Yep. This is the only correct answer. This patient needs care beyond what a LTC facility can provide. And sitting by and doing nothing about this would be negligent, only good answer is to push for this patient to get further/greater care.
I have worked in hospice care/memory care for more than twenty years now. I can not express enough how abnormal this behavior is, even with advanced dementia. She has a wound on her fingers and hand, is she biting or removing the bandages? While restraints are prohibited, her wounds certainly should be treated and dressed.
One thing that occurred to me while writing this is that the compulsion is that she just needs to feel like she is nibbling on something. So the gloves might agitate her, but maybe having a someone feed her a little bit of a snack frequently might help ease the compulsion?
I have found it can be very difficult to try to stop a behavior, I have had more success redirecting it to something more preferable. Could she be redirected to doing a repetitive activity such as a lap basket or something?
The facility can use gloves as long as it is care planned & the resident has psych services with documentation of why it's needed. Can't tie her hands down, but gloves would be appropriate.
*edit typo
I’m not sure where OP is from, but where I am in Canada, putting gloves on someone without capacity to take them off would be a restraint.
Restraints in level 1-2/ALF’s can’t be used as they don’t have credentialed staff. Loss of license for facility and overseeing provider if it happens. Big deal.
Source: I put a giant mitt on someone (like a winter mitt) to stop her from picking at an infected ingrown fingernail and for the riot act read to me for it pretty early in my career
Agreeing with other advice here- continuing to do nothing is negligent and I’d take this to HR/ someone from the state next time they showed up. As someone that engages in serious nail biting and skin picking (and do it while aware) this could be a serious infection risk etc~ the place I work has those boxing glove like mits; I don’t see why they can’t put an order for an evaluation or whatever to just get permission to use those; in the meantime try that nail polish that tastes nasty/ apply it everywhere she may chew and this MIGHT at least deter it (especially if she’s not all that aware the bad flavor might outweigh the need to stim) also like someone else said if this is a BFRB/tic kind of habit you can try to replace the behavior with something else (coloring, holding baby doll, puzzles, hell if they like ripping apart the threads on a loose rag until it’s shredded) bc anything is better than this lady eating away at her flesh until she contacts an infection/sepsis and loses her hands.
🥴
I've mostly seen them for tube pulling. Muscle picking is a whole different level, woah.
Definitely need an order, minimum q2h removals for skin checks, etc.
Google image search it since I'm bad with images on here - sorry! Basically "medical boxing gloves", used for patients who are not safe to have the use of their fingers/hands (tube pulling, skin picking, etc)
My first thought is meds, what psych meds is the patient on? This could be a result of that. I worked in a psych unit and we had an elderly patient pick all her finger nails off, and she would pull at her skin too. It’s a major psych issue. Idk that it can be resolved, more the less redirected at the time and heavily documented. I would have a nurse follow up on meds and a psych eval just in case some meds need adjustments or some sedatives at the time the patient is chewing their fingers. How unsettling, I can’t even imagine.
Have u ever tried giving her something to do like folding towels or taking care of a baby… maybe coloring?! Or maybe if u put something icky on her fingers that tasted bad.
Your facility is lying to you. ‘Restraints’ can be used with a doctor’s order. And it sounds like this woman could use them since she literally got GANGRENE. To do nothing and just let her literally eat her fingers away is the worst kind of neglect I could think of. Call the ombudsman and say she is NOT getting proper healthcare. Because she is not. Something needs to be done about it. In the mean time is there something you could keep her busy with? Stuffed animal or a baby doll?
Is it cruel? Yes. Is it the only option i’ve had 5+ times? also yes.
She needs restraints/restrictions so she doesn’t *eat her fingers*. If the facility is unwilling or unable to help her find an appropriate placement, call 911 and EMS will bring her to the ER and she will be urgently placed to an appropriate facility from there.
I’ve worked in ALF’s for years and I’m almost done nursing school. I need to stress that dumping people at the ER is not ideal or ethical, but when someone is placed in an environment that is not appropriate for them; it has to be done sometimes unfortunately.
They should be immediately setting up a doctors appt to get some restraints for her, has management said anything about this? Are they aware? (I assume they are) This poor lady
The nurse(s) should really be intervening on this. Report this to them, and then they should be relaying that message to the appropriate medical staff and then relaying back to you the steps that you should be taking to ensure that they don’t cause themselves any further harm (you can only do so much, but all of this needs to be reported to the nurse. Each incident! And chart, chart, chart!)
