The Social Network & Community JUST for Firefighters
What is the law/Standard of Practice on bedside report?
I am not an EMT/Paramedic. I work in an ER as an RN and have done so for the past 4 years. When I graduate nursing school i went straight into the ER and was greener than anyone should ever be. I learned very early on to listen to and respect the reports given by the first responders and was fortunate that 95% of time they were spot on and very informative. I was told that the EMT/Medics were to remain with the pt until the receiving facility's staff came to assume transfer of care and that anything else was, under the law, abandonment. Fortunately, in that time multiple ERs as a traveler, I never once had an issue where this was not done.
However, at my new job i am CONSTANTLY finding pts in the beds with no one there to give report. It is a semi-busy rural ER but i am talking about pts that have arrived 3 minutes prior and i have to go get the EMT/medics out of the truck, or out of the break room or off the computer. Today i had a pt that was alone, an obvious alzheimers sufferer and the complaint on the radio report was chest pain. I spent 5-8 minutes LOOKING for the ACLS crew to find out that in the 40 minute travel time they had given meds (ASA and nitro) started an IV and ran a 3 lead. A 3 lead?!? on a pt with an extended cardiac history - which i didnt find out about until the family arrived. They were unable to provide allergies or any coherent history on the gentleman.
I this was an isolated event i could possibly understand, but this is something that happens over and over.
The crappy report I can overlook for now. However, my main concern is having to SEARCH for the medical professionals that transported the pt, so as a community, can someone enlighten me on the actual laws or standard of practice that should be being follow? Thanks, and for the 99.9% of you guys that do your job well, thank you so much.
Replies to This Discussion
-
Permalink Reply by John Crabbe on
-
However, at my new job i am CONSTANTLY finding pts in the beds with no one there to give report. It is a semi-busy rural ER but i am talking about pts that have arrived 3 minutes prior and i have to go get the EMT/medics out of the truck, or out of the break room or off the computer.
However, my main concern is having to SEARCH for the medical professionals that transported the pt, so as a community, can someone enlighten me on the actual laws or standard of practice that should be being follow?
Simply put, there is absolutely no reason you should have to track someone down. By really all accounts, if you do not have someone to transfer a report to, you stay with your pt. Transferring the pt without a turnover is by all accounts, abandonment.
What gets me here is you state you are a semi-busy, rural ER, which to me, means you are not that busy, nor EMS that busy that they can just leave a pt without a proper turnover. Do you know any insight as far as the EMS involved, are they career, private, volunteer, etc? Is it the same service or a variety of services doing this? It shouldn't matter, but it can go to education. Really though, if such issues were occurring I would mention something to the Doc in charge and thus in turn to the service's medical director. There is no excuse for just leaving a pt without a proper turnover.
-
Permalink Reply by Paul Montpetit on
-
There is NO reason for that quality of care....unfortunately yo were obviously dealing with the same quality of Medic......in common terms piss poor. I will not cover for poor care....In my opinion if possible speak with the people involved..if that doesn't seem to get the job done you can go to the Department that they ride with or go to your county QI person (or State person) Have on hand the PCR number and dates and times if possible...they are very good at getting to the root of the problem and believe me they look at situations such as this with more disgust than you or I would. I understand your feelings...I am both a Medic and an RN do I see it from both sides and from your "report" totally inacceptable.
-
-
Ralphie....Got to both agree and disagree with you here....Let's be realistic...we have great medics (EMT's included) in the field....we also have ones that couldn't tie their shoes if their lives depended on it. How these people ever passed the course and OJT period is beyond me.....be real...haven't you seen "things" that make you cringe when you see or hear about it....? Well, as a Nurse (RN) I have seen the same with some Nurses...Maybe it is burn-out...or maybe they truely don't give a shit anymore...I can't answer that one. So, it is a problem on both sides of the ER door....and maybe if we work together we can do something about it...Our patients deserve it. Just my view you old goat herder....LOL...Take care....Paul
-
Permalink Reply by Oldman on
-
"I am not an EMT/Paramedic. I work in an ER as an RN"
First off, we won't hold that against you. ;0
According to the definition by uslegal.com:
Medical abandonment results when the caregiver-patient relationship is terminated without making reasonable arrangements with an appropriate person so that care by others can be continued.
