Nursing Home Dichotomy
Tonight at 2000, we received an unresponsive patient from the nursing home down the street that subsequently bought a tube, coded twice, and ended up in CCU on Epi and Levophed drips. This lady was normally alert and oriented, but today at 1400 they noticed that she was unresponsive. They didn't call EMS until 1945.
Tonight at 2300, we received a patient from the same nursing home with a complaint of a fever for one hour. Her temp on arrival was 99.1 and was reported to have been 100.3 earlier. We did a CBC and a UA, diagnosed a UTI and sent her back. She was in the ER for less than 45 minutes.
How on earth can you not send an unresponsive patient to the ER for almost 6 hours, but send a patient with a low grade temp in after 1 hour?
12 comments:
Shift change?
It's the weekend. We used to get hit with patients from the nearby nursing home on Fridays because the covering weekend docs didn't want to deal with anything serious over the weekend. During the weekends, nursing homes don't have enough staff or don't have the regular staff working. What day did the first patient come in?
Now Monkey,
You know Ms. Coma was "sleeping so well we just didn't want to wake her." And Ms 99.1 had to Daughter from hell who reads Web Md ibstead of doing Soduku or whatever the heck that numbers game is and she pitched a bitch fit at the Nurses Station and was sent immediately!
Also- my hats off to ANYONE who works in Extended care. I'm not bashing you- I know you are understaffed and underpaid- but For GOD'S SAKE- don't DOCUMENT that she was unresponsive for 6 hours...just ease her butt on in as if.......
Great Blog Monkey- New reader
anonymous nailed it.
RN's probably changed shift at 1900 or maybe even 1930.
If I had a dime for every time I saw the same situation....
My children tell me that they plan to put me in a nursing home someday....ON MOTHER'S DAY! The little darlings. It's sad hearing stories like this, but it happens all the time. I'm sure that John's assessment of what happend is right on the money.
MJ
"How on earth can you not send an unresponsive patient to the ER for almost 6 hours, but send a patient with a low grade temp in after 1 hour?"
Because by the time the average nursing home LPN sets up her med cart, makes a med pass, does her charting, sets up her cart for the next medpass, does that one, and charts again, and 8 hour shift has passed - during which she has laid eyes on her patients for maybe 10 minutes or so.
So it's not really surprising that some nurses push the panic button at the FIRST sign of a problem, no matter how trivial, and other nurses miss an acute change entirely until it's too late.
Plus, nursing homes do not attract the best nurses. If a good nurse DOES happen to work in a nursing home, the workload and the environment will eventually ruin her/him as a nurse.
I rarely listen to nurses when I pick up patients at nursing homes. The aides know far more about the patients than the nurses do.
Here's my take on nursing homes:
http://tinyurl.com/22rgxd
"The aides know far more about the patients than the nurses do."
Too true. In nursing homes the RN's don't have much contact with patients because they're buried in senseless paperwork.
The LPN's are too busy crushing pills and passing meds to 40 residents a couple/few times a shift.
If a resident gets sick, it's very likely that a nurse aide will be the one to catch it first and many of them are very good at that, but that's neither what they are paid nor trained to do. And they're busy as hell bathing/feeding/bedding and don't have time to chat.
Nursing homes are like war: they're all about ruining people.
At the very beginning of my "medical career" I worked as a CNA in a nursing home for 2 years. I knew absolutely nothing about patients except how to take vitals and how to do a bed bath. I worked my ass off for minimum wage, but I wouldn't change the experience for the world. I've changed a lot since then, but nursing homes haven't. Regardless how much I know about them, I'll never understand them.
When I worked day shift you always knew it was 7:00 AM because the nursing home down the street would send us one found dead on morning rounds.
I work as a prn RN in a nursing home/rehab. We have 25-30 patients per nurse. So, because of pushing pills and required medicare/medicaid paperwork, there is not a lot of time for assessment. The shift change was probably the reason that patient finally got sent, I know that I sent in someone over the weekend right after getting report, who went from alert and oriented to near comatose and O2 sats of 80%, who the other nurse thought might be "a little sick." Then I get stuck with the paramedic acting like I'm an idiot since this patient has been like this all day. Longterm care sucks.
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