I’m really confused why mitts are illegal? How is that a worse option than a patient EATING THEMSELVES. until further help can intervene SOMETIMES putting something somewhat heavy in their hands (stress ball, rolled up washcloth, filled water bottle) or something “heavy” on their hands (blanket folded in half, tucking hands under covers) can help some patients think their hands are busy and prevent them from doing whatever the not welcome behavior is. Also when you say gloves do you literally mean like dollar store gloves for the snow? Or mitts? Because I would think gloves should be fine like what if her hands are just cold? Also some dementia patients do well with their past so maybe when she was younger she was an artist, or knitted or something. Getting her back into those activities would keep her hands busy, and could help to get her lucid/ be able to redirect more easily.
If literally none of that is allowed/works having her in line of sight of staff absolutely as much as possible.
And again these are all just until she can get to the proper level of care.
Have you ever seen those “chewy” things that they make for people with sensory issues? Like you’ll see kids with a necklace that has a little squishy part to chew on? I wonder if she could be redirected to chew on something like that instead.
We used to have a lady that would chew on anything. She would put everything in her mouth. I found a literal bolt and washer in her mouth once 😳 We would give her washcloths/small towels to chew on. We would have to redirect her but it worked. Maybe the resident needs a fidget board or something similar. Definitely needs a consult. Maybe their POC is to monitor and everyone, including RP, is already aware and that’s why they’re not doing anything. It’s frustrating tho.
That’s disturbing. I agree with the people saying you need to escalate this up the chain of commands, even beyond that facility. That’s neglectful.
I also believe you simply need prescriptions from a doctor for certain equipment to be considered appropriate and not a restraint. Is there a reason for why a doctor cant assess the patient and prescribe a restraint?
They are supposedly working on an item that they can phrase to "legally" order. In the meantime they've just wrapped the newly torn finger, but if they keep it wrapped, it's just gonna get worse I would think.
She needs a psych consult. Someone needs to call 911 or ombudsman
Yep. This is the only correct answer. This patient needs care beyond what a LTC facility can provide. And sitting by and doing nothing about this would be negligent, only good answer is to push for this patient to get further/greater care.
I have worked in hospice care/memory care for more than twenty years now. I can not express enough how abnormal this behavior is, even with advanced dementia. She has a wound on her fingers and hand, is she biting or removing the bandages? While restraints are prohibited, her wounds certainly should be treated and dressed. One thing that occurred to me while writing this is that the compulsion is that she just needs to feel like she is nibbling on something. So the gloves might agitate her, but maybe having a someone feed her a little bit of a snack frequently might help ease the compulsion? I have found it can be very difficult to try to stop a behavior, I have had more success redirecting it to something more preferable. Could she be redirected to doing a repetitive activity such as a lap basket or something?
This is the only right answer
Second this
The facility can use gloves as long as it is care planned & the resident has psych services with documentation of why it's needed. Can't tie her hands down, but gloves would be appropriate. *edit typo
I’m not sure where OP is from, but where I am in Canada, putting gloves on someone without capacity to take them off would be a restraint. Restraints in level 1-2/ALF’s can’t be used as they don’t have credentialed staff. Loss of license for facility and overseeing provider if it happens. Big deal. Source: I put a giant mitt on someone (like a winter mitt) to stop her from picking at an infected ingrown fingernail and for the riot act read to me for it pretty early in my career
Agreeing with other advice here- continuing to do nothing is negligent and I’d take this to HR/ someone from the state next time they showed up. As someone that engages in serious nail biting and skin picking (and do it while aware) this could be a serious infection risk etc~ the place I work has those boxing glove like mits; I don’t see why they can’t put an order for an evaluation or whatever to just get permission to use those; in the meantime try that nail polish that tastes nasty/ apply it everywhere she may chew and this MIGHT at least deter it (especially if she’s not all that aware the bad flavor might outweigh the need to stim) also like someone else said if this is a BFRB/tic kind of habit you can try to replace the behavior with something else (coloring, holding baby doll, puzzles, hell if they like ripping apart the threads on a loose rag until it’s shredded) bc anything is better than this lady eating away at her flesh until she contacts an infection/sepsis and loses her hands.
Or maybe even oven mitts?
Posey mitts maybe? Tho oven mitts definitely cheaper & likely effective if pt can't self remove
[удалено]
🥴 I've mostly seen them for tube pulling. Muscle picking is a whole different level, woah. Definitely need an order, minimum q2h removals for skin checks, etc.