"Abandoning or neglecting a patient or client under and in need of immediate professional care, without making reasonable arrangements for the continuation of such care, or abandoning a professional employment by a group practice, hospital, clinic or other health care facility, without reasonable notice and under circumstances which seriously impair the delivery of professional care to patients or clients."
The patient was under "professional" care when brought in. If no report was given to you or any other nurse, and the patient was left by the crew, there may very well be a strong case for abandonment. At the very least, this behavior breaks the continuity of care.
I would bring the House Supervisor in on this one. One time is one time too many.
-
-
Hey Bud...we got called (fire) for "lifting assistance" We arrived..Possible OD....took unknow quantities of muscle relaxant and oxycodone.....Medic on scene needed some help so of course old lardass (me) jumped in and got the oxygen on and the 12 lead going....He starts dragging the stretcher out from under me and I asked if he was going to give narcan before rolling....He looks at me and states in front of family and crew..."Hey stupid, you don't give narcan for muscle relaxants" Well, just before I choked the shit out of him my partner taps me on the shoulder and gives me this "No, don't do it" look....I waited till we got to the hospital and after all said and done informed him that the next time he ever called me stupid in front of anyone that he had better have their names to use as witnesses for court against me because I would put his ass in the ambulance as a patient in front of God and country...He told me I didn't understand...and I reminded him about the second drug onboard this patient...oxycodone...and that narcan can be effective.....He went away with that deer in the headlights look.......moron
-
-
He won't speak to me anymore....8( LOL I see him in training or on calls and he ignores me...So I do the honorable thing and get as close as possible to him....LOL I had to do some practical stations when I upgraded and guess who my evaluator was....? Yup....my "Buddy" But to my surprise I got all "go's"
-
Permalink Reply by Christopher Ware on
-
I always assumed giving Narcan en route or at the same kinda put you guys in a bad position. What happens when the unresponsive pt wakes up temporarily from the narcan only to refuse transfer?
-
-
What happens when the unresponsive pt wakes up temporarily from the narcan only to refuse transfer?
Then you load back up with a narcotic and continue transport. :-D
Seriously though, such a thing really doesn't occur much. Many times we would give enough Narcan to bring the pt out of a stupor, but not enough to be fully alert. This helps to prevent a pt from potentially becoming violent, so we typically start lower with the initial dose of Narcan and increase as necessary.
However, if the pt were to become responsive and refuse transfer, then they really are SOL. Number one there is implied consent when first picking up the pt, secondly they are still under the influence of a narcotic, even though the antidote was given, which means they really can't make such decisions for themselves. Thirdly, if there was an insistence we would have LE place them under protective custody because again, they are not in the right mindset to refuse transport.
-
-
We called it; titrate to effect. Give em just enough to help their respiratory rate, and then slam the rest as we walked into the ER.
-
-
Can't refuse...He obviously is in no state to refuse anything...Has already shown himself to be non-rational in his OD....He cannot give informed consent therefore he cannot refuse...its one of those..."Sir, You can either ride in the ambulance with us quietly and be evaluated at the hospital or you can ride in the patrol car in handcuffs with the Officer, Now again will you cooperate?" You would be amazed at the number of times this approach has worked....
-
-
Remember the half life of Narcan is about 15 minutes....its not one dose and they are ready to jog to the hospital along side your rig.
-
Permalink Reply by Brian Dumser on
-
Around here that's called "abandonment", and it's a sure way to get an a$$ reaming by the Medical Director, Fire Chief, EMS Coordinator, etc. If you're lucky you'll still have a job afterwards.
© 2024 Created by Firefighter Nation WebChief.
Powered by
