mgriffiths Posted January 28, 2020 Share Posted January 28, 2020 93yo male post fall with hip fracture s/p THA with DMII and other comorbidities...currently in SNF, but SNF is failing perform bandage changes as directed, give meds (pain, DMII, HTN etc. meds), do finger stick blood glucose (FSBG), etc., etc. and further they are failing to send updates to ordering provider (i.e. ME). I have already called and talked with the SNF director...their reasoning to not do FSBG is concern for "infection." While that may (or may not) be a valid concern they have not communicated at all and the nursing staff made the decision unilaterally to perform no FSBG for at minimum 2 weeks. The SNF director was dismissive and hung up as I continued to ask questions...then magically was not available to talk. Who do I call to report? I have tried googling but am failing to find anything. Patient is medicare and if matters in the state of Michigan. P.S. - this is not the first time I have had issues with this SNF and director. If this patient's incision and/or hardware becomes infected this would be our third (out of 3) in the last 2 months, but all trauma patients NOT elective. Furthermore, we have zero infections for any total/partial joint replacement otherwise. Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 28, 2020 Moderator Share Posted January 28, 2020 wow , tread lightly but firmly first talk to CP to advise second this is a nursing issue as well as a licensing issue for the facility So with the CP awareness and support ask for a meeting the administrator and DON of the facility At this meeting (CP does not need to be there and would be better if they were not) address the specific issues you have with examples. Clearly, professionally lay out that should your orders not be carried out as order that you will not have a choice but to report to the licensing agency for the nursing home, and the Board of nursing for the DON, ADON, and the nurses - no joke this is a big deal that you need to first protect the patients, then your license... tread carefully and take really good notes and act ultra professional as they are going to come out swinging. I have found that the LESS I say in such situations the better it is.... good luck 2 Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted January 28, 2020 Author Share Posted January 28, 2020 Thanks...CP is definitely on board. They are actually his orders, but I'm the one directly managing the patient post op...will try to get a meeting set up. Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 28, 2020 Moderator Share Posted January 28, 2020 this is the case where you can come off as an ultraprofessional with the backing of the doc and mandate that it MUST change.... .period or else everyone's license is in danger.... New grads - read and think about this - it is rare that such a straight forward case comes up and when it does you MUST stand up for what is right! Quote Link to comment Share on other sites More sharing options...
kargiver Posted January 31, 2020 Share Posted January 31, 2020 One can easily make the case this is tantamount to, at least, elder neglect, and requires reporting to Michigan Adult Protective Services for investigation. Just understand, ethics aside, you are opening a can of hurt for a lot of people with something like this and if the shit ever hits the fan, you will be the one hung out to dry. https://www.michigan.gov/mdhhs/0,5885,7-339-73971_7119_50647---,00.html Good luck, G Quote Link to comment Share on other sites More sharing options...
kidpresentable Posted January 31, 2020 Share Posted January 31, 2020 50 minutes ago, kargiver said: you will be the one hung out to dry. Care to elaborate? This seems pretty open and shut to me. Doesn’t reporting “in good faith” afford certain protections here? 1 Quote Link to comment Share on other sites More sharing options...
kargiver Posted January 31, 2020 Share Posted January 31, 2020 24 minutes ago, kidpresentable said: Doesn’t reporting “in good faith” afford certain protections here? Sure does. in a vacuum. Nothing exists there though. Going after a SNF with an APS complaint will open floodgates hereto not considered. The point is - watch your back with issues like this. G 1 Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted January 31, 2020 Administrator Share Posted January 31, 2020 29 minutes ago, kargiver said: Going after a SNF with an APS complaint will open floodgates hereto not considered. The point is - watch your back with issues like this. ... which is why it's not optional to report, but required by law, in every state with which I'm familiar. NOT reporting could open you up to personal civil and criminal liability as well. ... like you NEEDED it to be any more complicated. 1 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 31, 2020 Moderator Share Posted January 31, 2020 the "poop" is extreme scrutiny, nurses that no longer help you, possible retribution through the PA board, and even removing your credentials.... Hence, make sure you doc is on board, have him/her also sign the complaint, and make sure you only allege what you can prove 100% beyond the shadow of a doubt.... Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted January 31, 2020 Author Share Posted January 31, 2020 (edited) Thankfully, the APS complaint was made by the patient's daughter and resulted in APS contacting us for further information. So I/we didn't have to file the actual complaint. But I 100% have my CP's, chief of medicine's, and Hospital Board's support. Also, the patient has been transferred to another facility at the demands of the daughter - supposedly a lawyer was involved...YEAH (sarcasm)!!! Furthermore, this SNF has no affiliation to my employer, just sometimes patients are placed there as they are discharged from our hospital. Therefore, I'm really not concerned about retribution in the form of nursing staff, "extreme scrutiny," etc. If I worked there or some other form of relationship existed I would already be making plans for a change in employment...but that would have occurred long ago before an APS complaint had to be made. I cannot work in that form of an environment...the #1 reason I recommend EVERYONE have a heft emergency fund (minimum 3 months salary or 6 months expenses in a high yield savings account or high interest checking account [like KASASA]). Lastly, I'm not sure why the state PA board would come after me and my credentials/license. But, ventana, I would agree that APS, CPS, and other reports be made in good faith with verifiable information. Story Time!!! Regarding making honest CPS reports. I had a family I used to care for in FM. The son was a wrestler and football player. A neighbor made a CPS report because the son DIDN'T have any bruises. The neighbor felt that a child who is a wrestler and football player should have bruises, so automatically assumed they were being covered up because of something "far worse." Resulted in a full blown investigation with the father being placed on UNPAID leave from his job for 90 days. He almost lost his job, only reason they didn't lose their home was a community fundraiser to help them financially, and his wife filing for divorce when she was initially made aware of the CPS report. Just as the report was being completed the son shows up with a huge black eye...FROM WRESTLING!!! I was actually his wrestling coach and during practice he caught my elbow...kind of awkward to submit a letter to CPS stating that I gave a kid a black eye. Before submitting I required that the principal, school board, assistant coaches, teammates, etc. all submit letters attesting to the fact that the black eye occurred incidentally at wrestling practice. Thankfully it blew over, but last I heard the parents were still in marriage counseling over the divorce filing (that the wife quickly retracted upon learning reality). Also, the report is still on file, so any other CPS (or similar) reports made against the father would have "increased credibility" due to history. Edited January 31, 2020 by mgriffiths 1 Quote Link to comment Share on other sites More sharing options...
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