Tuesday, June 11, 2013

Care Plan Meeting Misevaluation Leads to Another Emergency Room Visit

Misevaluation by her facility Nurse Manager at a recent Care Plan Meeting.

At our last Care Plan Meeting, NM said Mom was being "aggressive" and she wanted us to put Mom on anti psychotics; also Mom had significant weight gain and NM wanted to put her on a diuretic.

Mom has adverse reactions to almost all drugs and especially antipsychotics. Mom has a preexisting medical condition negating the use of antipsychotics along with a previous reaction to an antipsychotic. Both conditions should be in Mom's medical record and easily accessible to anyone considering recommending medications. But we haven't found them in her records and cannot convince the facility to enter these into her record; should have been from previous medical records given to facility when she transferred.

For the facility, however, drugs are a way of ease in managing their patients and require less continuing care and therefore lower cost.

When asked for specific dates/times/references for Mom's "aggressive" behaviour, no records were provided and no information was available.

There was a list of Mom's weight fluctuations but there was also a failure to note any reference to previous Urinary Tract Infections, retention of water and digested materials from impaction, as having had an effect causing the weight gain.

Both of these factors are significant signposts of a Urinary Tract Infection and should be charted and also separately noted for easy reference.

Records are kept but notations do not allow correlations to be drawn.

Medical care in a Skilled Nursing Facility often relies on accurate and timely observations of personnel AND positive and correct response all up and down the chain of command, especially with the Nurse Manager (often an LPN; she/he is responsible for an entire floor or section of patients and is directly responsible to the facility's Director of Nursing, usually).

We cannot seem to communicate with Mom's medical caregivers at her facility on various medical challenges with Mom from UTI's to LBD.

They refuse to accept and include a diagnosis of possible Lewy Body Dementia because of the word "possible" yet that is the full medical description. 

They do not see LBD as being a disease with constant fluctuations and want to treat it like Alzheimer's believing each progression should be constant, consistent and permanent. This is NOT LBD!

Read the following information about Lewy Body Dementia from the Lewy Body Dementia Association to understand the scope and challenges of LBD.
Within the info is general info on aggressive behavior and anti psychotic drugs as well as a general overall description of LBD SYMPTOMS AND DIAGNOSTIC CRITERIA.

Care Planning resulting in overlooking a medical condition leads to complications requiring the family to transport Mom to the ER -- yet again -- for a medical condition that should have been easily seen by the Skilled Nursing Center.

A few days went by and another "incident" occurred.

I received a phone call Mom was being very difficult, wouldn't get off the toilet and being verbally abusive to staff.

The Nurse Manager was able to put Mom on a cell phone. Mom didn't talk "with" me; it was a one way monologue with Mom saying she was going to sit there until the ambulance came to take her to the Hospital. Yes, she was expressing anger and frustration and some of her language was offensive but I could tell she was frustrated.

Mom was asking for medical evaluation in the only way she knew how and the Staff, especially the Nurse Manager, didn't seem to have the time to listen to what she was trying to tell them. The Aide and NM simply wanted her to get off the toilet so they could put her back in her wheelchair and "be done" with her.

Mom's reaction was similar to a small child's who wasn't being listened to and understood. She stood her ground and finally called in the "calvary" by saying she wouldn't get off the toilet until the ambulance came to take her to the hospital.

This is actually a violation of Resident's Rights in a Skilled Nursing Facility in Missouri, denying a resident the right to seek medical attention outside a facility.

Substantiated by the recent State Investigation of the facility, NM and other staff responsible for resident care often do not listen to the patients and follow State Regulations requiring Patient's Rights for medical services outside the facility. This isn't an isolated incident, it happens all the time in Skilled Nursing Centers where almost all are understaffed.

UTI's are very frequent in the older population, especially the very elderly. Combine this with any form of Dementia and you have a challenge. Meeting the challenge is easy when you're informed and understand Dementia and especially Lewy Body Dementia.

READ ABOUT common areas everyone should understand about Lewy Body Dementia and especially information giving insight to the person challenged. 

Skilled Nursing Centers and Living Centers of all types should be places where family can trust their loved ones are in professional and caring hands and not have to intervene and ensure State Rules and Regulations are followed.

Once again daughter and I changed our plans, rescheduled our complete day to get to the facility early afternoon after receiving the call from the NM my Mom would not get off the toilet and was very "angry". 

I knew we'd be running her to the ER; it was Saturday and staff was cut back and by nighttime, a skeleton crew would mean Mom would get very little help including the frequent toileting her diarrhea and incontinence she was experiencing would require.

Mom's communicative abilities are exceptionally impaired at times but she, like so many of our elderly, are often "childlike" in that they sense, they feel, a problem within their bodies but they do not have the language or the mental abilities to explain what is happening.

Verbal skills that have declined as Mom's have with her Dementia often affect clear and concise communication (what we generally ask for and expect in adults) and should be addressed with more training of professionals and family members who serve as Care Givers.

With LB and other forms of Dementia, the person often cannot clearly explain the pain they're experiencing and may even talk about pain in a location other than where it's focused.

Dementia is a brain challenge. Just like various forms of Cancer targeting different areas of the body, Dementias have common yet different actions and cause differing reactions in abilities and progressions of the disease.

Today, we do not link together these various mental degenerative and individually titled "diseases" but I believe some day we will see the brain as being an organ as affected in its medical conditions as any other part of the human body:  heart, lungs, kidney, etc.

Perhaps in the future a Neurologist or other specific "Brain" Specialist will be as common for physical exams as today's specialists in heart, bone, etc.

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