Mom’s old Skilled
Nursing Facility "loves" PNR medications! Especially the kind that are
for "pain" and for "discomfort", emotional as well as
physical. Imagine many facilities love these types of medications.
You see, while they may have to be
reported to the State depending on when they were “last given” if it falls
within a window of time the DHSS requests, they may not have to “list” these
because they’re “as needed” and not “prescribed daily dosages”.
Little loopholes mean big
opportunities to facilites. They’re a part of the infrastructure of Long Term
Care Facilities we never really notice, don’t pay more attention to and don’t
realize how extensive they are as a practice.
What happens when you take narcotics?
You generally get
drowsy, often sleep a lot and you almost always “mellow”. Seniors often sit or
lay in bed and require a lot less attention – giving the facility the ability
to operate with fewer staff.
I’ve
witnessed many “nurses” (those LPN’s responsible for sections fo the floor and
specific patients) ‘inquire” or “ask”: Patient A, do you need anything for
pain?” OR, “Patient A, on a scale of 1 to 10, how’s that pain you’ve been
having? Would you like to have a “B” that’s been prescribed for you ….when you
need it?”
Those pills can be addictive. They
can build up tolerance and require heavier dosages or types to gain the same
effect.
Just like
we’re being advised NOT to take antibiotics because of the raising of tolerance
and immunity of bugs built around frequent usage of certain kinds. THOSE PILLS
CAN BE ADDICTIVE.
Who advises the
residents about this “side effect”? That’s right, that’s the Dr’s place to
explain but he’s not there; he’s only available through the Nurse contacting
his office and not able to “speak with the patient” when the Nurse calls to
request “something”.
I’ve heard
these same nurses on the phone to the Dr’s office saying, “Patient A could use
something to calm down, she seems to be agitated and doesn’t appear to be
getting enough rest.”
I’ve had
the Floor Nurse call me and try to convince me Mom needed “something” to calm
her down; she seemed “more agitated than usual” or “a little more difficult to
work with”.
Some people
like that feeling; many are traumatized by what they consider to be a
"loss of control" and a "feeling of helplessness". With
Lewy Body Dementia, there are types of antipsychotic drugs that carry the
warning MAY CAUSE DEATH.
Opportunity. Often
unnecessary and more often not warranted. Ease. Convenience. Good for the
facility. How about the health and well being of the patient?
Overuse may also be attributed to Federal and State mandated evaluations where questions about "MOODS" are mandated.
How do you handle
these “offhand” requests if the floor Nurse calls and wants to get an "as needed" prescription for "mood changing" medication?
You’ve been caught at a time when this is the
farthest from your mind or daily schedule. It’s not convenient. It would be so
easy to accept what you’re told, to just this once let it happen.
It's important to understand the basis on which this drug can be given. There is no mandate the resident has to ask for it. The Nurse or the Licensed Medications Distributor can access the patient's need for the medication and can try to "administer" it to her/him.
BE VERY CAREFUL. This request can also include a sliding scale of levels of medication. We had that happen and almost lost Mom. She was limp as a rag doll from too high a dose and we were very fortunate it did not kill her -- that we were vigilent and arrived in time to take her from the facility to the ER and to have confiscated the drug before it was administered yet again by the same Licensed Medications Distributor.
CAUTION ALWAYS. EXPECT WHAT YOU HEAR
ISN’T WHAT IS MEANT. ASK. PROBE. ENSURE. Your loved one’s life
itself may hang in the balance.
Here are some ways we responded. We suggested "alternative methods" provided by Teepa Snow and others who are in the forefront of care giving for Seniors and especially those with Dementia.
Questioning
what was being done in the facility to provide activities and interests Mom
would enjoy, that would occupy her mind and body, that would give her
"something else" to focus on.
Suggested Action: Leaving the room
and returning after a short time.
Quite
simply: What would a parent do with a child that didn’t want to cooperate with
a direction that was for their safety and well being or in their best interest?
TRY A DIFFERENT APPROACH.
Change The Environment. Take her/him something new that’s “tactile”.
Touch intrigues many people.. For Mom, involve her in being busy with folding
stacks of washcloths and when they were done, take them out of the room take
them apart and go back and ask if she’d like “some more” to do.
Mom needed and many Seniors need, to
be active and need to be positively accomplishing something. Sitting around playing games,
putting together puzzles, cards or even TV was never their lifestyle. They can’t
change now. Their minds are “set” and the best action to take is to honor and
recognize their habits and their interests and work with them.
Frustration and boredom are catalysts
for people of all ages to do and say things that are counter productive. It doesn’t take much professional
training but it does take common sense to look, listen and learn from our
Seniors about what values and interests make their days positive.
Every day decisions
are being made concerning what medications are given to residents in Long Term
Care facilities.
Reports on the overuse
of drugs to "adjust" behavior are rampant.
Overuse may also be attributed to Federal and State mandated evaluations where questions about "MOODS" are mandated.
It's an open door for Dr's to
slide through and "evaluate" the "patient" as being
depressed or "in need" of this drug or that drug.
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