Anxious discharging pts home

[Katie83.]

Anyone else take home anxiety when a patient had issues such as sympomatic hypotension especially at the end of tx? I'm so chicken about discharging them, and I continue to think about them all night.

[Mnca]

I know how you feel. I either asked the pt to check their BP when they get home and call me; or I call them and asked what their BP is; if they are symptomatic; and who is home with them; then I teach them both S/s of hypotension and fall prevention. Also helpful if they have a parameter when to hold BP meds.

[Katie83.]

Glad I'm not the only one who calls pts to check on them from time to time. Everyone else I work with thinks I'm crazy.

[amoLucia]

Define 'symptomatic'.

If you are so concerned that there's S&S that could make for an 'unsafe' discharge, then you should be bringing up the issue to MD, discharge planner or case manager. Maybe a simple intervention can be implemented.

But I would caution you about calling them after they leave/discharge your unit. It could be against your facility policy. It might differ if you are a primary case manager.

And you don't want to get into the predicament that a pt gets your phone number, email, text, etc. (They'll be calling you 25 years from now!)

[SmilingBluEyes]

I guess I don't get it. You discharge people who are symptomatic WITH low BPs? Have I got that right? If so, no wonder you worry. You should. There have been cases where patients left and ended up in a car accident or the ER with their symptoms, or even died.

There should be clear parameters where you work, say, not d/c a patient w/SBP less than 100. Or symptomatic. EVER (if symptomatic). If their sx and BP don't resolve to baseline for them, and you have taken all appropriate actions, like fluid boluses, you have to consider sending them out to the hospital for further evaluation. Dialysis is hard on the body. And yes, symptoms should always be stabilized/resolved BEFORE being d/c to home. Always.

Talk to your clinical manager about safe parameters for d/c for each patient. Exception orders from the nephrologist/NP should be on record for every individual with SBP less than 100 or greater than 205---- Or heart rates out of the norm. There should be exception orders for each patient who "normally" falls out of standard safe d/c criteria. We all know some patients will always be hypotensive/hypertensive or have brady/tachycardias. They should have orders on record that it is ok to d/c home with these vital signs. This is a lot of work at times, but it covers us all.

Cover your patients and yourself.