“What it would require is for me to work the extra 20 hours as well as my regularly scheduled 25.5 hours. It would require my regular clients to adjust the times that I normally arrived, but it definitely was able to be done.
By mid week, there was a problem…………………….”
“When I arrived today, the facility staff stated that the client was to be seen by her doctor tomorrow and the sore was spreading…Holy Crap on a Crutch….this day was only getting longer….and my diabetic client was still waiting. But, the bigger problem was waiting for me in the basement….
Basements…I really do not like basements. Unless there is a tornado bearing down on me, I find basements are usually the breeding ground for molds and spiders. Because of molds and spider, basements are not my favorite locations to find medication cabinets; but that is where this facility decided to store the client’s medications.
The cabinet was of press board with a laminate finish. It had 4 shelves; a shelf for each of the facilities clients. There was a hasp and a Master lock on the outside for security and on each shelf was a small plastic basket that held the blister cards. Each shelf had cash box with a small pad lock. The cash boxes held narcotics. Not a much of a sophisticated set up, but functional all the same.
Next to the cabinet was a small desk that had a low shelf under the desk top. On top of the desk were plastic medicine cups where the facility staff would punch out the client’s meds and transport them to where the client was sitting in the upstairs TV room. A small fold out chair was in front of the desk where one could set to chart.
The lighting in the basement was a small watt light bulb; not the best. When I sat at the desk, my body would block out most of the lighting, so it was less that adequate. Just another dingy old basement that harbors mold and spiders. I didn’t feel comfortable down there.
From the first visit, I had a gut feeling of dread about this client and this facility. As I noted in my last posting, the actual need for a nurse to come into this facility didn’t exist. I was coming into this facility to fulfill a guideline for Medicaid. As I lamented in my last posting, my entering into this facility was an inconvenience for everyone…
From the beginning, the hour that I arrived was at meal time. Not the best time, but it was when I could come.
It was the same on this day, the client was eating her supper so I went to the basement to fill her medication box.
I didn’t learn until later that I should have never gone down to the basement alone. The correct procedure was for the staff to go to the basement and bring the client’s basket with her meds upstairs to me and when I was finished, they returned it to the basement.
That never happened. Instead, when I arrived, the staff either handed me the keys or indicated where they were located and I proceeded to go to the basement.
On this Wednesday, I washed my hands extra long because of the potential staff infection in the home and the staff pointed to the keys that were lying on the kitchen counter.
I went downstairs, unlocked the cabinet and took out my client’s basket from the cabinet and placed it on the lower shelf at the desk. I pulled up the chair and placed my bag at my side next to the chair.
The first blister card that I took from the basket was a new medication. As required, I wrote the name of the medication, the directions and the doctor’s name on my nurses notes. I mentally noted that this was a new doctor and it was an unfamiliar doctor to me. This wasn’t all that out of the ordinary.
Most of my clients have many doctors. They see specialists for their complicated diagnosis and having several medications ordered from differnt several doctors is not that unusual.
But, this doctor’s name caught my attention. We have several doctors from India, Korea, Pakistan etc. in this area, but it was out of the ordinary to find one who is Thai.
I recognized this name as Thai because, years ago, I worked at a Job Corp. It was the early 80’s and not long after the Vietnam War. At this Job Corp, there were many Vietnamese, Thai and Hmong. I became familiar with the names and could tell the nationality of the student by paying attention to the spelling of their names. Because of this past experience, I noted that this was a was a Thai doctor which was slightly unusual to find one practicing in the Midwest. It was just one of my musings while I prepared to dispense my client’s medications.
As I proceeded to fill my client’s med box, I continued my musings about the Thai doctor and wondered why this particular medication was ordered. It didn’t fit with any of my client’s diagnosis.
The new medication was a muscle relaxant. This muscle relaxant wasn’t the kind of med that is given for an injury, but rather, it was prescribed for someone who has spasms resulting from compressed nerves in the spinal cord or compressed fracture of the vertebrae.
I had researched this medication because I had another client on this medication, but my present client didn’t have any condition that would indicate her need for this medication. It was puzzling me.
The directions were for 3 pills 4 times a day which equalled 12 pills a day. That was a lot for an initial dose. The card that I picked up was for a 2 pm dosage. The other times, breakfast, lunch and supper, were on separate cards. This was a lot of pills.
I was tired and my focus was on getting this client’s med box done and getting on to my diabetic client. As I mindlessly punched out the pills of this new medication, I just couldn’t get passed wondering why this doctor ordered this medication and when did my client see this doctor anyway.
As I continued punching out pills from this blister card, I couldn’t get away from my questioning this medication…something was not right…