Reality is that SNFs are very rarely sued for negligence, unless there is a death. And families and patients will not complain because they fear realiation, these patients are not going to be there for a few days, they are usually there for a few months to years. It is a different mindset. They do the best they can with the limited funds they have, always cutting corners. Best practice is never considered if costs are involved.
In regards to this gentleman, I would call the MD and Director of nursing and explain the risks of a broken PICC, as well as the fact that you tried that route and it was not successful. I think 3 tries should really be the max---does he have another place to reinsert at this point?
I really like the idea of a tunnelled cath to his back, that will definatly work. Getting someone to pay for it would be the next big issue.
You run the risk of if you refuse to place another PICC the pt will get sent to the ER and have a TLC placed either IJ or SC. That is quick and easy access for an ER MD.
You can suggest PO meds such as ZYVOX, but there are reimbursement issues. Although that would be much safer for the patient and SNF, so some may go along with it.
A port is really not an option--the pt will undoubtably pull out the needle and the needle will end up in the bed, and he will get stuck. Not to mention, some SNFs do not have nurses that are familiar with port management. You are then buying life long maintenance with this port, another thing SNFs would prefer not to pay for. And, when the patient deaccesses the port for the 50th time, clotting off will be an issue.
SNF patients, especially confused ones, are always a challenge. I really feel PO is best whenever possible.
Get the MD and DON involved.
Chris Cavanaugh, CRNI
----- Original Message -----
From: Dianne Sim <[EMAIL PROTECTED]>
Date: Friday, May 19, 2006 5:13 pm
Subject: RE: How many times?
To: [EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]
> I think that the SNFs don't understand that they can be liable if
> they don't
> prevent injury to their patients (even if self-inflicted) by using
> restraints appropriately. Obviously all other options must have been
> explored, and exhausted, an MD order obtained, frequent checks of the
> patient done and documented.
>
>
>
> Dianne Sim RN
>
> CEO & President
>
>
>
> IV Assist, Inc.,
>
> 2675 Appian Way
>
> Pinole, CA 94564
>
> Phone: (510) 222-8403
>
> Fax: (510) 222-8277
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> Email: [EMAIL PROTECTED]
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>
&g!
t;
&g
