Also now that her fecal blockage appears to be out, Fatima was successful this morning at changing her diaper on her own. Hopefully that keeps up. But I told Fatima to let us know if she does need an extra hand because 2 Ativan (if needed) and proper pain management just not enough. Paul Teitelbaum 917 747-6806 On Jul 28, 2023, at 10:43 AM, Maria Licoudis <mlicoudis@thekey.com> wrote: Hello Paul, I will review all the medication instructions with the caregivers. Thank you. Best, Maria Maria Licoudis RN Client Success Manager 514-907-5065 TheKey.ca On Jul 27, 2023, at 10:16 PM, Paul Teitelbaum <pt@alumni.upenn.edu> wrote: Maria, Sorry. The last email got messed up. Trying again here with the full message . . . . I need to update you on the proper administration of my mother’s medications based on discussions I had this week with Dr. Piche and with the pharmacist a couple of weeks ago. Basically, if this is followed properly and as my mother stabilizes at home and her body becomes accustomed to the new pain medications, eating and drinking more (which is good) and her body increasingly tolerates the side effects, her constipation (and diarrhea from the laxatives that over time should be needed less) should subside. This is exactly what happened to her the last 2 times she was hospitalized (in October for kidney blockage and in November or December for Sepsis): hospitalization and change of medications and food -> weakness, constipation, side effects at home -> adaptation to medications and stabilization And if the regimen below is followed, she should not need any subcutaneous medications until she’s really at the end, and that is the time when we would get an LPN involved. The hospital was not expecting that my mother would need subcutaneous administration of medications at this time. The only reason they put in the butterfly and sent the bag of infusers home was as a precaution and just to have another way to give meds if oral couldn’t be given. But my mother is taking orals meds. Also, it was explained to us on Tuesday by Dr. Piche that the only benefit the butterfly provides is somewhat faster action - 45-50 minutes for the pills vs 15 minutes for the subcutaneous. Not really such a huge time savings particularly if the oral meds are managed properly, and really no advantage for Ativan for anxiety as explained below. Please relay this to the caregivers. 1) Pain management: - In addition to the fentanyl patches (1.5 patches) which replaces the 4.5 mg long acting Dilaudid because the hospital started to have some compliance issue with the pills as my mother, who wanted to get out of the hospital and go home, started to reject what they were doing to her there, the caregivers can give up to 18 pills per 24 hour period - The caregivers need to ask my mother at least every 30 minutes if she is having pain. If she has pain, give 1 mg Dilaudid (short acting through breakthrough pain) and wait 60 minutes and ask her again. If she still has pain, give another. They can then repeat this a 3rd time (3 hours in a row) and then should skip 1 to try to make sure she has enough for overnight. If they need to give 4 in a row, they can but then might have an issue at night - They should each try to limit to 6-7 per shift if possible (they are not at the level yet - Fatima only have 3 during her shift today and I recall another day earlier this week I think she only gave 2) - The following is a sample schedule for getting close to the maximum administration of of the Dilaudid short acting (this is 16 pills, but they can max to 18) 7:30 am - 1 pill 8:30 - 1 9:30 - 1 10:30 - skip 11:30 - 1 12:30 pm - 1 1:30 - 1 2:30 - skip 3:30 - 1 4:30 - 1 5:30 - 1 6:30 - skip 7:30 - 1 8:30 - 1 9:30 - 1 10:30 - skip 11:30 - 1 12:20 am - skip 1:30 - 1 2:30 - skip 3:30 - 1 4:30 - skip 5:30 - 1 6:30 - skip <span