Risks and benifits of taking coumadi. Dr wants to discuss if grandfather should stop taking it.

[lenora]

Originally Posted by runswithscissors

Well guess what.

My client fell the day before yesterday at 9 PM and had to be EMT admitted to the ER for a cut arm, her back hurt couldn't/wouldn't walk, and I suspected a UTI. She's still in there because of her white blood count.

I knew it was a UTI because that day, she kept saying she was "afraid of falling in the bathroom" and she never says that except the LAST time she had a UTI and fell - 9 months ago.

Awful experience with the hosp. They had her laying flat with a C collar for the first THREE HOURS nobody saw her to DO anything.

Waiting for "tests". They never came to get her for films or urinalysis for the first 3 hours just let her lay there.

They HAVE quality management processes in place but the people and scheduling were just ridiculous.

The RN assigned to her room was a complete idiot, came in with NO chart after 1.5 hours asking questions. I said, where's her chart we brought with her from the ALF? Everything is on there and I prefer you have it in FRONT of you when discussing her medications. Anyway the doctor had breezed by and ordered the tests so HELLO???

He brings the chart in and after glancing at it says:

"OH she's off the Adderall and the Ativan doesn't work? Why don't you take her off her meds and use [something I never heard of]...that'll knock her out GOOD".

WHAT THE HELL?

I go "What are you talking about? Why do you care about her PRESCRIPTION PRESCRIBED MEDS? She's here for a FALL and a suspicion of a UTI. And what makes you think her meds DON"T WORK and NO, she's not OFF The Adderall, the dose got decreased. And NO, we're not interested in "knocking her out good" and do NOT write anything down from our discussion here."

"WHERE IS THE URINALYSIS AND CAT SCAN TRANSPORT?, THAT'S WHAT WE'RE WAITING FOR HERE."

MORON.

THEN, after 4 hours STILL no urinalysis, I'm trying to get her a cath (they wanted to use a BED PAN with a back injury AND C COLLAR.....and tell her to "lift yourself up".........what the hell.......

because she has to go to the bathroom BUT we need the sterile catch urinalysis and I had to escalate to the RN Floor Manager and Advocate to get someone (and a FEMALE) in to cath her.

The RN, a MALE, wanted to do it and I said , No we need a female and he threatened to have "security to escort you out". The advocate was eyerolling when I told her about that.

Then later, he inserts her drip line with DIRTY HANDS no GLOVES after touching everything including her veins and asks her "Hey do you want some morphine". I KID YOU NOT. It took him WAY TOO MANY tries, too.

He left bloody stuff ALL OVER THE ROOM, on all the tables, floors etc.

LONG story short, when I went up to the hospital admissions room, after DX the UTI and white blood cells, I told the charge nurse what to watch for with her anxiety and that pay attention LOOK AT HER CHART from the ALF...the Ativan was PRN for anxiety BUT she gets it every day at noon, then if she's having a problem at night (rare)....and she had it 12 hours earlier so they could give it when she woke UP instead of waiting for noon to keep her calm. It was 6 am and she was sleeping and I was getting ready to go home.

I WARNED her that she seems fine but if she starts saying she's going to leave that's her anxiety and to act FAST because the Ativan is effective with her and it takes about an hour.

She said "Oh excellent it's so helpful when the people who take care of her KNOW how to help us".

BUT she forgot and didn't write it down so by 11 AM they were ready to RESTRAIN her.

IDIOTS. They didn't even GIVE her the Ativan, they just pulled out restraints. IT was only LUCK that the daughter caught them on the phone after trying all morning long. So then I went over and they sent someone from her ALF. They even had my business card TAPED to her folder/chart and never called me. OH BUT the restraint are the FIRST thing you think of????

I go back and the new nurse is arguing with me "well the charts says Ativan PRN not that she needed it". JEEZE, OK that's what I'm trying to tell you....I told the night nurse all about that!!!! Now we have someone sitting there 24 hours to prevent more problems.

She was FINE after getting the noon Ativan.

NO dementia patient should be DIAGNOSED by ER people or even hospital people who don't KNOW THEM and it's not their JOB. They are in there for the FALL and THAT's IT.

And they shouldn't be left alone in the ER..or left alone in the hospital room or even any SENIOR IMO. Last year they used restraints on her and knocked her out with some potent crap that made her hysterical and like on LSD for about 3 - 5 days later. So you NEVER want that to happen.

She was the ONLY ONE who was left down in the ER as long as she was. And she should have been high priority considering that her mental condition would make their jobs 100X harder by wasting time.

There is NO EXCUSE on the face of the earth for an 87 year old woman with dementia in an awful C collar and IV to have to wait 5 hours on the overnight, for a stupid urinalysis OR a cat scan and reading. And the place wasn't even crowded, nobody in the waiting room and only about 4 rooms had people. TWO were babies sleeping.

