication. The provider accused me and things got ugly. Needless to say, I removed myself from the patient's care team.
I have to sit down with the SLP and her manager in two days because she made a formal complaint of my behavior. I feel she overstepped her boundaries and outside her scope of practice. I also believe she damaged my relationship with the provider and his ability to trust my judgment in the future.
What can I do? What should I do? I'm lost and upset and beyond frustrated. Any advice would be helpful. Thank you!!
