I just had to know what all nurses think about this order. Long story short. I work in long term care and as you know, there will always be offensive odors whether in the halls or patient rooms. Anyway, one of our physicians go into a patient room to assess or examine and noticed a foul urine smell. This particular patient urinates on herself inspite of nursing staff assisting her to the toilet; she is ambulatory with some dementia and she is not incontinent so she can urinate at anytime with out us even knowing. So, I am checking physician orders and the physician writes an order stating: "make sure patient room is cleaned twice a week, there is a foul odor and increase her baths. First of all, as a healthcare professional, this order was insulting to me as a nurse who is use to seeing medications, PT or etc written on legitimate physician order sheets, not this mess. The doctor could have mentioned the odor to nurse manager or supervisor but why write it as an order. Also, the rooms are carpeted which harbors foul smells, this was not a good choice to make so far as the floors. My final thought is that if you can not take the foul odors as a doctor, then maybe you need to find another career.
until the stinky carpeting can be removed, try using the pet formula of resolve carpet cleaner/spot and stain remover. it comes in a red pump bottle and that stuff is magical! it really removes some foul
smells and stains. the regular version is good too but the pet version is better.
we have nine rescued cats, a dog, and in spring we plan to add a puppy and it really does work! all our gang is spayed or neutered, but no one arrived that way and our pale beige carpeting (where we have it) has been sprayed by intact males and after blotting, then using the resolve, absolutely no smell whatsoever. none! we had to repeat the treatment in one case.
I'm not a nurse so I don't see doctors orders. But us CNA's did get in trouble once because the doctor wrote an order to organize the resident's closet.
I think the first thing that should be done is to get rid of the carpeted floors. House keeping is not going to shampoo the carpet every day and our facility usually is odor free except when someone has just been changed during rounds. I still disagree with cleaning a room as a physician order when it can be communicated in another professional way. Just my opinion.
If you have a patient urinating on the carpet housekeeping is going to have to shampoo it every day, it's a health code violation.
Reeking of urine is a dignity issue, if it takes a physicians order to get her bathed every day so be it.
Inappropriate urination (not remembering to use the toilet or understanding that the urge to void signals a need to use the toilet) and waiting too long resorting in an accident are forms of incontinence. If she's wetting herself enough to have a 'foul odor' I have to question if she's actually being toileted every 2 hours as she should be.
If there are behavioral issues then they need to be addressed so that her health and hygiene needs are being met. If your unit/facility can't meet her needs then a transfer to an appropriate setting needs to be facilitated. You can't just neglect a dementia patient because they are difficult, if she's not being toileted on schedule or if her behaviors that inhibit care are not being addressed it is NEGLECT.
I think this is a great order. Shows a doctor who is thinking a little outside the box to support this resident's health and hygiene. It is likely if he just suggested more baths or room cleanings than normal - you would say you can't just do that. So by writing it as an order you can access the required supports to do it as you have to follow doctor's orders. If you have done as you said everything you can to keep this woman clean and there is still a foul smell of urine then I think more baths and more room cleaning is a good next step.
Lifeofanurse
198 Posts
I agree with the posters who say this is a CYA situation.
He is by acknowledging the odor issue, covering his own AND YOURS.
He is assuring that not only is she bathed...but often. Her family may fuss and complain but you can only do what you can.
Tell him next time you see him...it's not the pt...it's the carpet. Maybe he can push the issue more than you can to the administrators.