It was around Easter time one year when the following exchange took place:
“Hand me my peeps,” Isabelle commanded from her geri-recliner. She pointed to something behind me.
I turned and saw a package of yellow baby-chick-shaped marshmallows on her tray table. The word “Peeps” was written on the front of the box. I handed them to her and watched as she stuffed one, and then another into her mouth. As she picked up the third, I pointed to her red wristband. “I guess you’re careful about the sugar with the diabetes.”
“I don’t have diabetes,” she stated flatly, munching the third peep.
This was only the second time I’d seen Isabelle, and I’d had to convince her to meet with me today. I didn’t know if she had diabetes and had forgotten, or was in denial about it. It was unlikely that her wristband was the wrong color, but she sounded so certain I had to consider the possibility. “Red wristbands are for people with diabetes.”
“Everyone’s been saying that since I got here two months ago, but I don’t have diabetes. Check my chart,” she directed me. “Check it now.”
I went to the nursing station and pulled out the thick binder, reading through the diagnoses on the Physician’s Order Sheet. No diabetes. I went to the nurse, who thumbed through her records. “No,” she said, “she’s right. She doesn’t have diabetes. I’ll change her wristband after I finish what I’m doing.”
I went back to Isabelle, who’d been referred for anxiety, and told her what happened.
“I wonder what other mistakes they’re making,” she said.
I had my work cut out for me, but, for now at least, Isabelle was letting me on her team.
Wow, this is actually very scary.
Isabelle could have been seriously injured or killed if she was given medication for a disease she didn't actually have (or if she had actually had diabetes and her blood sugar and diet weren't being monitored.)
Your anecdote struck me on a more personal note as well: my father is diabetic and my mom has asthma. Both are in their late 40s/early 50s and otherwise in excellent health but a medication or diagnosis mix-up would be one of my biggest concerns if they ever need to live in a nursing home.
I agree, Lydia, it's scary having to rely on other people (and systems) for care. When it's my turn, I hope to be able to speak up and have others advocating on my behalf, and I'll be darn sure to ask to see the psychologist! Having another set of eyes, and especially a set that can also look in the charts, can be invaluable.
What I hope came across in this post about workplace communication is that the resident is an important team member with worthwhile information that should be attended to. I'm sure I wasn't the first person she told that she didn't have diabetes.
Here in Michigan, we take great care to ensure our residents have the correct medication, the right care, and get the attention they deserve. I desperately hope that the situation you encountered was a fluke, and not something that you see repeatedly.
I also appreciate how you listened patiently to Isabelle. It's important that our residents know they are being listened to and given choices in their senior years.
Maybe things are different in Michigan, but I've never worked in a nursing home where things didn't fall through the cracks on occasion. Actually, I've never worked anywhere that things didn't get missed once in a while. Is there a worker among us who hasn't remembered on the way home from work something they forgot to take care of? What I find far more disturbing is that for two months staff members were monitoring Isabelle's diet, she was telling them she didn't have diabetes, and no one took the time to check her chart. I agree, it's important our residents know they're being listened to — they often have valuable information to contribute.
Point well-taken. I just hope case that this could be taken care of. It's really important to be organized to avoid mistakes.:)
Assisted living, it's always worthwhile to look at systems when an error like this is discovered. Of course, that needs to be encouraged from the top, with an administration that asks staff to bring issues like this to their attention in order to fix broken links in the chain.
Dr. El,
In my years of working in nursing homes I've learned a couple of things in regard to communication. First, if I can not follow a residents train of thought, it probably isn't me ( I have no problem understanding and communicating with people on the whole) and that the resident is probably confused. Second, even if a person has cognitve loss they can still be accurate reporters although they might not be able to grasp all aspects of what's going on. Lastly, just because a resident says or reports something that doesn't seem quite right, it doesn't necessarily mean it's not accurate. So, in point, I'm just reiterating what you stress…listening to our residents.
Amen Sue. Case in point: I had a resident with dementia who kept insisting that she had "RSD". Initially, I thought that this was her name for something else that was really wrong with her since it was not on her list of diagnoses…until I looked it up on the internet. Suddenly, her symptoms and the medications she was on made a lot more sense. Never assume that because they live in a fog that they don't have moments of clarity.
Great point, Sue and K. Tree. Sometimes the words of a confused resident aren't exact, but if you listen closely, the meaning is clear.