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My daughter had a hemorrhage type stroke on 1/23/11. She was on a ventilator for approx. 3 weeks and her left side was immobile for several weeks but now is regaining feeling/usage of her arm and leg. We put her in a nursing home that have a therapy group on staff to assist her in regaining her independence and dealing her life changes when she left the hospital.

Prior to her having a stroke she had a water retention problem that resulted in serious swelling to the point she was unable to flex her legs until she was put on a diuretic.

Now to the problem: Last week she started feeling congested and was found to be gaining weight. When questioning the staff it was found that they had stopped her diuretic medication but had done it without either discussing it with my daughter, myself or the prescribing doctor. To beat it all this change was done by a staff nurse. My question would be: Are changes of this nature acceptable?

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They may try but they are not supposed to. I have POA for mom and every medication change is passed by me first. I did have to move mom from another facility because they were not following the proper procedure and mom was being overmedicated.
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I also am durable med & fin POA. I find it deplorable that I had to continually check with NH to find what meds mom was on in the NH. The nurse practitioner employed by mom's Dr prescribed -presumeably with his knowledge, but I was never informed. Same thing happened when mom was put in the Behavior Unit at the hospital (long story -much delayed UTI diagnosis while in hospital & bizarre, horrible behavior). Psych Dr in BU did not advise me either and additionally, REFUSED to advise me prior to antipsychotic medications she decided to prescribe & administer -said she couldn't work that way. I didn't think my request to be advised was unwarranted or unusual (Mom was 95) particularly after I found she had been put on Seroquel & other antipsychotics and the same UTI behavior was continuing after the antibiotic should have cleared it up. Turned out the behavior was mostly side effects from the Seroquel and worsening dementia... I sure did consider the Dr's response to me to be outrageous.
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NO NO. I would go to the doctor in the facility with your daughter( especially with your daughter if she is alert and oriented times four- name date place and situation) and tell them that this is not acceptable. That they cannot change any of medications at all unless they talk to you and your daughter!!!
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No. Only a doctor, an NP, or in some states, a PA can change a written prescription.
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Those changes are not acceptable. In nursing home settings the Dr.'s go by what the head nurses tell them. They are supposed to see the patient regularly. Do they? The team, from CNA's to therapists and Dr.'s should be working together for the betterment of the patient. If no one is complaining then satus quo rules the roost. Remember the squeky wheel gets the oil or in this case the attention. You need to hold all of them accountable because the system usually doesn't. Set up a planning meeting with all aspects of care and even include home administration. When they know you care and are holding them accountable, your care for a loved one should be considerably better. Try it and you should see a much better effort in care. When they think there is a possibility of loosing you or a possible law suit, then things become very different as well. Make some noise and you should get results. Rehab time is critical in situations like yours.
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Jack,
Absolutely NOT! There is a law suit here. Any changes in meds must be discussed with the Doctor, Medical Power of Attorney and hospital/nursing home staff. Unless in an emergency situation and you are not available, then they must consult you after the fact. (Then the damage may have been done.) They did this with Mother and she had a stroke in the hospital. I am not an advocate for litigation, but you should check into it! One more thing along this road, but I look at it as educating people that NO! DNR's are important in this type of situation too. Hopefully she will recover somewhat.
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Thanks to all for their thoughts on this. This forum has provided info. that I needed for asking better defined questions.
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This should be reported to the Dept. of Health in your state and you should have a meeting with the DON of the nursing home-make as much noise as you can about it and I would talk to her MD at the NH
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My Mom was given new medications without my knowledge or approval. I'm her durable medical and financial Power of Attorney. This was a a Skilled Nursing Facility to which she'd been admitted to for rehab after a stroke. Well... she had a bad reaction to the medication (she turned violent and clearly not herself). They'd been giving the medicaiton to her for 2 days before I was curious enough to question someone about her medications. I immediately told them to discontinue medication.

BTW, it was her delegated Nurse Practictioner that made the change, not a RN, CNA or administrator. Nurse Practictioners can perscribe medications, but must consult with their boss (the doctor) before adminstering. I've no idea if this guy consulted with anyone or he played God.

