What to do? Alcoholic and discharge too soon

[annaliz]

Hey hope someone can help me.Went to see a patient discharged from hospital diagnosis GI bleed. He has dementia (only 54), denied even vomiting prior to admit and in hospital per hosp. Notes. Went to see him as they ordered HHA. Reason why is because they can't take care of him. He is belligerent, confused, prior to hospital. Drink whole bottle of liqueur daily.He was sent home on only protonix, lactulose, propranolol.He won't take meds by family. His BP was only 100/50 hr 60 so I did not give propranolol. When I was there he wanted to repark his car I tried to redirect but could not. So I took keys from him and of course became escalated. So I ended up giving keys back he got in car turned on ignition , I CALLED COPS. Who came and persuaded him to give up car keys.The mother is scared of him and can't call 911 as she has no concept of it. He has no primary MD. im worried if his clinical condition is unresolved as his BP is low. And no meds to address behavior was on haldol iv in hospital then straight discharge.plus when he is ready to drink again and has no liqueur concerned safety/withdrawals.Any advice as to what do? I told family is he becomes a threat to self or them to call 911.

[AMN74]

You said he has no doctor.. who is going to sign your 485? I would have notified that doctor of what is going on, and probably called 911 to send him back to the hospital. He became a danger to himself and others when he got upset and demanded his car keys, enough so that you "gave in" and gave them back to him. That is cause for discharge from home health right there. You do not have to take that from anyone. The family may "put up" with that kind of behavior because patient has a alcoholic disease, but if the patient is not willing to make changes, take meds and get better...what are you going to do with the patient? What is your plan? What are your goals? How can they be achieved?

[destova]

How old is the pt? How long of a history with alcohol abuse? What was the rationale for discharge from the hospital to home rather than a tx facility?

Having dealt with an alcoholic husband for ten years before finally leaving, I know what it's like when drunks get pushy and stuck on an idea (moving the vehicle in your case).

Personally, I think you did the right thing in calling the cops. Your own safety is at risk in that type of situation... however, I'd have called them sooner.

I'd talk to my supervisor and see if social workers could be brought in to look into a full inpatient detox program. If they say no, you could always call yourself to report a dangerous living situation on the mothers behalf. Good luck!!

[KateRN1]

What kind of agency accepted this referral? Seriously. Who admitted this patient? Is this Medicare home care? This patient is not appropriate for home care and it's not a safe situation for any clinician.

[emilysmom,RN]

I have a couple men that tell me they are drinking but they do not drive. One man said the 2 liter soda had alot of rum in it. And the other one said the day he fell he drank alot of rum and coke and is a diabetic and wondered why he passed out.

[sweetsugar]

I had a patient who met me drunk and naked at the front door every time I went to see him. I kinda drew the line when he pee'd on me, though.

[cara vander wiel]

I agree that this patient should be discharged from home care and 911 called. The hospital discharge planner really goofed this one up! They wanted to get rid of this one! Adult protective services would probable recommend that 911 be called.