What would you do?

[nowplayingEDRN]

I have not been agency all that long (almost a year) and after my first agency assignment, took a FT spot with a hospital bit have continued to take per diem shifts doing different things for the Agency. 2 weeks before christmas, I did a per diem shift at a hospital for what was supposed to be ICU but turned out to be Step-down. Here is my dilema:

I was assigned a pt of the Jewish faith that was in the end stages of life. The family had made the pt. a DNR but when the BP started to plummet the Rabbi came in and made the decision that the Levophed drip should be put back on the pt to maintain the BP (this is not my dilema). In report I was told that the pt was unresponsive, total care, PEG tube, T&P q2h, had a decubitus on the coccyx and a supposed "skin break down" on the scalp that could not be found, a trach and needed frequent suctioning, constipated and was recieving massive amounts of stool softeners, laxatives and enemas to try and get him to have a BM.

It was rather challenging trying to perform the necessary tasks for this patient while working around the family and Rabbi but I did so with little disruption to the time schedule for meds. I was told that the patient had been bathed on nights and so that was something that did not need to be done. I was struck by the poor condition that this patient seemed to be in. he was so frail lying there in the bed. But what struck me most was that it seemed like this pt was NOT unresponsive at all. Yes, he was contracted and yes he had involuntary movements but it seemed like when I would go to pass meds through the PEG he would stiffen up, preventing the meds from sliding easily through the PEG until I told him what I was doing, at which point it seemed to me that my pt would visibly relax and the meds slipped down and allowed me to flush the tube and straighten his bedding and clothing back out. This reaction from the pt puzzled and troubled my 6th sense a bit. This however was reconfirmed when toward the end of my shift I needed to help with a partial bed bath because of well.....he was getting massive amounts of stool softeners and laxitives! So when we were done with the linen change and partial bed bath (washing hands when done removing gloves of course! ) I decided to do trach care as his trach tie looked to be a sorry mess.....well this was the start of a nightmare for me (having been a floor nurse when staffing numbers on nights were of dangerous levels!) I have been short staffed before and worked in places where staffing numbers are not where they should be but I was appaled at how absitively filthy this trach tie was! It was evident that it had been left on the pt from the begining of time as it had embedded its self into the very edematous, swollen skin of this pt's neck, which started to bleed a bit when it was removed. I cleansed the area with NS and put telfa pads down when I noticed it was bleeding before applying the clean trach holder then performed some serious trach care and applied a new dressing to the trach. Now being on a mission, i went to change the dressing on the supposed breakdown that no one could find on the scalp. Well, you can't find something when one does not take off a cap that a pt is wearing can you???? Needless to say, through all these dressing changes, I noticed a tear running from the corner of the pt's eye! Now, I realize that this was the first time I was in this facility but this was just the frosting on a less than warm and fuzzy welcome. The whole experience at this place was nightmare-ish and when I called the Agency on Monday to let them know how things went, I made it abundantly clear that it was a less than positive experience for me and I was not sure I would be willing to go back.

Here is my dilema.....the condition of this pt was deplorable and I was debating whether or not I should drop the dime and make a report on this pt to the proper authorities. What would you do??

[ColdFusion]

I don't know what to tell you because my first thought is, did you get the charge person that night and show them the patient's condition?

I'm also confused about his DNR status - I didn't know a rabbi could rescind a DNR order. I thought the family was in charge of that....?

You could explain what you found to your agency and let them handle it.

Or you could make the call yourself....I don't know what I would do but I would do something...

[Daytonite, BSN, RN]

What a dilemma! You know what? I'd check your state nursing law and see if there is some kind of section in there that mandates you to report neglectful care and be guided by that.

[Haunted]

What proper authorities would you contact about this? I have never had any response when I would report equally awful situations, no feed back whatsoever. I am also seconding the Rabbi's ability to change any existing medical orders. I am familiar with Jewish tradition and end of life rituals but have never heard of that one.... glad you were able to provide some quality nursing care for this patient, there is a warm, sunny beach vacation in your future!

[nowplayingEDRN]

I don't even know what authorities to actually report this situation to. I do know that I went back to this same facility one more time and was sent to a completely different unit. Unfortunately, these people made things so distasteful that I finished my shift and then spoke with the agency on the next business day and told them that I was not getting paid enough to take the abuse that was being dished out. My hearts and prayers still go out to the patient, if he is still on this earth. Haunted, may your future prediction come true for me, I could use one of those vacations.:Melody: