Deciding COVID Take Home Doses

(I am changing this patient’s description to protect identity)

We have only a few patients who refuse to wear masks. One of these people, an admission from a few months ago, has been dosed in his car since we don’t want him to endanger other patients by his refusal to wear a mask. He’s been dosing with us every day, but after the first three weeks I felt comfortable to give him Sunday and holiday toke homes.

Now he’s asking for the extended COVID take homes, which for a recent patient like him means up to four take home doses per week and coming to dose only the other three day.

But when his counselor first asked me about it, I snapped, “No! He says he doesn’t believe COVID is real and that’s why he refuses to wear a mask. Why should he benefit from COVID take homes?”

Even as I said this, it didn’t feel right.

Decisions about take homes, although ultimately decided by the medical director, shouldn’t be made on emotion. That’s why we have case staffing. So, I asked this counselor to present the issue at our case staffing session the next day.

I was pleasantly surprised at our staff. I heard some mature and considered responses.

One person said something to the effect that the take homes are for the benefit of the patient, whether that individual agrees with us about the risks of COVID or not. And those take-home doses also benefit staff and other patients, by limiting crowd exposure.

Yep, I thought, that’s the right answer.

Another person said she didn’t think this patient would misuse his take home doses, and he was compliant in all other matters, other than having continued positives for marijuana and not wearing a mask. And wasn’t that the main consideration, whether the patient can consume the take home doses as prescribed?

Right again, I thought.

One of the counselors pointed out that it would make nurses’ jobs easier by giving one less person to car-dose on those days he will get take home doses.

Yep.

Decisions about take homes shouldn’t be made with a punitive mindset. My reflex response to the patient’s counselor hinted of judgementalism, which is why it felt wrong. I was angry with the patient because he didn’t agree with me about COVID. Whether he agrees or not isn’t the point of the extra take homes, as my staff recognized.

So, this patient got his extra COVID take homes even though he doesn’t believe in COVID and I wish him well.

And I’m so proud of this staff of wonderful people I work with.

8 responses to this post.

  1. Wow! That’s a beautiful example of what we all do– the quick reaction, especially in times of stress. How rare it is to review that “fast” reaction and “slowly” revise it with more deliberation and input from others. That is the hard part, to reflect and revise.

    Reply

  2. Posted by MarkEssex2016rbl on December 14, 2020 at 12:54 am

    Great example of leadership – being able to realize the ‘quick reaction’ for what it was and that it might not be the right response, and listening to others before making the rash decision. I learned something today and need to practice that myself, so thank you!

    Reply

  3. Posted by frank wood on December 14, 2020 at 1:14 am

    The patient who doesnt think Covid-19 is real and wont wear a mask etc,…is an idiot…..Give him his damn take homes and treat him like a child that he is……What an idiot endangering peoples lives….

    Reply

  4. Posted by susanmscarlett on December 14, 2020 at 2:31 am

    Thanks for posting this, Jana. This is a confusing time, even after 9 months, and I constantly am weighing the most beneficial course of action with the extra COVID-19 take homes. You have clearly created an environment in which your staff members feel confident in expressing their views.

    Reply

  5. Posted by Charles Erickson on December 14, 2020 at 1:26 pm

    I would have reacted the same as you. It really requires a “cooling-off” period before one can make a sound decision about that. Don’t beat yourself up.

    Reply

  6. Posted by Zac Talbott on December 14, 2020 at 5:28 pm

    I was going to ask why he couldn’t handle a single take home on a Monday or a Wednesday if you thought he could handle one on a Sunday (assuming you spread out the take home doses where he’s coming every other day). But your staff had even better questions. Thank you for allowing your humanity to show. None of us are perfect, and all of us are emotional during this crazy time. Multidisciplinary treatment teams are amazing things, and that’s what this shows most of all. May they abound everywhere!

    Reply

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