Straight reporting
    Night before last I, yet again, had to instruct the Evening Floor Nurse on duty about the correct prescription type of iron my mother is supposed to be getting: He attempted to not only give her the wrong type but the wrong dosage. When I noticed it I told him where he could find the correct type. This, despite the fact that her med instructions clearly read "Niferex-150 Forte" and almost all her meds are packaged in flat cards with burst bubbles specifically for her and filed under her room and bed number.
    Last night the Evening Floor Nurse on duty discovered that Mom's Niferex-150 Forte was missing from Mom's filed meds and was nowhere else in the med cabinet, so Mom didn't get any iron. The nurse assured me that she would reorder that med so Mom would receive it in the morning.
    Yesterday when I arrived at the facility between noon and 1215 I couldn't find Mom. She'd already had her OT and she wasn't in her room. A CNA found her in the Arizona Room/Resident's Lounge in front of a Big Screen TV watching what looked like an episode of John Jake's North/South, I think that's what it's called. She was deep into the episode. From about three feet away I asked her if she wanted to continue watching the movie until lunch was served. She said yes. I noticed, casually, that she was breathing with her mouth open but she often does this so I didn't think anything of it. I returned to her room, let everyone know I'd found her and was pleased that she was doing something besides sitting in front of her window. Lunch was served about 20 minutes later. I returned to the Arizona Room to retrieve Mom. It was then, when I was practically on top of her in order to wheel her to her room, that I noticed she was lightly gasping. I checked the oxygen tank. It was empty. Once I returned Mom to her room I reported the oxygen problem to the Day Floor Nurse, as well as attaching Mom to her concentrator. I also removed the tank from the tank caddy on the back of Mom's wheelchair, removed the regulator, placed it on the vanity, took the tank out of the room so it could not be reconnected, took the tank to the main nurses station, asked a nurse, there, to return it to the oxygen storage room. The nurse did what I asked, although she scolded me for carrying the tank around and not following protocol, which apparently involves signalling (with the call button) a nurse or CNA and having them return the tank. Another person, not sure of her professional identity, sitting at the main nurse's station, joined in the scolding and cited facility protocol involving liability if a tank should be dropped and explode. I acknowledged the protocol and countered that if I could be sure that Mom would not have been reconnected to an empty tank, which has happened before, I would have followed protocol and left the tank in the room to be retrieved, but I could not be sure of this. When I returned to the room told the floor nurse that Mom should no longer be put on tank oxygen or be disconnected from her concentrator, as this problem of Mom languishing on an empty tank, even in therapy, has happened before. The Day Floor Nurse scolded me, telling me that it was "cruel" that I should confine Mom to her room if she "wanted" to go someplace else. I relented but added that I was relenting only if she, the nurse, could "guarantee" that my mother would not, again, within the next two days (48 hours) before Mom's release, be connected to an empty tank, and if she would see to it that the problem was relayed to her relief staff. She responded that she could not "guarantee" that this would happen but, in essence, she would do her best.
    Then, I took Mom into the bathroom to change out her brief. I discovered that not only had she leaked through to her slacks but had begun to leak through to the wheel chair pad on which she was sitting. She had also developed rather large (five inches by two inches, approximately) red spot on her left thigh where her briefs had settled because they hadn't been securely tightened up into her thigh creases. While she was on the toilet, as well, she began, with some difficulty, to have a bowel movement. Earlier during my visit I had asked the Day Floor Nurse to please check the BM records to see how long it had been since my mother had moved her bowels, because I hadn't noticed that she'd had one for a few days. She said she would. At the point at which my mother began to strain during her bowel movement, I reminded the Day Floor Nurse of this request and reported the difficult bowel movement to her. She told me that, yes, records are kept, as I was aware, but they are kept in the CNA reports and she would have to access these. As well, she said, she would give my mother a half dose of Milk of Magnesia, with which I agreed. When I returned to the bathroom my mother was still straining, although she'd eliminated a fair amount. I insisted on wiping her, even though she felt she was not "done". I noticed some minor bloody spotting on the three wipes I used. I returned to the nurse, reported the spotting and requested a full dose of Milk of Magnesia, which I saw to it was chased with a full 8 ounces of water. I also directed my mother to stop straining, directed her to get up from the toilet, cleaned her thoroughly front and back, slathered barrier cream on all red areas, briefed her, dressed her and returned her to her chair.
    She ate lunch zestily without incident.
    While Mom was eating I approached two of the three CNAs on the floor, reported the dirty brief and empty oxygen tank problems and launched into a somewhat emotional litany as follows: I told both that I was talking to them because it is my policy not to go behind people's backs when problems occur. I "get it", I said, about the facility being understaffed and the staff being overworked. This is why I've been at the facility so much; in order to pitch in and make sure that my mother gets the best care she can. However, I said, in these last two days I also must make sure our home is prepared for Mom's arrival and won't be able to be at the facility much. Mom, I explained, beginning to tear up, had only two days (48 hours) left at the facility. I was not interested in taking her home constipated, with urine rash and breathing problems because of lack of oxygen. By this time I was beginning to tear up uncontrollably. Please, I said, take good care of my mother in my absence. I told them I'd be back around dinner time.
    When I returned to Mom she polished off her lunch. I monitored her liquid intake with some difficulty, but successfully (I got a little over 16 ounces down her before it became obvious that she would take no more. I asked her if she wanted to take a nap. She did. I put her in bed and set her up for sleeping.
    I left soon after to return home to clean and take a nap. At this point I want to note that although I'd gotten to bed early enough the night before, I awoke at 0130 yesterday morning with diarrhea, which continued, every 15 minutes to half hour, until 0530, which is why I was up writing a post so early yesterday. Thus, by this time, I was severely sleep deprived. Thus, it took me awhile, during cleaning and moving things around at home, to even think of countering the very intimidating response about my "cruelty" lobbed at me by the Day Floor nurse. Suddenly, as I was cleaning in the afternoon before finally taking a two hour nap between 1500 and 1700, I realized, wait a minute: Which is more cruel? To "keep" Mom in her room connected to the oxygen she needs, when, frankly, it doesn't make any difference to her if she is in or out of her room and I am sure that the idea to go to the Arizona Room was not her idea (although, in principal, her being there was all right with me and she did enjoy the excursion and the movie), or to get her out of the room without oxygen (which I suspect ran out sometime during therapy, as these people aren't particularly keen on checking oxygen tanks, either) and allow her to gasp for some hours through an "enjoyable" excursion?
    I haven't had a chance to talk, again, with the Day Floor Nurse, but I will, today. I am somewhat more rested.
    My schedule at the facility will be pretty much the same as it was yesterday. I will be reporting, here, any incidents of lackadaisical care that I discover today. I hope there will be none. I also hope that the iron that the Evening Floor Nurse promised to order has arrived and Mom will be getting her prescribed iron supplement.
    Just the facts, m'am.
    I am, now, seriously considering, if not exactly legal action, contacting the corporate office, cataloging all my notes and posts on lackadaisical care, and sending them out. Although I am conflicted about this because I actually don't want to waste energy fighting a fight on a battleground which we will soon be leaving, anyway, at the same time I want someone in authority to at least be aware of what has been going on and what could have further gone on with my mother if I had not been at the facility as much as I have been. Energy, energy, where shall I spend thee?
    Later.
- posted by Gail Rae @ 06:01   email  this post