Who does this stuff? Really, you can't make it up!

[ShayRN]

So a family wants their mom sat up in a chair. She is dead weight and exceeds our hoyer weight limit. Sorry, safety issue can't do it. So they try to put her up on the side of the bed themselves, she falls on the floor. A complete lift and one of our nurses ends up in ER and is off work for a while. Next day, they do the same darn thing. Put her up on side of bed and down she goes. Tonight, I walked in and found her sitting up at the bedside AGAIN. I told her daughter, if she falls, I am calling the ambulance crew for a lift assist and she will have to lay on the floor until they get here. Guess what happened? What. the. heck. I am so frustrated. Any advice for tomarrow, because I gotta be honest, my back really hurts right now.

[ShayRN]

Your facility should not accept a bariatric patient if they don't have the proper equipment to care for the person. Do you keep this woman in bed 24/7?

To answer everyone's questions, yes, most of our patients DO stay in bed 24/7. We are an inpatient HOSPICE facility. The majority of our patients die within 3 day of admission. We have managed to get this particuler woman's symptoms under control and the plan is she is going home in 3 days. However, the fact remains she is a hospice patient and is dying. The DON actually helped lift her after her first fall, he is VERY aware. The medical director knows as well. However, one of the rights a hospice patient has is the right to be involved in decisions regarding her care (family tells us she is asking to get up) and the right to have visitors at any time. We cannot stop her family from coming as long as they don't threaten us. I have honestly considered that they are allowing her to fall with the hopes that she will be able to stay, as it stands now she is scheduled to go home on Wed. But the problem is, prove it... My other idea was this (don't know how it would go over with DON), if she falls because they are sitting her on the side of bed, THEY need to call out family members to pick her up. One time of 10 siblings being called out to get mom off the floor MAY put a stop to the nonsense, but I doubt I could get away with it, lol.

[cherrybreeze, ADN, RN]

Your facility should not accept a bariatric patient if they don't have the proper equipment to care for the person. Do you keep this woman in bed 24/7?

To answer everyone's questions, yes, most of our patients DO stay in bed 24/7. We are an inpatient HOSPICE facility. The majority of our patients die within 3 day of admission. We have managed to get this particuler woman's symptoms under control and the plan is she is going home in 3 days. However, the fact remains she is a hospice patient and is dying. The DON actually helped lift her after her first fall, he is VERY aware. The medical director knows as well. However, one of the rights a hospice patient has is the right to be involved in decisions regarding her care (family tells us she is asking to get up) and the right to have visitors at any time. We cannot stop her family from coming as long as they don't threaten us. I have honestly considered that they are allowing her to fall with the hopes that she will be able to stay, as it stands now she is scheduled to go home on Wed. But the problem is, prove it... My other idea was this (don't know how it would go over with DON), if she falls because they are sitting her on the side of bed, THEY need to call out family members to pick her up. One time of 10 siblings being called out to get mom off the floor MAY put a stop to the nonsense, but I doubt I could get away with it, lol.

So your DON was aware of the first fall, is he aware of the rest? I don't understand, if they know about all of the falls and WHY they occurred, that they haven't intervened. That is just beyond me.

Shame on this family, for willingly putting their loved one at risk, no matter WHAT the reason.

I can understand the posts that say it's not acceptable for a patient to be in bed 24/7, but it DOES happen...especially when they are so immobile that there isnt' really any benefit at all from getting up to sit in a chair. They can't be turned, and there's more pressure on the coccyx in a chair, so it actually may be more detrimental for them to be "up." I've had that argument with families before, too; they want their loved one "up" even though said loved one weighs 350 lbs, and does not bear weight. They refuse to let us use a mechanical lift ("they won't get stronger that way!") even though it's the only safe way to attempt to move them. It's frustrating, to say the least.

[celclt]

maybe more family education about the process of dying, getting them involved in care (lotion,ect)

[blondy2061h, MSN, RN]

For the family members, right? :)

Exactly! Don't you wish, sometimes?

[leslie :-D]

However, one of the rights a hospice patient has is the right to be involved in decisions regarding her care (family tells us she is asking to get up) and the right to have visitors at any time.

this is what i was referring to, when i said they need a kick in the pants.

you and i both know this pt is not requesting to get oob.

and, we both know how manipulative families can be.

i'd be personally having an earnest 1:1 with the pt (alone) and eliciting feedback...

then documenting in nn's.

furthermore, no one has the right to impose injury on another.

this is bs, and we both know it.

leslie

[leslie :-D]

So your DON was aware of the first fall, is he aware of the rest? I don't understand, if they know about all of the falls and WHY they occurred, that they haven't intervened. That is just beyond me.

Shame on this family, for willingly putting their loved one at risk, no matter WHAT the reason.

as is typically the case, the don and med'l dir are placating the family.

but i guarantee they both know what is really going on, and are choosing to turn their heads the other way.

i've seen it more often than not.

and it's sickening.

leslie

[cherrybreeze, ADN, RN]

as is typically the case, the don and med'l dir are placating the family.

but i guarantee they both know what is really going on, and are choosing to turn their heads the other way.

i've seen it more often than not.

and it's sickening.

leslie

It is. I guess it's my ingrained naivete about people...even when I know better, I still expect people to do what's best, right, etc. For some reason, I still get surprised when that DOESN'T happen, even though I've seen it so many times, you'd think I'd be used to it by now.

Will they be so placating when this patient finally suffers an injury, like a hip fx, and the facility has to foot the bill?

[Moogie]

as is typically the case, the don and med'l dir are placating the family.

but i guarantee they both know what is really going on, and are choosing to turn their heads the other way.

i've seen it more often than not.

and it's sickening.

leslie

ITA. This is the kind of garbage that frustrates nurses, causes harm and discomfort to the patient, and ensures that at least one person on the nursing staff is going to get a back injury.

It's one thing to not advocate for one's staff----it happens ALL the time---but to put the poor patient through this kind of discomfort just to placate a clueless family is simply heinous.

[NotFlo]

To answer everyone's questions, yes, most of our patients DO stay in bed 24/7. We are an inpatient HOSPICE facility. The majority of our patients die within 3 day of admission. We have managed to get this particuler woman's symptoms under control and the plan is she is going home in 3 days.

Thanks for clarifying! I was thinking this was a conventional LTC situation. That makes a huge difference. Crazy family.

[ShayRN]

ITA. This is the kind of garbage that frustrates nurses, causes harm and discomfort to the patient, and ensures that at least one person on the nursing staff is going to get a back injury.

Been there already. Nurse went to ER Friday and will be off for awhile now. Grrrr. Oh well, will let you all know what happens when I go in today!

[cookienay]

Patient and staff safety supercede any patient and family wishes. period. just say no and let them know that mommy sure will miss them when they have to be escorted out because they are interfering with patient safety.

[VivaLasViejas, ASN, RN]

I certainly hope everyone---INCLUDING the DON and supervisory staff---is documenting the h-e-double-hockeysticks out of all this. Families like the one you've described always seem to be the quickest to call a lawyer when the inevitable happens and their loved one suffers a serious injury (or worse).