What could have been done differently?

You did what you could, the resident has free will.

I don't see how leaving the facility is going to make his UTI worse. It's not like you could do anything except maybe encourage PO fluids. Holding him against his will wouldn't make anything better. It's not like there's magical curing mist going through the vents of the facility, right?

i am more curious about if used street drugs while out.....this might give reason to discharge....

Did you explain to the resident that he is being treated for a UTI and would benifit from saying in house? Did he have and order for LOAs? Did you document the above?

If yes...you did what you needed to do. LTC residents are still people and can come and go within reason. You can't "make" him stay inhouse, but I would have strongly advised him to stay and rest.

The CMT should mind her own business. When she has a license she can criticize your nursing judgment.

Michelle

I agree with Sue, I love how people without licenses critize how we do our jobs and our judgement.

given the circumstances, a low grade temp and a uti would not be a reason to restrict LOA. so what did he do while he was out? what's his Blood alcohol level or presence of street drugs? maybe he went to dunkin donuts and drank a gallon of coffee and pissed himself silly?

there is always a ton of what if's and i dont knows in every situation. you did everything possible to keep this person safe while in your care...the LOA is an unknown variable...dont sweat the small stuff...tomorrow is another day with its own ups and downs.

peace

Why are you thinking he is doing drugs or drinking?

We have residents that go on LOAs for just a short period. Some go home, some might go out to eat, some might go to church or shopping or just out for a drive.

i would have spoke with the patient and the family and made sure they knew that he was not feeling well and was on abt's....after that he can sign himself in and out all day long....when he comes back you re-assess and go from there.....patients have to take account for themselves at some point....you cannot refuse to let a patient go oop just because he has a fever...your are required to educate then let them make a decision....i agree with sue tell your cma to mind her own business..

Why are you thinking he is doing drugs or drinking?

We have residents that go on LOAs for just a short period. Some go home, some might go out to eat, some might go to church or shopping or just out for a drive.

because he is Hep +, came back drowsy/lethargic, and was blatantly insistent about going out......

Morte: Yes, the hospital personnel ran some tests on him and he came back positive for illicit drugs; they didn't say which ones and he is not allowed any visitors alone in the room with him per their policy. I told him when he told me he was going out that he was considered to be sick from running a temp. He blatantly stated "I don't care what my temp is, I'm still going out." I documented this and reported to my DON and administrator both when he came back acting drowsy. I think I did all I could do in this case.

I have another question though; what do LTC's typically do when a resident goes out and comes back stoned/inebriated? Is it enough to discharge them completely from the facility?

Thanks and blessings, Michelle

Morte: Yes, the hospital personnel ran some tests on him and he came back positive for illicit drugs; they didn't say which ones and he is not allowed any visitors alone in the room with him per their policy. I told him when he told me he was going out that he was considered to be sick from running a temp. He blatantly stated "I don't care what my temp is, I'm still going out." I documented this and reported to my DON and administrator both when he came back acting drowsy. I think I did all I could do in this case.

I have another question though; what do LTC's typically do when a resident goes out and comes back stoned/inebriated? Is it enough to discharge them completely from the facility?

Thanks and blessings, Michelle

it would seem that if he is not allowed visitors in his room this would also preclude leaving and coming back, since it would amount to the same thing. ie being in the company of another person and unattended by staff. Was your administration that naive that they didnt think about that possibility? I am thinking you need to get the PTB in a discussion about this, sooner than later. take care.