Jack Asked April 2011

Can nursing home staff make prescription medication changes without consulting patient or the Power Of Attorney?

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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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Claire33 Nov 2012
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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N1K2R3 Apr 2011
No. Only a doctor, an NP, or in some states, a PA can change a written prescription.
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tommullen Apr 2011
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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bobO Apr 2011
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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Jack Apr 2011
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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195Austin Apr 2011
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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bpryor01 Apr 2011
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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Diana09 Apr 2011
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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