Trach change disagreement with Case manager

[zook1065]

Being an LPN I need reviews from my case charge RN for my PDN PT. Prior to starting my demonstration on changing a trach, I asked my client if they wanted the trach ties changed. The PT doesn't like them messed with and just had a shower with tie change the day prior. The PT refused and it was explained that ties should be changed daily.....with still, a refusal. The charge stated she was going to do it or have it done anyway. So to fast forward, after the change, and respecting the PT wishes, I was told I couldn't be checked off because ties weren't done, and was done incorrectly because of that. The RN was very upset I didn't change them

By the way the PT is 18 with no guardianship.

So was I wrong in honoring the PT wishes, not that it was a past problem with skin breakdown on the neck, and respecting their rights. I did argue my point but it seemed useless.

I'm just frustrated and needed to vent. Did I do this wrong?

[ceebeejay]

If the pt is 18 and not guardianship, then it would have battery on your part to go against their refusal. I was taught to just document that they refused x treatment and that teaching was given about the risks associated with their refusal.

[zook1065]

That's what I thought, but the case manager insisted I did it all wrong.

[mclennan, BSN, RN]

So when you pulled the P&P to review it together, what did it say, and what conclusion did you come to?

[tryingtohaveitall]

You were changing the trach but asked if they wanted the ties changed? Why? That's when it's the easiest to change it and you were already doing a procedure. Have the new tie ready to go on the new trach, fasten and done.

[CloudySue]

Correct for a routine situation, incorrect if it was for a skills test. A facilitator needs to see it done like textbook to sign you off. But I wouldn't even think to ask, just take a new tie and attach it to the new trach. Just as I wouldn't ask a ct if they want a fresh pair of socks when getting dressed for the day, I'd just do it. Same thinking.

[ktwlpn, LPN]

Better yet,advocate for the patient and try to obtain a better quality of trach supplies. We stopped using those ties YEARS ago.They are a pain in the butt, all that tedious fumbling triggering the cough/gag reflex over and over, I'm not surprised an alert and oriented patient hates that. But I second Cloudy Sue-I wouldn't have thought to ask,I would consider hat part of routine care and probably been half way through before the patient realized.

[caliotter3]

Better yet,advocate for the patient and try to obtain a better quality of trach supplies. We stopped using those ties YEARS ago.They are a pain in the butt, all that tedious fumbling triggering the cough/gag reflex over and over, I'm not surprised an alert and oriented patient hates that. But I second Cloudy Sue-I wouldn't have thought to ask,I would consider hat part of routine care and probably been half way through before the patient realized.

Agree with both of these comments. I automatically use a new trach tie with trach care, change. Never would think to ask unless an off-schedule trach tie change is necessary and in that case I would probably be saying something like, "I'm changing your trach tie now because the old one is soaked and messy." It wouldn't usually be a matter of patient choice.

[tryingtohaveitall]

Better yetadvocate for the patient and try to obtain a better quality of trach supplies. We stopped using those ties YEARS ago.They are a pain in the butt, all that tedious fumbling triggering the cough/gag reflex over and over, I'm not surprised an alert and oriented patient hates that. But I second Cloudy Sue-I wouldn't have thought to ask,I would consider hat part of routine care and probably been half way through before the patient realized.[/quote']

Maybe I missed something, stopped using what ties? Can you share a link to what you are using?

[ktwlpn, LPN]

If I can find a link I will post it. Our kits have Velcro fasteners on the necks bands.Nice and easy.

[ktwlpn, LPN]

do a search for tracheostomy tube holder

[SDALPN]

We still call them ties even if they are the Velcro type.

This situation is plain and simple. The patient has the right to refuse. What took place was battery/assault. Simply document the refusal and that the patient is educated as to why they need to be changed more frequently. You can be checked off by doing the tie change on another patient or on a doll/mannequin.