[canoehead]

I dislike the dumpjobs on Fri evening when admin has gone home and whoever is working decides someone has a "change in mental status" sent by ambulance to the ER, but they have been crotchety and confused for years. So a little Ativan and Haldol is given, pt falls asleep, ready to go back, and they refuse to take him/her. It is a dump- so now hospital gets to be a boarding home for someone with a placement problem. What happened to EMTALA there?

[traumarns]

what i hate, is when the ltcf sends the patient who fell. needs sutures, that is fine and dandy but normally we need to send them back BUT ALAS, no phone number, address, or name of the ltcf on the face sheet. just the pts information, diagnosis, religion, core status....
i then have to look at the trip sheet, (if i can find it, but that is another whole ball of wax) and find all i have is the address, still no name of the facility. ugh... then a call to the dispatch of said ambulance company to find out WHERE the heck this person came from.

what should have taken 10 mins to do. call ambulance to take pt back, then call home to give report, and aftercare instructions. takes an hour or more to do.

THAT is the most frustating thing. i never minded getting nh patients. many times they are in and out. just the hurry up and wait for lab/xr results. then transport. it is when i have to spend stupid amounts of time trying to figure out where they came from, and who to call.

[CATHYW]

Tom, I felt the same cringe when I worked ER, and recieved these patients with urine soaked sheets that had dried and been resoaked, and peas and corn under their breasts. Yeeeuuucchh!

On the other hand, I was always overjoyed to call report BACK to the ECF. Several times I was greeted with, "but I was told they would be admitted!" Turns out the nurse that sent them to the ER told that to the oncoming shift, not the Dr.! We do have one ECF in our area that is fabulous, and like Shygirl's has a 2 year waiting list. A person could die, waiting to get decent care!

[RainbowSkye]

I know. I wonder what the answer to this is. I know the nursing home staff are overworked and underpaid, but.... A couple of weeks ago I had a gentleman come to our ER from the local long term facility. I was told in report (these nurses always do call, well almost always) that he had cut his hand during a visit to the doc earlier that day. Come to find out this nurse call 911 for a wound she had never looked at (the folks who transported him to the doc's office bandaged him). The laceration turns out to be an itty-bitty skin tear. Now there's no way to get him back to "the home". Which is okay because the man is febrile, stinks to high heaven of nasty urine (which turns out to be solid green when I cath him). So he gets admitted for uroseptis. Makes us nurses look bad.
Do any of you nurses who work in long term care have any suggestions?

[JE1RN]

I WORK IN THE ER BUT IF THAT WAS THE CASE I WOULD HAVE NO PROBLEM CALLING THE HEALTH PROXY AND THE STATE HEALTH DEPT.AS FAR AS THE USE UF UNDER PAID AND OVERWORKED THAT GOES FOR ALL OF US

[Coldfoot]

...they are just as helpful to the Medics when they pick'm up at the Home. Try to be understanding when the Medics can't answer those silly questions like "How long has he been like this?" or "If this is confussed then what is baseline?" Just gotta throw out a couple experiances.......IM D50.......Call for ALOC, arrive to find a HUGE PULSATING MASS IN THE ABD with bp of 80/60....... IV Start for dehydration sec. to overdose on Lasix..... Gotta drive you nuts sometimes

[cotjockey]

LOL...We see stuff like this all the time. I work ER and I'm a volunteer paramedic, so I tend to catch it from both ends. I just love it when we show up at the NH and the nurses yell at us for opening up the transfer packet..."That's confidential....that's for the ER, not for you!" Well, if you want this lady to get into my truck, you'd better give me a little history. We have one NH that sends us patients for enemas all the time. The best (worst) was when I was in paramedic school. Picked up a lady at the NH for "severe respiratory distress." We show up and the lady is there in bed, flat on her back, and mouth breathing - her tounge was STUCK (tight) to the roof of her mouth. Her sat was 76% and her resps soundsed like STRIDOR! My preceptor rolled up the HOB, I did a little oral care with those little pink sponges and got her tongue loose...and what do you know? Her sat came up to 99% on room air and her "stridor" went away.

[Indiana ED RN]

[quote]Originally posted by traumarns
BUT ALAS, no phone number, address, or name of the ltcf on the face sheet. just the pts information, diagnosis, religion, core status....


Hello All

I must agree with the above comment... but I find something even more amazing. The many times I have had a patient come in that is altered and the paperwork states he is DNR. Fine and Dandy if the patient could tell me his name....because there is not an armband to be seen. My newest trick for this is to have someone come from the nursing home to verify who the patient is and have them place an armband on their patient!

Me

[Kayzee]

Been reading your posts, and hope you realize that there are good LTC facilities. I work at one, and these people get the best of care. I realize there are many bad ones out there, and I wish something could be done to close them. I'm shocked at some of the care and conditions of these facilities. When we send out a resident, info is definetly sent with. Too many of our fragile elderly are not monitored or given the care they desrve.

[tatianamik]

Originally posted by teeituptom
I will never understand nursing homes or nursing home nurses.

I had one refuse report on a patient that we were returning. NH stated mental status changes (told paramedics that they had arrainged a direct admit to the psych floor as she had a psych history, but that was not done). All our Doc could find was a UTI. They refused to accept the patient back. We went so far as to call the administrator of the nursing home at thier house at 3am. The administrator refused to accept the patient back. Licenseing board was getting a phone call the next morning...