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Now a new nurse says we have to get a new Dr. order for any changes. She won't even give Tylenol or supplements without a doctor order. We are in a assisted living, not a nsg home.
The doctor is in charge of the medications. Not the nurse and not the family. The nurse may lose her license if she makes the changes you ask for. talk with your mother's physician if you want changes.
Are you a doctor and able to over ride the other doctors orders? If not, why are you even putting a nurse in this position as it is not her job to follow a families requests, it is her job to follow the doctors orders.
A .5 mg dose of Lorazepam is a 'baby dose'---it probably wouldn't do a thing to your mom.
Also, to cut it in half would be a challenge as they are so tiny. Many pills cannot be cut, as they lose their efficacy if cut. (Time release meds come to mind).
BUT--the bottom line is, the Dr makes the orders for whatever reason and the nurse's job is to administer them. Period. She could lose her job for fussing around with dosages.
The only way 'around' this is if mom is in control of her meds, which is some AL's is the case, but mom would have to be able to completely understand what she's doing.
gardenview1, any time I get a prescription for a med that I have never taken before, I always cut the pill in half as I am pill sensitive. And my primary doctor knows I do this. Is that why you wish for your Mom to take half a pill?
But when one is living in senior living and using the med-tech staff to get one's meds, there needs to be a doctor's script on-file. So, yes, the doctor needs to write out a new script if there is a change in dosage.
Yes, the Nurse is correct. ALs are also overseen by the State. They must keep records of medications given and the dose needs to correspond to the Doctor's orders or the AL gets into trouble. This goes for OTC too. My Mom suffered from arthritis in her lower back and Tylenol helped with her occasional discomfort. The doctor wrote it up "2 pills a day" which would not help at all. Nurse called and asked that the order be changed to " 2 pills when needed" .
I agree 5mg is a low dose. The Nurse is now in charge of Moms medications. We were told this going in with my Mom. You have every right to question. Especially if you think Mom is having an adverse reaction to a med. You have a right to go over the Nurses head and call the doctor. We were allowed to use Moms PCP and the Nurse called him with any changes she felt was needed. I was the one who caught the Tylenol thing and the Nurse agreed and called the doctor. I am lucky I have a Nurse in the family that is qualified to question doses but she cannot change a doctors order. Not under any circumstance, she can only request.
0.5mg of lorazepam? I don't think it comes in a smaller dose than that. The nurse is right. It's not for you to determine the dose. The nurse has to follow the orders the doctor gives.
When it comes to pills, one needs to check not only the main ingredient in a pill but also the fillers.... the binder.... and the coating. The main ingredient may be ok, but it could be one of the fillers that one could have a side effect. Filler are used to make the pill large enough to handle.
Or the binder that is used to keep the pill together. Typical binders are tapioca flour, lactose, sucrose, microcrystalline cellulose, polyvinylpyrrolidone and various starches.
Or the coating that makes the pill easier to swallow. Shellac is very common. Please note that shellac is also used to polish apples to make them last longer.
I remember a few years back, I could only take a certain pill if it was made by a certain manufacturer. If made by someone else, big time side effects. I was amazed to find out that my Mom could only use the same manufacturer as I was using. Neither one of us knew the other had the same problem.
I just reread and this says "new nurse". As most of us said in your last post, the other nurse was wrong in not following doctor's orders and could get fired. This new nurse is absolutely correct. No RN* can override a drs. order.
*I say RN because Nurse Practioners can prescribe but not sure they can override a doctor.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
Assisted living is still responsible for administering the medications.
And yes, a nurse can get in trouble/fired for not following what the doctor prescribed.
Also, to cut it in half would be a challenge as they are so tiny. Many pills cannot be cut, as they lose their efficacy if cut. (Time release meds come to mind).
BUT--the bottom line is, the Dr makes the orders for whatever reason and the nurse's job is to administer them. Period. She could lose her job for fussing around with dosages.
The only way 'around' this is if mom is in control of her meds, which is some AL's is the case, but mom would have to be able to completely understand what she's doing.
But when one is living in senior living and using the med-tech staff to get one's meds, there needs to be a doctor's script on-file. So, yes, the doctor needs to write out a new script if there is a change in dosage.
https://www.agingcare.com/questions/will-a-nurse-be-liable-if-she-tweaks-or-changes-a-dr-order-for-a-resident-to-please-the-family-or-do-476412.htm
Yes, the Nurse is correct. ALs are also overseen by the State. They must keep records of medications given and the dose needs to correspond to the Doctor's orders or the AL gets into trouble. This goes for OTC too. My Mom suffered from arthritis in her lower back and Tylenol helped with her occasional discomfort. The doctor wrote it up "2 pills a day" which would not help at all. Nurse called and asked that the order be changed to " 2 pills when needed" .
I agree 5mg is a low dose. The Nurse is now in charge of Moms medications. We were told this going in with my Mom. You have every right to question. Especially if you think Mom is having an adverse reaction to a med. You have a right to go over the Nurses head and call the doctor. We were allowed to use Moms PCP and the Nurse called him with any changes she felt was needed. I was the one who caught the Tylenol thing and the Nurse agreed and called the doctor. I am lucky I have a Nurse in the family that is qualified to question doses but she cannot change a doctors order. Not under any circumstance, she can only request.
I think the nurses and doctors taking care of your mom sound like they’re doing fine.
Give it a few days and ask them if the see any positive changes.
Or the binder that is used to keep the pill together. Typical binders are tapioca flour, lactose, sucrose, microcrystalline cellulose, polyvinylpyrrolidone and various starches.
Or the coating that makes the pill easier to swallow. Shellac is very common. Please note that shellac is also used to polish apples to make them last longer.
I remember a few years back, I could only take a certain pill if it was made by a certain manufacturer. If made by someone else, big time side effects. I was amazed to find out that my Mom could only use the same manufacturer as I was using. Neither one of us knew the other had the same problem.
*I say RN because Nurse Practioners can prescribe but not sure they can override a doctor.