Question for nurses

[Lackinghope]

If you are a nurse, especially if you work in a care home do you know what a volvulus is without googling?

To put it bluntly, the CHM is a complete arse.

I agree, she shouldn't be calling me in the evening, telling me she disagrees with doctors.
she actually took it upon herself to email the care home GP to change the dose to x 4 daily before it was switched back to twice a day.

And now my sibling and I are taking time off work to go tomorrow to be there when the doctor and palliative nurse visit. I really don't trust them , we feel we need to be there to make sure she doesn't bulldoze them into doing what she wants.

There are different types of morphine, try and find out exactly what she's been prescribed, if you Google the carehome it should show who the registered manager is and what qualifications they hold. It's unusual for the manager to be on duty at this time of night, is it a nursing home or residential home. Does anyone have power of attorney for health. I'd go in tomorrow and wait there until the doctor arrives, is your mum conscious at the moment or sleeping very deeply. If a nurse or carer is withholding prescribed medication it needs to be recorded, discussed and approved with the GP and the GP is ultimately responsible for prescriptions.

I'm really not sure what her concerns are. I would maybe ask her what she is worried about. She should be worried that your mum is in pain and should want to help.

It's a nursing home, the CHM seems to be on duty all the time, she answers emails at all times of the night and day , even when we've been told she's on annual leave.
My sister and I have poa, but mum is deemed to have capacity because there isn't an MCA 1 form, she is asleep most of the time but can be roused.

if you Google the carehome it should show who the registered manager is and what qualifications they hold

She a graduate of the care home 'management academy' 🙄

On the managers profile it should say what experience she has, if she has a nursing or social work background and what professional qualification. If your mum is unable to communicate then she may not have capacity, this is something you need to discuss with the doctor who can carry out a capacity assessment. All her care should always be in her best interests only, if she does not have capacity I would invoke health poa and consider asking for her to be moved.

@MissMoneyFairy she has no nursing or social work background, she started at the home as a carer and then worked her way up, graduating from the ' care home management academy'

Are there any registered nurses working there

So looks like she was on liquid morphine, which she refused and is now on tablets .

Yes

Nonsense
I'd ask the CHM where her/his evidence is to support such a Nonsense statement...
Nursing is an evidence based profession.. the registered nurses in the care home need to be speaking up under the nmc code of conduct

She said that she's seen eol residents with ulcers and sores in their mouths from liquid morphine due to them having dry mouths .

Nonsense
That's down to poor mouth care in the home
Mouth tends to get v dry at palliative care
When I worked in hospice we offered pineapple chunks or juice to resident ls who were able to swallow and alert. Alongside good mouth care every few hours. Use to proper mouth washes etc

😧This is beyond ridiculous now, the manager needs reporting. If end of life patients in her care home have ulcers and sores this is due to poor mouth care.
Fingers crossed you have a good outcome with the GP today.

I’m so sorry that your mum is going through this when she should be receiving care and treatment in line with her own wishes and preferences, not some batshit woo woo dreamt up by an unqualified numpty.

I am also sorry that you are having to expend time and energy to try to sort the situation out, when your mum should come first.

My thoughts are to start with the GP and or the district nurses to get her pain relief sorted. Phone the surgery, tell them you have LPA and that your mum’s treatment is neither effective nor in accordance with her stated wishes. Tell them she is unable to advocate for herself.

Secondly, you can report what is going on if you have the energy. I appreciate that your Mum is your priority and you may not want to, but sadly it is unlikely that your mum is the only one receiving poor care. You could consider reporting your Mum as a safeguarding concern to the local authority as she may be being denied effective pain relief, which is abusive. You can also report the home to the CQC. If it is one of a group of homes, it may also be worth contacting an area or national lead.

I hope your Mum’s symptoms improve and that the next steps are gentle.

Like others have said this is due to poor mouth care and dehydration, nothing to do with morphine. Sorry but with lpa I would ask for the capacity assessment today, is it a private carehome, are you self funding. I would put in a complaint to the GP, look to have your mum moved. The manager has no nursing background and the RNs there need to advocate.

Just got back from the care home. Saw a lovely doctor, who has had words with the CHM . Mum is staying on the dose of 20mg morphine am and pm . She will have top up doses of oramorph before she has anything done (bathing , hoisting etc).
She is also going to have something to help with her anxiety, can't remember the name but something like diazepam.
Mum has crackles in her lungs, we have declined antibiotics.
The doctor asked us what we would do if the assisted dying legislation was passed and we said we would definitely take advantage of it, she nodded and said good to know.

That's good to hear the doctor has been kind, the chm clearly has no knowledge of analgesia, comfort or basic essential care. Hopefully no more emails or phone calls.

So pleased you had a good outcome from the GP visit. It may have been lorazepam for anxiety.
I hope things stay calm for you and your mum now and that she is peaceful.

Glad to read your update @Lackinghope and hope your mum is more comfortable.

I was a Registered Nurse many years ago as was my wife - we both know what it is.

Yes that it 🙂

They've started mum on the anticipatory meds , so I'm not sure how much longer we'll have her.