What could have been done differently?

[mondkmondk]

I worked this past weekend. I took report from the day nurse on Saturday about a resident who had developed a UTI. Someone overlooked the pending C&S and the lab I guess never did it so the day nurse obtained another specimen and sent it to the lab and started the resident on Cipro. Since he also had a fever the on call doc ordered him a one time order for Ibuprofen. (This patient also has Hepatitis C and can't take Tylenol). So I come on and am going to get a full set of vitals on him. We currently use one of those thermometers where you run it across the forehead and down below the ear. His first temp. was 104...this was after the Ibuprofen and after his initial dose of Cipro. So I called the on-call doc. While I was on hold, one of my aides checked it again and it was 102. So when the doc got on the line, I told her of the temps. She got snippity with me and told me I hadn't given the Ibuprofen and Cipro enough time to work and to just monitor him.

Well, so here comes this guy to the desk wanting to take him out of the facility for an hour. I check his temp again and it is 99.4 and this resident is his own person and tells me he's going out, temp or no. So I sign him out and make sure to document all this carefully. A CMT passing through from another unit, stops and is watching me sign him out. After they leave, she tells me that I will probably get in trouble for letting him go out with a fever. ????

He comes back and is lethargic/drowsy and I check his temp again and it is 99.2. His other vitals are fine. So should I somehow have tried to make him not go out? Today he spiked a 102 temp and is now in the hospital. Same CMT thinks I'm to blame because I let him go out. For one, he is his own person; I cannot make him stay in the facility. Should I have done anything differently?

Blessings, Michelle

[mamamerlee, LPN]

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

[wooh, BSN, RN]

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?

[morte, LPN, LVN]

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

[CoffeeRTC, BSN, RN]

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.

[SuesquatchRN, BSN, RN]

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

[Debilpn23]

Michelle

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

[Siddhartha]

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

[CoffeeRTC, BSN, RN]

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.

[txspadequeenRN, BSN, RN]

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..

[morte, LPN, LVN]

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......

[mondkmondk]

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