8 Necessity for medical decision maker concurrently with advanced care planning in preventing unnecessary pain, suffering

<h3></h3> Only Registered Nurse for 45 bed Low care,15 bed High Care facility. RN worked Monday to Friday 7–3 pm after hours Enrolled Nurse and personal carers where rostered. Female resident with Macular Degeneration, Dementia, Breast cancer with secondaries. Fall with a fractured right neck of femur. Transferred to large metropolitan Public Hospital for treatment. Resident had surgical intervention for fractured NOF. Several blood transfusions, family reported to RN at aged care facility that she appeared to be in significant pain. After discussion with medical personal at the hospital the family were convinced, it would be beneficial to do prophylactic screws to left hip as a precaution. Resident transferred back to Facility Thursday at 4 pm in significant pain and inadequate pain management strategies. Analgesic patch and sub cut morphine injections. RN remained on shift until midnight to manage the pain of resident. RN returned to facility at 6 am Friday referral to Palliative Care made and Infusion pump ordered and in place by 5 pm Friday. RN left facility at approximately 7 pm, resident appeared to be resting comfortably. Registered Nurse notified by phone Saturday at 7 am resident was deceased, to return to facility to verify death. As a Registered Nurse this experience has lived with me since due to the significant pain the resident went through on returning to the nursing home. Not only this however the family asked for me to intervene whilst the resident was still at acute facility as they felt that the pain management was insufficient. Upon contacting acute nursing staff regarding this, the acute staff stated moaning and groaning that the resident was doing was part of the behavioural symptoms of the diagnosed dementia and ‘not actually pain related’. The experience shaped how moving forward as a Registered Nurse, a manager, as a CEO the importance of ensuring that residents have the ability to make their own choices regarding treatment and the importance of having a nominated medical decision maker to enforce medical treatment to prevent unnecessary pain and suffering. If there had been an advanced care plan, and nominated medical decision maker for this resident her last days would have been significantly different. Being a manager/CEO has meant the ability to influence change and improve policy and procedures to ensure better outcomes and care for residents. Importance of Right Documentation to make the Right decisions at the Right Time.