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

[morte, LPN, LVN]

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.

[tewdles, RN]

this sounds like a can of worms...

Does the facility supervise his visits? Does that mean that he can only have visitors if the facility has adequate staff to supervise him? Do they staff with additional support to accomplish that? or do the other residents suffer lack of assistance because one of the direct care staff is sitting in the room with this guy? Does the facility charge an additional fee for this heightened level of intervention?

can of worms...

[morte, LPN, LVN]

this sounds like a can of worms...

Does the facility supervise his visits? Does that mean that he can only have visitors if the facility has adequate staff to supervise him? Do they staff with additional support to accomplish that? or do the other residents suffer lack of assistance because one of the direct care staff is sitting in the room with this guy? Does the facility charge an additional fee for this heightened level of intervention?

can of worms...

would seem a good argument to see him "git gone"