I find it quite horrible that Fentanyl patches were left on patient’s body - first of all, as a controlled substance it is accounted for in the nurse med cart (and counted/accounted for each shift change; double locked - sign off by LPN or RN who has the shift and is passing medications). When a patch is put on and old one off, double signature for destruction. The narcotic sheet has signing on and off for applying and destroying - so it is clear only one patch on patient at a time. We also check body location of current Fentanyl patch and sign each shift that we see the patch on this patient’s body location. Yes the state is going to jump on that one!
Residents with 24 hour patches with memory medication, put new one on and take old one off. I have one resident with a 12 hour patch that gets put on at 9 am and taken off at 9 pm - nurse signature on computer Medical Administration Record (MAR). We also have TAR - Treatment Administration Record.
travelnut, I have been researching Medicare hospice benefits and limitations. I am probably going to revoke hospice if the CT is not covered. But I doubt that coverage is a problem. The language is clear that regular Medicare will pay for things like testing that are not related to the hospice diagnosis. With dementia as the terminal illness, that leaves things wide open for other medical issues, it would seem. I’ll check in the morning.
What bothers me is the relentless, negative, almost punitive tone of the hospice nurse whenever I am not toeing the line so to speak. When I wanted to reduce morphine use for minor pain, to reduce fall risk, I had to go to a meeting to reevaluate the appropriateness of hospice. She just doesn’t like me questioning anything. The AL director supported me in that meeting and told me I had “been pleasant but made my point.”
It is in the AL’s best interest to keep my mother on hospice because the hospice aide does everything the AL aide might do but the AL can charge the same price
Not getting a lot of sleep on my mother’s love seat !! But I have stopped her from taking the pressure bandage off few times We’ll see what she uses for her teeth after breakfast!!!
The medication mix-ups are common. The Electronic Medical Records are supposed to help with that, but don’t. They tend to show everything ever prescribed, not what is currently prescribed. I don’t know how patients without vigilant families survive the system. Maybe they just don’t.
This is so true! The hospital had one of my son’s meds at a dosage FOUR TIMES too high. The nurse showed it to me on a computer screen. I’m sure it was a dosage from years ago, but there was no date next to it! Rather a major shortcoming of the system.
Our system has us with narcotics on MAR and on paper.
My daughter works at a hospital with individual medical dispensing, and if one narcotic pill is missing they have to call in the police for a police report.
@MomofJandL to say medication mix-ups are common - unless you are a health practitioner on that system, you are an outsider making a very broad blanket statement.
Sorry @MaineLonghorn on your son’s hospital error on medication level. The hospital doesn’t ‘pull over’ old medications - the meds have to have current MD orders and entered in. Hospitals have mechanisms to deal with errors, as do other health care providers.
I know in our area there are a lot of Hospice agencies - some better than others.
Broad range of care services and how various places deal with things. Just like there are excellent MDs, Nurse Practitioners, Therapists, Etc, and many with much room for improvement.
Yes, I am making a very broad statement because I have seen it with multiple patients on multiple systems in multiple health care facilities. I have actually never seen it work well. That doesn’t mean it doesn’t work well ever anywhere, but I wouldn’t count on it.
My medications on EHR have been wrong on most systems and it’s very difficult to get correct. I have tried repeatedly on many different systems as well. They are still mostly wrong, not distinguishing between Rx prescribed many years ago for which I have never ever taken but had on hand “just in case,” taken a pill or two as a one time need, and those currently being taken on a regular basis.
I have asked the front desk and my providers in the various medical systems to correct my medical records each time and they try to but mostly they are unsuccessful and the medication list is very long, cumbersome and largely meaningless.
This is not to say that the system can’t be properly administered, it’s just unfortunate that because it’s so often Rx on EHR are wrong it isn’t more helpful to all.
My mother’s situation is really getting me frustrated. Her doctors have known since early December that she is severely anemic, they can’t find the cause, but they do know that when this happened last year iron infusions helped tremendously in getting her energy back. But we just can’t quite get a plan for the infusions. In the meantime, she was hospitalized for a different reason, and the antibiotics she has been taken (first for a cat bite, and the last 3 weeks for pneumonia that she may or may not have) have knocked her flat out.
We know she won’t get stronger without the infusions (don’t know if she will get stronger with them, but it’s worth a try), we know the antibiotics are killing her appetite and draining her energy, and we can’t get the medical team to work the issue. Ok, I’m not a doctor. But the handoff from the primary care physician to the hematologist to the hospitalist to the rehab doctor has not helped. In October she was living in her apartment and coherent, and now she needs help getting out of bed and is confused. And since the rehab doctor has never seen her any other way his expectations are low. And my siblings and I are trying to tag team this which is also part of the problem.
Aaargghh!
Thanks for letting me vent. We’ll keep working it, and keep reminding the new team that they should have high expectations. And we know that she won’t live forever, but that doesn’t mean she has to give up today.
Wow MomofJandl that is a lot of change in a very short time. I know what you mean about low expectations.
SOS concern we see med issues on systems all over the place. Let us know where to go for care!
I managed to talk to a higher up at hospice who is going to personally make sure the CT Scan is paid for. The info we get about the fracture will help us determine a path for comfort.
Now I have to change that dressing and redo the packing. A little intimidated!
Dragging around getting things done is totally frustrating. Handoffs from one doctor to another with everyone in their silo isn’t in the best interest of the patient. And I completely agree that low expectations from the doctor (and perhaps is perceiving you as naive or out of touch) is another hurdle to cross.
