Here it is pretty much every day that they dump. You can always tell when it is going to happen though, SHIFT CHANGE at the NH. It seems like every day when they change4 shifts, about 30 minutes after shift change, they start shipping Pts out to the ER for various reasons.
I love going in and getting "refusals" from Pt's that still have capacity to make there own decissions, and didn't want us there to begin with. One such case was, that we got called for the Pt who assulted a staff member, but we weren't going for the staff member, somehow they seem to think that we have magical police powers or something. This Pt was just there for rehab due to a broken hip, not due to the usual dementia, or alzheimers, etc. So we go in and the nuse says "he assulted one of our staff members and the Doc wants him to go to the ER for a psych evaluation." By this time law enforcement was there and we go into the Pt's room and ask what was going on. The Pt told us what had happened...evidentally the staff member was trying to make this guy do something that he REALLY didn't want to do. I asked him if he wanted to go to the hospital, and he told me that he wasn't going anywhere with me. I of coarse asked all the "are you with it" questions , which he answered all correctly. I said" ok sir, I just need you to sign this paper for me." I thyen went out and told the nurse that he wasn't going with us, well that went over real well (insert sarcasim here), she sadi "you have to take him, we have a Doctor's order." I said "Maam, I don't care if God himself told me to take him, I'm not going to!" I was quite proud of myself for thinking that on up on the spot like that. The Police officer then steps in and says, "Maam, he right, he can't take him against his will or I will be taking him to jail for kidnapping." So we left. Just an added note, the nursing home kicked that Pt out on the street. They had the police escort him off there property right then. PD said that he was on the side of the road waiting on his wife to pick him up when they left.
Most of our homes are apt to dump at any time of the day or night.We usually get the "But he was OK 30 minutes ago." or I just found her typecalls. Gotta love that sudden onset pneumonia.
I like that "but we have a doctor's order." They can't comprehend the rules we have to play by. I love it when they call the doc and he says they have to go. Then they look at us blankly when we tell them the patient is AxO X4 and signed the refusal with handwriting that is more legible than mine. No matter how many owners, managers, or supervisors talk to them it is almost impossible to get them to understand our rules are different than theirs.
I've had a patient AOx4 refuse and the "nurse" said that the pt. was due for meds soon and won't be oriented after them. Can I come back?
Also we run into a lot of staff that "just came on shift" or " I'm covering for that nurse and I don't know anything about the patient, can't you just take them?" What scares me if they think we can or even would....who set the example? Are other "privates" or FDs taking patients with no HX or info anyway?
The answer is yes.
OK I understand completly. We can usually tell which nurse is on by the number of nh calls we recieve. The problem starts with the nurse and ends with the Dr. Most physicians in my area will admit that when they are called with a complaint at 0300 they for one arent awake and dont really want to deal with the prb. and 2 simply dont trust the nurses evaluation and want the pt sent out for liability sake. They probably feel the same way when a nh calls about a pt during the night with a clogged foley or a red itchy leg. the only difference is we have to handle it and not just pass the buck.