This is killing me!
Family member of resident in assisted living facility where I work is demanding we medicate her with pain killers and sedation ATC even though she's not in pain. Rose has terminal breast ca. Up to a few days ago, she was alert, eating, able to communicate needs, but weak. Son (POA, an attorney) hounding us and Hospice to give her PRN pain killers and sedation ATC to the point of harassment (calls several times a day), even though resident verbalizes she's not in pain when asked. Last night, he came in and again instructed me to give her Roxanol. I asked resident if she was in pain and she said no and shook her head. I walked out and refused to give it to her, explaining that it's a PRN order for pain. He followed me out and told me he doesn't want me to take care of his mother; then he called Hospice and convinced them to change orders for pain med and sedation to q4h ATC and to make her NPO. I couldn't believe it! I informed administrator I would not be a party to euthanizing this woman. Today, Hospice is providing their nurses to medicate her per son's request. There's something terribly wrong with this picture.
Maddie I hate to say this but this is how Hospice works I have never seen anyone go into end of life hospice care last longer than two weeks and it's usually due to the sedating effects and respiratory depression caused by pain killers.
This is also the model that Healthcare Reform wants us to follow so as to lessen the patients suffering and minimize the cost of keeping people alive.
Welcome to the Brave New World
Hppy
Sadly, I must agree with hppy. We are trained to think and assess first and then apply care appropriate to the clinical condition at the moment however, more often than not, medical care is delivered according to preset standards and not clinical judgment. Maddie, you experienced what it feels like to work in the health care boutique but with the additional rub of a heavy-handed attorney POA. That must've sucked.
Survival Rule # 1: Show up, follow protocol, leave.
Survival Rule # 2: Document, document, document, document and, document...
R
I hate to say this, but the hospice caved in to keep a patient, and make family 'happy'.
As Ricu said: Document! Does patient have any other co-existing problems (ie, brain mets, dementia, Alzheimers) that would affect mentation? Thus, if patient states not in pain, TRUST THE PATIENT!
I am sure there is something else going on. I know for a fact Assisted Living is not cheap. Perhaps said POA is afraid he will have to pay expenses? Perhaps he is setting up a potential law suit? Not sure about the rest of you folks, but I see quite a few Law firms advertising about nursing home cases, etc.
Maddie, I'd like to know what your 'higher ups' have to say about this situation? Or do they say anything at all? They should be aware of what's going on, and should be consulting with their higher ups.
You hit the nail on the head, Cougar.
Not sure, but I may come back for a few more swings later......
"Perhaps said POA is afraid he will have to pay expenses?" AHA! Cougar, you HAVE hit the nail...I was wondering why POA kept telling his family "she's only got a few days to go" and calling to find out if we had medicated her while the woman was still going to the dining room and playing bingo last week. Well, all three nurses refused to give PRNs around the clock, so admin brought in Hospice to do it starting on Monday. She died yesterday (lasted four days). So preset standards override clinical judgement? "Compassionate care" is now euthanasia? This is not only unethical, it's downright scary!
I wonder if the patient tells the son one thing and the nurse another. My experience with breast cancer patients is that as they approach death, they do have a lot of discomfort and anxiety. At the end, they usually have a lot of pain. If this lady doesn't have dementia or brain mets, she is able to revoke her power of attorneyif she so desires. I am poa for my parents. Both of them have made it very clear how they want things addressed at the end, and what type of care they want. My mother, now deceased, was terrified of dying in pain. She was not terrified of death. She was terrified of the pain that might be involved. There might be more to this picture than what you are seeing. Sometimes the patient is comfortable with talking about death, and they will tell you exactly how they want to die. Although, I stereotype the personalities of attornies, bad me; she may have had this discussion with the son.
OK, back for a few more swings here. And I am sure you guys know I can swing.
Pam and Maddie, how long have you guys been in nursing? Just curious. Me? Long enough to have seen quite alot (though I am sure I've still got more to see).
That said...Pam, I am sure that what you mentioned could, in fact, have happened. Yet, wouldn't you expect there have been other comments made to others?
Maddie, I agree: Does sound like something was going on. Hppy has a soapbox for that issue; trust me!
I will post more later....
nice one cougar!
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