@MomofJandL I have seen the low expectations in action as well. It is hard to have people in rehab not know how she was just a short time a go. I had to keep at them to coordinate the care and meds and to seek the functionality she had. They kept saying it was the new baseline but I knew we could get her back to more of a normal situation. I understand your October to now view. You saw her both ways. They saw her the current way. Keep at it
It must be very easy to fall prey to seeing people a certain way. FIL had serious Bell’s Palsy as a young man, his entire face sagged on one side. But in his 90s he had a few small strokes. The last year of his life, we could not get hospice and AL people not to go down the “stroke” pathway, it did not make a huge difference in his case, but it was just obvious they were starting from an incorrect assumption, it was frustrating as it would shade all their thinking.
@somemom I agree. The doctors/clinicians/nurses should look at how the person was before (through interviewing the family, AL, MC etc) instead of just assuming it is the condition it most looks like to them at that time. For you glad that it didn’t make a huge difference. Hang in there all caretaking is not an easy job!
Wow, I’ve been away from this thread for a while. So much going on with everyone’s elders. I don’t know where to start. Such fortunate parents to have all of you caring warriors there for them. For those of you who had to deal with so many med errors, transition of care issues, and what sounds like, unkindness; as a medical professional, I am sorry. We need to be better.
I wish all of you could have the family care home experience my parents have. Though despite good care, mom is precipitously declining in the last 4-6 weeks. She is failure to thrive plus dementia and therefore, qualifies for hospice and we are setting up the referral. She is eating and drinking very little. I’ve asked them to encourage but not push. In the meantime, dad is hale and hearty and chats up a storm with everyone who comes around. We can’t understand 99% of the conversation but get an occasional word.
@surfcity I often feel sorry for myself that both my parents are cognitively impaired. But, I am blessed we found a situation in which they can stay together.
@SOSConcern - FIL had the fentanyl patches applied to various spots on his body by different staff. Their reasoning was that MIL was pulling them off of him. (We had no reason to believe this.) the mere fact that a new patch of a controlled substance would be applied without finding and removing the old one shocked us all. At a minimum, they should have noted where the patch was applied for aid in later removal and one of the family members informed if indeed MIL was removing them. Good to know there are standards that would normally prevent this.
The only reason they were found was he ended up in the ER for an unrelated heart issue. I think the Nurse was reprimanded. All nursing staff did have to go through training. There had been turnover in staff, but that’s no excuse.
It is a reminder for all to check AL facilities with the State. I wouldn’t have thought about it if simply moving into an apartment.
@GTalum - sorry to hear about your mother. My mom had the best care at a similar care home. It was so much better than a large skilled nursing facility.
When a serious infraction happens at a facility regulated by state laws, one of the remedies the facility automatically does is having an education session, with all attendees signing off that they attended and understand and will follow policies/procedures with the specific education focus. At our facility, 3 day suspension is an option beyond being written up; if being fired is justified, that happens too.
AL and Skilled Care/Rehab have different regulations, and some states have stronger AL regulations than others.
My mom is finally going to be moved to rehab today. The insurance company denied coverage and so the head of the stroke recovery program had to spend a couple of days fighting with them. Grrr. . .
I hired an aide to stay with my dad from 9-6 every day, per the personal care facility suggestion. They cannot devote a person to him and he has constant anxiety about where mom is and they are worried about him. He will hate having a “babysitter” and probably see her as part of the giant conspiracy his brain occasionally dreams up, but at least she is paid to be there and try to calm him down and she does not have the emotional layer that I do when seeing him acting so not like himself.
IT is exhausting trying to talk “down” to my parents at their compromised cognitive levels. Dad can have complex discussions about politics and things related to his old job but then can harp over and over that mom is in jail and he cannot see her!
Everyone says that we caregivers have to take care of ourselves. It is difficult when the facilities are constantly calling and needing information or a parent is calling and crying because they don’t know where they are!
I do take comfort in that my parents would be mortified if they really knew how much this was impacting my life and I know they would want me to take care of myself but it’s still hard.
Thanks for indulging my stream of consciousness rant
@surfcity My siblings have been telling me for the past couple of years that I have done enough, it would be ok to put our mother into a home, but they have no clue how much work it still is when they are in a home. Mine would have to be 45 minutes away from my home and it’s so much work, I saw that with the in laws in their assorted homes.
@surfcity and others, here’s what happened with payment for rehab after my mom (90 years old) had knee-replacement surgery in September.
Surgery was scheduled for a Monday morning and went well and according to plan. M stayed that night in the hospital, per the joint-replacement-program protocol.
M was released from the hospital the next afternoon. Protocol was that she would be at home with someone there (i.e., one of my siblings or me) for the next two weeks. Her pain pump was dislodged after she was home for a few hours (with my three siblings in attendance). She was in great pain and could barely move, even with my sibs’ help. The sibs took her to the ER. M was readmitted to the hospital.
M said she didn’t want to do rehab at home; wanted to do it at a facility. Hospital staff agreed and helped make arrangements for M to go to a continuing-care-retirement facility two blocks from her house. Hospital staff quietly but firmly insisted that she spend only two nights in the hospital.
The two nights were key; if it had been three, Medicare would have paid for the rehab.
M has secondary insurance. Insurance company told the social worker at the CCRC that it would pay “up to” 100% for the “approved stay.” Insurance company then said the rehab stay was not approved because M was in too-good condition.
Social worker went to bat for M. The insurance company eventually agreed to pay for a two weeks’ stay.
