Discharged - RN doubts

84RN · Mar 13, 2012

What do you do when you have a patient who is being discharged to home, lives alone and it is just kind of obvious that patient should NOT be living alone anymore or at least for a while due to mobility issues and two falls in the last two months? Family was on scene, involved and concerned but not able to provide the needed assistance and not yet there yet in terms of accepting this person probably needs more help than they are getting and probably on a permanent basis. The patient could barely move from the wheelchair to the car. I just had a bad bad feeling about sending this person home. Is this something I just have to get used to or was there something that should have been done? Who makes that call and who talks to the family about it?
Postscript: I am a new grad and working with a preceptor. Just had my sixth shift on the floor.

The discharging physician may not be aware of the patient's home situation, and lack of caregiver support. In this case, I'd give the dr a call and explain your concerns, and ask if the patient could get a Home Health referral. Home Health agencies have RNs, PTs, OTs, HH Aides, and MSWs on staff, and it sounds like this patient could use all of the services, and would meet the homebound requirement.

During the course of the HH episode, the family support would be explored and those needs addressed.

TerpGal02, ASN · Mar 13, 2012

This is frustrating. Reminds me of the situation with my uncle. He has epilepsy and congenital right sided hemiparesis that has just worsened with age. Now his left arm is not working so well-brachial plexus injury from a fall. He falls......A LOT. He came to live with my parents in '08 after a pneumonia that landed him in ICU. About a year after that my parents bought another house and moved out. My uncle is still in the house where I grew up with 2 of my adult brothers. However, one is basically living with his girlfriend now and is never around and the other is a 22 year old college student.....and well he's not around much either. My mom looks in on him once a day usually, but its not enough. I was going over there to look in on him, but I got so frustrated with the whole situation I just can't do it anymore. My uncle needs a MUCH higher level of care. Probably needs to go to assisted living or at the VERY least a home health aide but my dad does not want to talk about it. One of our last conversations ended with him hanging up the phone on me after I told him for the billionth time that I am not a doctor, nor a miracle worker and he needs more help in that house.

GitanoRN, BSN, MSN, RN · Mar 13, 2012

undoubtedly, this is a difficult task to follow through when deep within your mind you're aware that the pt. who has been d/c don't have the means to defend from themselves. having said that, even when you have contacted the social worker to assist in the case, and made the doctor aware of the pt.'s situation plus educated the family if...there's a family...there's a voice within you that realizes that the pt. won't be getting the quality of care; that they need in order to survive. however, one needs to remember that we can only do so much in order to assist our patients when they are d/c from a facility. consequently, this is just the tip of the iceberg, as the "baby boomers" generation grows older we will face more challenges regarding this subject. needless to say, it is a frustrating dilemma that we as nurses will have to endure sooner or later, with some of our future patients.

Creamsoda, ASN, RN · Mar 13, 2012

Was there a discharge planner involved? They are key to a successful discharge.We don't think of these things a lot of times while they are inpatient and thats why its super important for the d/c planners / case managers to be involved early on.

NBMom1225 · Mar 13, 2012

If there is no on-call case manager or SW on the weekends, we usually call the ones that are down in the ED for assistance, they always have someone there.

nurseprnRN, BSN, RN · Mar 13, 2012

i forgot to mention earlier-- insurance, including medicare, often refuses to pay for a readmission for the same diagnosis within 30 days, on the assumption that the condition wasn't cured, or the patient was given inadequate resources for managing it, or discharge was premature. if this poor lady bounces back, that will cost your institution more than having a case manager on call or in the house on weekends. you might point this out when you make your report on this situation to the hospital risk manager, because risk management also looks at financial risk as well as risk of lawsuit, and s/he will be interested.