By Brenda Sutliff, MSN, RN
Fred has been developmentally disabled since birth. He was non-verbal and came to our hospital with a bowel obstruction due to Pica. He lived in a long-term nursing home known to have a less-than-desirable reputation, but it was one of the few places that took Medicaid patients in our area. Upon admission, we learned that the facility was now being closed due to multiple violations.
As I reviewed his case to prepare a plan for his discharge, I was surprised to find that he had visitors. We had not been aware that he had any family because he had a state guardian. These were distant relatives who were unable to care for him but still made the effort to visit. In researching his history, I knew each time he came into our facility, all he did was sit in bed with the TV on with no other stimulation. I learned from reviewing the facility's notes that he had previously walked at his facility and enjoyed coloring. This was new information. Why did we only ever have him in bed?
Staff who had had him in prior admissions tried to discourage the care team from ordering a PT evaluation. They assured me that he did not walk. I forged ahead and collaborated with the physician to order the PT evaluation. Physical therapy saw him, and the next thing we knew, Fred was walking down the hall. He would not win a race, mind you, but he was doing it.
It had also been known that he had loved to color. I spoke to our social worker, and she was able to get crayons and coloring books for him from our Child Life Specialist. Fred immediately started coloring. He brightened up, seeming to really enjoy this and no longer just sitting in bed staring at the television hour after hour. After seeing what he could do, I reached out to his guardian to begin a discharge plan that was more appropriate to Fred's needs. Together, we were able to find him a group home that was familiar with Pica care and had an opening for him. It took quite a bit of time, 96 days to be exact, but Fred was going to a real home in a place that could meet his needs.
A place where he would not sit in bed day in and day out, but would instead receive the care he needed and the interaction and programming vital to his quality of life. Hopefully, he will not come back for another surgery due to his Pica because he was going to a place where they really understood his needs. This patient remains a reminder to me to be an advocate and to learn about my patients. Never give up on finding creative solutions to meet the specific needs of the patient and to achieve the best care and outcome available. We positively impacted Fred's life, and we were effective in enhancing the quality of his life simply by taking the time to learn more about him and advocate for him. More importantly, Fred had a profound impact on me and my practice as a case manager. This episode occurred in 2010, and I still carry Fred in my memory today.
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Bio: Brenda Sutliff, RN, is the dedicated Manager of Utilization Management at Lee Memorial Hospital, part of the Lee Health system serving Southwest Florida. A registered nurse with over fifteen years of experience in hospital case management, Brenda has managed care coordination across high-acuity areas including ICU, orthopedics, neurology, and pediatrics. She oversees utilization review processes, collaborates with interdisciplinary teams, and ensures alignment with regulatory and patient care standards.