The Social Network & Community JUST for Firefighters
How do you react when doing interfaclity transfer and you find the pt not stable.
Nothing to sweat we transport from this facility all the time they always have it together until one day we get a call?? And the peeing contest begins. Here is the situation me and my partner respond to a local medical facility to transport a pt who is 79 yoa as per our standing orders we check heart and lung sounds before moving pt and check pt's chart for any problems. Pt is a nasal @ 2 lpm but she has pull the nasal off and her sats are down to 80% now mind you this pt is still in her room at the medical faclity and we haven't signed for her yet but we put the nasal back on bump the O2 up to 5 lpm and her sats come up nicely but upon checking lung tones the breathing is course and very diminished in lower lobes. We report the situation and we are told she is ready for transport we advise the medical staff we can transport until clearance is given. The charge nurse listens clears her and off we go or so they thought. How would you react in this situation.
Replies to This Discussion
-
Permalink Reply by Jason Brooks on
-
In my experience, and having been a trouble too many times before, it is easier to pack up and leave than argue. Load them and treat them in your squad. You will get nowhere arguing and they will call and complain getting you in trouble for doing the right thing. We have ha run ins at nursing homes where even the doctor is truly in the wrong for even calling for a transport. It is much easier to bite your tongue and take them in.
-
Permalink Reply by lutan1 on
-
I would have thought it would be a legal minefield that need sto be answered by your dept's legal counsel.
You take them, you assume liability I would have thought....
-
Permalink Reply by anne potter on
-
In all honesty if the pt is in a hospital sit ..one why would you turn up her o2 to 5 liter .. what if she is a retainer thus causing her more problems.. I have seen pt leave the hospital that the DR is happy if they are holding a Sat of 89% with orders not to touch the o2 unless less than 89%... Where was this pt going to another medical facility or nursing home... where????? If this pt is a lunger that probally was the best her lungs ever going to sound...Don't ever assume a situation.... I have been in the ems field for a long time,but I also have the pleasure of knowing the hospital side also... So before we decide what they did was wrong...Have you thought that maybe this was the best she was going to be????? Where were you taking her higher care??? therefore she was heading for a better place.....Nursing home.. I would then guess the Dr.s know she will be a returner.... Once in side your rig then that also is a safe haven for you to transport to the next stop......
-
Permalink Reply by Dave on
-
Few questions, where did you get dispatched too? Was it a Hospital? A Dr office? or a Nursing home. Also, what level care are we talking about? You Paramedic or Basic level? Third, what was the discharge Dx? I have been a Medic for 13 years, one thing i have learned is....all private EMS companies care about is cash in there pocket. You discuss anything with a RN who thinks they are better then you and they will call. Then panic sets in and they Company gets all pissy! I am not one to take crap, and routinly tells staff that putting CHF pts supine on 2 lpm via a Non rebreather is piss poor treatment and they should stick too what they do best....and It aint pt care!!
-
-
Hummmmmmmm bully for you, but yea where did this happen again are you talking a hospital did this????.. I also have been in the ems field for 26 years... Yet to see that happen....Take crap from who the nurse??? ..lol yea
-
Permalink Reply by danny on
-
anne to answer your questions yes it was a hospital, we are under contract with them, and once they call us for pickup they for all purposes go on about their business with other pts, no disrepect to the staff at this facility they are like us over worked under paid but still. pt had no history of copd etc. we were to transport to the nursing home. and so far as the issue of pumping the O2 up we advised the medical staff that we were doing it and the nurse who was in charge of that pt said ok. for the record while in the hospital sitting if during our assessment we find a situation with the pt we report it and they know about it. anne she had pulled her nasal canal off the 5 lpm brought her up to a nice 94 % and increasd her loc. charge nurse was miffed because her staff didnt catch it. we transported later that day but not at that moment. and the pt was darling and expressed her opion rather bluntly lol
-
-
Thanks Danny, for the extra info..Still no matter what thay tell you that pt remains the pt of the nurse who cares for him or her... Tooo bad for that nurse who did not pay attention it falls in her lap.....Charge nurse never checked the pt... hummmmmmmm when you transported did she stay at 5 liters or did she return to 2 liters???... No vitals of the pt before you transported....???? I would have to say document document the heck out of situations like this... Until that pt is in your rig the hospital is the soul owner of this pt... I work on a floor of med surg, we have to sign a paper before the pt leaves the floor,it has her current vitals on it and a last note from us stating pt is stable.... Also on the Ems side of i t I don't take a pt untill this document is signed by the nurse who is caring for the pt..... Sorry that you ran into a bad apple..Danny and thanks for the extra info......
-
Permalink Reply by Kimberly A Bownas on
-
I work for a paid ems service and we do a lot of transports from the hospital to nursing homes. I have had it were we had a patients with a fever and we had the nurse retake the temp. and then call the doctor. We told the nurse that the nursing home wasn't going to take the patient cause of the fever. We do know this, cause they have done it before. It is hard sometimes cause we don't know what the norm for the patient is. The best thing that I can suggest is have the nurse call the doctor that was tending to the patient, just to verify that he agrees with sending the patient out. I just had that happen this week by the way. My partner and I didn't think the nursing home would take the patient. The nurse called the doctor and he said she was ready to be discharged. Come to find out at the nursing home the way the patient was breathing was normal for her. We didn't know this and it was a concern of ours cause we thought for sure that the nursing home was going to send her back.
It can be tough but you know, we have to be advocates for the patients and if you and your partner have concerns talk to the nurse and have the nurse call the doctor and make sure that he still wants the patient to be discharged. It is a tough thing cause sometimes we are treated like we are idiots and don't know what we are talking about. It can be tough, but in the end if the hospital says yes send them back to the nursing home, all you can do is document it on your pcr. I have made sure that I have done that too. Did you end up not transporting this patient in the end?...
Good luck and Stay Safe...
-
-
No anne,I have seen this in nursing homes, and Rehab hospitals. I can write a book on poor care that alot of these places have gotten away with. Lets see......the pt who developed chest pain on friday, had a 12 lead with ST elevation in 2,3 avf, with blood work confirming, Cardiologist left for the weekend, Nursing staff waited till monday..post dialysis to call us. The COPD pt who developed SOB around midnight, increased the o2, a few hours later she developed more SOB, put pt on NRB.....about an hr later pt was being bagged by staff....an hour after that they called the ambulance!! This was at a rehab in Boston that people fly from all over the world for treatment. The rigored body with food in the mouth...staff stated the pt became unresponsive while feeding her!! the list goes on and on.....
-
-
Iks no getting sick from where you are at...
-
-
You are so right .. Sometimes we forget that as a transport you only see the pt for a few minutes..Sometimes pt's are transported back to a nursing home to die,because that is their home and alot of people want to die at home... For some home is the nursing home.... Also pt's are in the nursing home because they are tooo ill to be sent home ,but not sick enough to be in the hosiptal... So when at sometimes you may look at a pt and think my god they look bad ,but as a nurse we look at them and say it's the best they are going to be.....Need to go home and be in a familiar place to them.... I think no one is wrong on this post .. I thought this was a good post for learning about the transfer of elderly to nursing home... Not for sure the deal of bad care from what I read in the post from Dave, but over all... Good Post.....
© 2024 Created by Firefighter Nation WebChief.
Powered by