BTW, the doctor came in at 4 AM to specifically say "Great job, you know your patient. We wouldn't have done that urinalysis and gotten the bloodwork based on her symptoms of back pain and it IS a UTI and a bad one. Her WBC needs her admitted for IV antibiotics and she needs fluids, so thank you". And shook my hand.

AGAIN, EVERY senior especially with dementia is a RULE IN for a UTI. Especially women with the wiping issues. Especially when they are falling. (not necessarily Bean's GF who is suspected of a form of dementia that includes falls).

I understand your frustration and I would suggest that the next time you accompany your client to the ER that you remember that you catch more flies with honey. It's a pain in the arse (especially for someone with my personality) but it has worked for me thus far. I remain calm but firm. Keep in mind, the more you b**** to the staff, the more likely they will avoid contact with you AND your client. Some will go so far as to delay checking for lab results (when there is no clear emergency). It sucks, but it is what it is.

[runswithscissors]

Originally Posted by lenora

I understand your frustration and I would suggest that the next time you accompany your client to the ER that you remember that you catch more flies with honey. It's a pain in the arse (especially for someone with my personality) but it has worked for me thus far. I remain calm but firm. Keep in mind, the more you b**** to the staff, the more likely they will avoid contact with you AND your client. Some will go so far as to delay checking for lab results (when there is no clear emergency). It sucks, but it is what it is.

First of all why would you assume I was anything other than calm? Because I used CAPS? Andy why would you assume I don't know about hospitals? "Bitc#ing"? LOL OK.

This was a clusterf*, bottom line, and it can't be denied or blamed on the PATIENT/CUSTOMER. I didn't write an hour by hour dissertation, I'd be here for three page.

I spoke with the Floor Charge RN (not the weirdo) who was very nice several times because even SHE was concerned because my client was trying to remove her C collar and getting agitated and crying about her back pain because she couldn't move around wearing the C collar and having to go to the bathroom. SHe couldn't GET her to the catscan either. They couldn't sedate her again she had already had something at 5 PM. She was right outside our door, for goodness sakes.

I even WARNED her about last year that she tore the joint up (metaphorically) and had to be restrained so proceed delays with caution. SHE wanted her out of there, as much as me.

The fact that you say they'll retaliate against the patient says it all. AND EXACTLY why they have a quality process and advocates. AND encourage the patients/familes to ESCALATE.

I'm a dog walker, you cannot be excitable. And certainly you can't be excitable with a dementia patient and I'm the one known to keep HER calm.

Your admonition has nothing to do with the RN coming in to "CHAT" and overstepping his role, while ignoring giving me an update on the orders that the doctor left. He started off asking me if they have RNs at her ALF and then segued to bragging about knowing all about dementia meds. I'd say he was JOB HUNTING, not focused on his PATIENT'S needs. I didn't even know what he was doing for 20 minutes before finally saying "WHAT are you asking me?????"

Why does he care if RNs are at the ALF? To get a job, that's why. Which occurred to me later.

It also has NOTHING to do with the overnight hospital charge nurse FORGETTING to give the information to her replacement on the shift report.

It has NOTHING to do with the hospital jumping to restraints and ignoring her sedative that was right on the chart.

You seem to forget the quality process inserts the ADVOCATE in between the patient and the staff AND on the wall it lists every step of escalation and advises the CUSTOMER "If you have ANY concerns at all, contact the MANAGER on ext XXX". The MANAGER is the medical director that ties it all together among the medical staff. And the person you call if the ADVOCATE can't resolve the issues.

Why do you think they have that on the wall in every room?

The ADVOCATE facilitated everything I needed in the ER. I didn't KNOW she needed an advocate on the floor since the RN charge nurse was happy to have the downlow on the lady. WHO KNEW she'd forget it?

I think you're also forgetting that these facilities are RATED in the quality point system on these factors. TIMELY treatment, ACCURACY, and NOT passing on infection by not wearing GLOVES, for example. Which, ACTUALLY, I was so dumbfounded seeing I was speechless.

Perhaps you're happy to sit around not advocating for YOUR client (do you have any?) , but I won't do it, just like I didn't do it for my mother drowning in bureaucracy for two years.

And NO, I'm not going to sit around debating the meds my client takes with someone who has no business deciding they know more than her shrink, neuro and GP physicians.

No, you do NOT get more timely treatment by using HONEY (even though I was being nice), you just take longer to get answers, that are potentially not even CORRECT if you are not involved. Why are you assuming I went in with guns blazing and never ASKED NICELY where are THE TESTS after 3 HOURS????

Why do you think the ALF sent one of their STAFF over there the next day to make sure that she was treated correctly when I had to leave? Do y ou know that is UNHEARD OF you normally have to have the family pay a private agency but they called in an extra staff member who she knows...because they care about her.

