Just when things seemed to be going quite well at the SNF, the evening shift nurse last night told me Derek had been ordered a UA, CBC, and a whole page of lab tests including thyroid [she showed me the order]. The 'care manager' [the only nurse on the floor I don't like] had faxed the PCP and told him that Derek had lost weight [about 12 pounds, net, since his admission in December] and [because of state surveys, no doubt] she was demanding a battery of tests! So they got the order as well as an order for Periactin, for 'anorexia'. He eats an amazing amount and is not thin by any means.

Well, I hit the roof, without losing my temper. I told the evening nurse [and wrote a note and signed it to that effect] that under no circumstances was he to be ordered lab tests without my consent unless he has symptoms of acute illness and that I didn't consider a slight loss of weight, in a terminal illness, to be acute. AND that Periactin is anticholinergic and that he must not have it!! I also added that no medications, other than antibiotics, are to be ordered without being first approved by his neurologist.

I had a terrible night trying to sleep after this. Am I being overly reactive to these issues? I can't wait until Monday when the 'care manager' is back at work to hear her explanation. I had just a few days ago discussed with her the possibility of Hospice/Palliative care. Her comment was, "I don't see how Hospice can do anything that we can't do!"

Pat,
I don't think you over reacted at all, they know you are there every day, this to me seems a little underhanded to say the least .

I don't blame you one bit, Pat. It seems to me from what little you have said about this person, that she is trying to throw her weight around, maybe climb the ladder. You KNOW Derek's history, and thank God you are on top of things. Imagine what could have happened if they had gone ahead and given him the Periactin. I just admire the fact that you could keep calm - I don't know if I could have!!!!!!

What about also circling back to his PCP on Monday to make sure that the orders can be rescinded and to make sure from that end that tests and meds are not ordered without advising you, and that med changes must be through the neurologist? You caught these but what if someone conveniently forgets to tell you others? This is incredible.

Julianne

Yes, I'm going to fax the PCP this weekend. Actually, his PCP is out of town and the guy who is filling in wrote the orders. But I'll fax the memo to his PCP. Through the years with Lewy I have seen this sort of thing happen all too often where medications are concerned. As I posted before, it was a psychiatrist who ordered Risperdal for him when he was briefly in a nursing home in AZ recovering from a hospitalization. That was a major disaster. He obviously did not bother to consult Derek's neurologist! I sometimes wonder if doctors communicate with one another or bother to read their charts.

Oh, Pat, this sounds so much like what I went through with the former head nurse at the ALF and the CNPs. I hope you have a better outcome than we did. Lynn

Pat, in no way were you out of line. Thank God for a wife like you!

Dorthea

Thank you, one and all, for your support and your reinforcement of my actions. Sometimes I have strong doubts about whether or not I'm over the line and, obviously, I'm not afraid to speak up.

Speaking up for your LO who can't speak up for him or herself is critical in their care. ! Lynn

Hi Pat. Considering how involved you are and how you are obviously skilled at nursing and excellent at caring for your husband I think it was really underhanded of the evening care nurse to take action without consulting you. In fact, I wonder if it is against the SNF's statement of rights. Tests are one thing but changing meds are another. This sort of thing is so dangerous for our loved ones and it creates so much more work for us! I think long and hard about any med change and consider all the factors -dosage, side effects, anticholinergic, etc. before suggesting or allowing a change.

I'm convinced that, in general, doctors don't communicate with each other or read charts. Especially when one is covering for another. Good luck to you with this situation.

I can certainly attest to drs. and CNPs not communicating about my dad. If I didn't coordinate, it didn't happen, until the hospice nurse came on the scene. Then she did a great job, but that was after I had to fire the psychiatrist. Lynn

Pat, if I am ever in a Nursing Home, I hope to heaven that I have an advocate like you in my corner. Derek is so blessed to have you. Nan

Pat, you are a woman much more reserved than I! I'm sure the entire floor would have learned of the mistake and of my opinion of the care manager. You handled it perfectly. I can't wait to hear the outcome once the care manager is confronted with her grievous error. Please keep us filled in and good luck to you in settling this. Sher