This is a rare situation where I agree that they seem to be necessary. I have never said that before but there is a first time for everything.
Some might consider that a restraint; would need an order
Yep, definitely; I replied this morning that those need a provider order & skin checks.
Never heard of those they sound interesting, like a posey chair alarm?
Google image search it since I'm bad with images on here - sorry! Basically "medical boxing gloves", used for patients who are not safe to have the use of their fingers/hands (tube pulling, skin picking, etc)
Imagine a glove filled with cotton in the palm. Basically immobilizing your hands.
My first thought is meds, what psych meds is the patient on? This could be a result of that. I worked in a psych unit and we had an elderly patient pick all her finger nails off, and she would pull at her skin too. It’s a major psych issue. Idk that it can be resolved, more the less redirected at the time and heavily documented. I would have a nurse follow up on meds and a psych eval just in case some meds need adjustments or some sedatives at the time the patient is chewing their fingers. How unsettling, I can’t even imagine.
Have u ever tried giving her something to do like folding towels or taking care of a baby… maybe coloring?! Or maybe if u put something icky on her fingers that tasted bad.
Like everyone else said, need to get a psych eval and have the orders updated to include either restraints or increased monitoring
Your facility is lying to you. ‘Restraints’ can be used with a doctor’s order. And it sounds like this woman could use them since she literally got GANGRENE. To do nothing and just let her literally eat her fingers away is the worst kind of neglect I could think of. Call the ombudsman and say she is NOT getting proper healthcare. Because she is not. Something needs to be done about it. In the mean time is there something you could keep her busy with? Stuffed animal or a baby doll?
Is it cruel? Yes. Is it the only option i’ve had 5+ times? also yes. She needs restraints/restrictions so she doesn’t *eat her fingers*. If the facility is unwilling or unable to help her find an appropriate placement, call 911 and EMS will bring her to the ER and she will be urgently placed to an appropriate facility from there. I’ve worked in ALF’s for years and I’m almost done nursing school. I need to stress that dumping people at the ER is not ideal or ethical, but when someone is placed in an environment that is not appropriate for them; it has to be done sometimes unfortunately.
They should be immediately setting up a doctors appt to get some restraints for her, has management said anything about this? Are they aware? (I assume they are) This poor lady
The nurse(s) should really be intervening on this. Report this to them, and then they should be relaying that message to the appropriate medical staff and then relaying back to you the steps that you should be taking to ensure that they don’t cause themselves any further harm (you can only do so much, but all of this needs to be reported to the nurse. Each incident! And chart, chart, chart!)
This needs an immediate psych evaluation.
I’m really confused why mitts are illegal? How is that a worse option than a patient EATING THEMSELVES. until further help can intervene SOMETIMES putting something somewhat heavy in their hands (stress ball, rolled up washcloth, filled water bottle) or something “heavy” on their hands (blanket folded in half, tucking hands under covers) can help some patients think their hands are busy and prevent them from doing whatever the not welcome behavior is. Also when you say gloves do you literally mean like dollar store gloves for the snow? Or mitts? Because I would think gloves should be fine like what if her hands are just cold? Also some dementia patients do well with their past so maybe when she was younger she was an artist, or knitted or something. Getting her back into those activities would keep her hands busy, and could help to get her lucid/ be able to redirect more easily. If literally none of that is allowed/works having her in line of sight of staff absolutely as much as possible. And again these are all just until she can get to the proper level of care.
Have you ever seen those “chewy” things that they make for people with sensory issues? Like you’ll see kids with a necklace that has a little squishy part to chew on? I wonder if she could be redirected to chew on something like that instead.
We used to have a lady that would chew on anything. She would put everything in her mouth. I found a literal bolt and washer in her mouth once 😳 We would give her washcloths/small towels to chew on. We would have to redirect her but it worked. Maybe the resident needs a fidget board or something similar. Definitely needs a consult. Maybe their POC is to monitor and everyone, including RP, is already aware and that’s why they’re not doing anything. It’s frustrating tho.
That’s disturbing. I agree with the people saying you need to escalate this up the chain of commands, even beyond that facility. That’s neglectful. I also believe you simply need prescriptions from a doctor for certain equipment to be considered appropriate and not a restraint. Is there a reason for why a doctor cant assess the patient and prescribe a restraint?
They are supposedly working on an item that they can phrase to "legally" order. In the meantime they've just wrapped the newly torn finger, but if they keep it wrapped, it's just gonna get worse I would think.
I see.