Friday, January 2, 2015

Help! I've Fallen Down The Rabbit Hole and I Can't Get Out!

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?
  
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. 

No comments:

Post a Comment

We welcome your comments and any additional information we can research and pass on to others. Together we learn and grow.