Needless to say, I had words with this man.
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I've had experiences when the doctor just neglected to specifically continue the prescription and no one noticed for a while. And even if the patient does notice, they often are of the attitude "Oh well, the doctor must know what he (she) is doing..........."
I was wondering too, Is possibly the nurse in question a nurse practitioner with the authority to write or change prescriptions?
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My Mom had knee replacement and was placed in Nursing home for Rehab and the house doctor change her medicine. I had to advise them she was there for rehab only and that her personal physicians had perscribed her medication and it was to say as noted by the doctor at time of transfer from Hospital. I had to keep on them for a number of things like no rehab therapist and that is why we were there and they said they were a rehab with staff to comply with doctors orders. You have to be on top of it at all times My Mom was very knowledgable about what she was on for medication and notified me right away so I was able to correct the problems as they happened ( which were many) I had to be a voice for her and I have a loud voice when I have to be. If you can not check on things make sure you find someone who will for you. She was being treated like she was not able to make her own decisions and incompatant. When I threaten to call Medicare and the local newspaper things happen quickly to be corrected.
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THATS A FLAT NOOOOOOOO..GET THEM FIRED IM A NURSE THEY CANNOT DO THAT
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I have contacted the Nurses Administrator at the home. The nurse that made the decision is off as her father passed. They are to follow up when she returns.
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No I'm my work at nursing homes residents wernt allowed to have a tylenol or cough drop without a dr. Order. Even pain meds that come with someone from a hospital cannot be given until the dr. Seeing them at the nh puts in his order for it. She should be reported to the administration as well as the state. As a nurse if this occured she knows better. And should be in trouble for it.
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It would be extremely unusual for a staff nurse to make any med changes without and order from the MD. It is possible that her labs were bad and the MD ordered it held for a few days. If any nurse took it upon themselves to change a medication order without consulting a MD they should be reported to their State Board of Nursing for practicing nursing outside her scope of practice.
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I think you have to ask that they call you about all med and therapy changes; that's been my experience too that they don't always even then. I periodically get a listing of my mom's meds. She once had her PPI d/c'd by a doc who assumed it had just been given in-hospital, and Mom of course could not tell him that she'd been sleeping upright in a chair and stoped eating many favorite foods before she was on it. Of course he could have looked at her file and noted she has a hiatal hernia, and maybe asked someone who could have told him, like ME, but only the best ones take the time. I only found out about it when I tried to figure out why my mom who had been sleeping flat with just a pillow suddenly wanted a hospital bed. Oh, and they would NOT have even SHOWN me her meds list had I not presented my Medical POA and reassured them it was not a HIPAA violation. Worse than that, the facility my mom is in now accidentally restarted a med that had caused fluid overload and mild CHF - apparently a d/c summmary was sent early and the update hadn't made it yet. I caught that one as sson as I saw her legs puffing up again, and thought I was going to have to pull her out that weekend, but despite fussing a little over having to call and get orders and not just take my word for it, they were able to do so promptly and got the error fixed before she got even one more dose. If your loved one can't tell you about meds anymore, some serious watchdogging is in order. You want to try to not make it a head-butting thing, or scream at them that they are incompetent or criminals unless they really, really are - e.g. making mistakes left right up down and sideways, not just occasional, or refusing to fix things or to listen to side effect concerns - but do make it clear you want to stay on top of it. In Mom's case I could honestly explain that it was because she has had some unusual reatcions to the things people usually and normally try for her conditions.

So it may not be gross negligence, but someone just misapplying standard practice of trying to reduce unnecessary drugs - which can be a good thing - but without taking enough care to find out why they were on them in the first place.
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NO
If that happened it needs to be addressed immediately! Very unprofessional & possibly criminal.
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Short answer NO. The staff nurse is not a physician. Prescriptions should not be altered by anything other than the prescribing physician or another licensed medical doctor. You should talk to the administration of the nursing home and have this investigated as it could have resulted in serious harm to the patient. Helen
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