My clients' family is quite happy to have someone navigate on their mother's behalf considering they couldn't even get a status from anyone on the phone for 5 hours all morning after she was admitted. USING the HONEY technique, completely forgetting all they had to do was call the advocate and ASK because they were so frantic.

AND if they HAD called the ADVOCATE early, they would have gotten someone on the phone and been able to remind them about her anxiety issues and give the Ativan, which would have PRECLUDED the DRAMA of almost restraining her.

Perhaps you are unaware that restraints are considered a LAST resort and they're supposed to try everything ELSE first and need to write up a big report on why they had to use them.

ie Florida Nursing Home Laws do not play around:

Physical Restraints

Both Federal and Florida law restrict the use of physical restraints for nursing home residents. Under the Federal Nursing Home Reform Law, a physical restraint can be utilized only to treat a resident’s medical conditions or symptoms. Restraints never can be used for discipline or the nursing home’s convenience. (See Section 483.13(a) of Title 42 of the Code of Federal Regulations). Florida law (Section 400.022(1)(o) restricts the use of restraints allowing only those restrains authorized in writing by a physician for a specified and limited period of time or as are necessitated by an emergency.

In the case of an emergency, restraint may be only applied by a qualified licensed nurse who shall set forth in writing the circumstances requiring the use of restraint, and, in the case of use of a chemical restraint, a physician shall be consulted immediately thereafter. Restraints may not be used in lieu of staff supervision or merely for staff convenience, for punishment, or for reasons other than resident protection or safety.

The law restricts the use of restraints because there is a large body of research showing that the use of restraints is harmful, both psychologically and physically.

http://www.burzynskilaw.com/Physical%20Restraints.htm

The same LAW prohibits withholding food/water for any reason, which was ANOTHER SUGGESTION someone HERE made to someone else on another thread.

[lenora]

Originally Posted by runswithscissors

First of all why would you assume I was anything other than calm? Because I used CAPS? Andy why would you assume I don't know about hospitals? "Bitc#ing"? LOL OK.

I'm a dog walker, you cannot be excitable. And certainly you can't be excitable with a dementia patient and I'm the one known to keep HER calm.

Your admonition has nothing to do with the RN coming in to "CHAT" and overstepping his role, while ignoring HER orders that the doctor left. He started off asking me if they have RNs at her ALF and then segued to bragging about knowing all about dementia meds. I'd say he was JOB HUNTING, not focused on his PATIENT'S needs. I didn't even know what he was doing for 20 minutes before finally saying "WHAT are you asking me?????"

Why does he care if RNs are at the ALF? To get a job, that's why. Which occurred to me later.

It also has NOTHING to do with the charge nurse FORGETTING to give the information to her replacement on the shift report.

It has NOTHING to do with the hospital jumping to restraints and ignoring her sedative that was right on the chart.

You seem to forget the quality process inserts the ADVOCATE in between the patient and the staff AND on the wall it lists every step of escalation and advises the CUSTOMER "If you have ANY concerns at all, contact the MANAGER on ext XXX". The MANAGER is the medical director that ties it all together among the medical staff. And the person you call if the ADVOCATE can't resolve the issues.

Why do you think they have that on the wall in every room?

The ADVOCATE facilitated everything I needed in the ER. I didn't KNOW she needed an advocate on the floor since the RN charge nurse was happy to have the downlow on the lady. WHO KNEW she'd forget it?

I think you're also forgetting that these facilities are RATED in the quality point system on these factors. TIMELY treatment, ACCURACY, and NOT passing on infection by not wearing GLOVES, for example. Which, ACTUALLY, I was so dumbfounded seeing I was speechless.

Perhaps you're happy to sit around not advocating for YOUR client (do you have any?) , but I won't do it, just like I didn't do it for my mother drowning in bureaucracy for two years.

And NO, I'm not going to sit around debating the meds my client takes with someone who has no business deciding they know more than her shrink, neuro and GP physicians.

No, you do NOT get more timely treatment by using HONEY, you just take longer to get answers, that are potentially not even CORRECT if you are not involved.

Why do you think the ALF sent one of their STAFF over there to make sure that she was treated correctly.

My clients' family is quite happy to have someone navigate on their mother's behalf considering they couldn't even get anyone on the phone for 5 hours all morning after she was admitted.

This:

"I go "What are you talking about? Why do you care about her PRESCRIPTION PRESCRIBED MEDS? She's here for a FALL and a suspicion of a UTI. And what makes you think her meds DON"T WORK and NO, she's not OFF The Adderall, the dose got decreased. And NO, we're not interested in "knocking her out good" and do NOT write anything down from our discussion here."

Seriously?