Please explain this nonsense to me! - page 2

One of my residents fell out of the hoyer 3+ weeks ago. Didn't hit her head, but smacked her back on the leg of the lift. Nurse calls MD to send her to the ER, because she's SCREAMING in pain. No... Read More

  1. by   michelle95
    Is it NOT legal to go on and send the patient to the ER anyway? That's what I would do. It's better to be safe than sorry. I would much rather have that doc ripping me one for writing an order in his name than to have a patient that is suffering because he won't attend to them.

    I dunno.

    I knew of a facility that had a similar incident in which a resident fell, and no one thought anything was broken, but the next day she was complaining of severe pain. An x-ray was taken and it turned out that she actually suffered a broken hip. I believe the facility was cited by the state for neglect.
    See, I'm confused by this. If the resident was denying pain and there were no suspicions of anything broken, how is it neglect if they didn't send her out for an x-ray that night? I could see if they didn't send her out the next day when she started to c/o pain.

    There are flip sides to every issue. If there is no reason to send them, then don't for that would be a waste of money. However, if there is a reason...you can darn well bet that I will send them with or without the doctor's approval. What if someone was having a massive stroke or heart attack and you couldn't get a hold of a doctor? To me, it would be neglect as a nurse if you didn't send them.

    This is a bad situation for that resident. I feel for her and hope that some of the nurses taking care of her will grow backbones.
    Last edit by michelle95 on Mar 6, '05
  2. by   Schmoo1022
    This makes me extremely MAD and SAD. What happened to pain being the 5 V/S and pain being whatever the patients states it is. That DR. is an @$$!! If any patient of mine was screaming in pain everytime she was moved..I'd be getting an order for an X-ray wether she had a fall or not! Something isn't right. Even just to rule out a break and cover my butt. I guess I am very lucky that my Medical Director (who also has the majority of patients at my facility) Is very easy to get orders from..as long as their is justification. He has a lot of trust in us, which is extremely nice!

    You sound like a really great CNA....and believe me you know more than you give yourself credit for!
  3. by   LadyMadonna
    What does the DON have to say about this?
  4. by   CoffeeRTC
    Quote from LadyMadonna
    What does the DON have to say about this?

    Exactly!! There are atleast 2-3 nurses that have taken care of this resident every day...What are they doing for her? This is very neglectfull! This should have been written up as and incident (with medical equiptment) and reviewed by the ID TEam. The medical director and DON normally has to sign off on these and there should always be a review of the incident for causative factors, resident out come and prevention of further accidents.
    As a nurse I would push for the Xray and tell the family this is in their best interest to get it done. We would have the xray done in our facility....lots of times the family doesn't want to send them to the ER An accident like this would warrent a call to the state. This is a reportable incident and should be investigated so accidents like this don't happen again.
  5. by   kat911
    Do you have Adult Protective Services in your state? That is another option. they can require a medical screening.
  6. by   weetziebat
    Quote from lovingtheunloved
    the thing is, her son/poa says he's going by what the doctor says. can something still be done in spite of him? it breaks my heart to see her in that much pain and there's not a darn thing i can do about it.
    well, perhaps the son/poa either doesn't really care, or he places far too much trust in that doc. and the nurses are working under their own licenses, so they are responsible for the patient's well-being. that means much more than taking what the doc says as gospel truth. if the patient has a broken hip (for example) the nurse is responsible for not seeing to it that the patient received proper care. if the doc said 'give 'em arsenic' would the nurse do it?
    if you get nowhere with discussing this with the nurse, i'd report it to the mandatory abuse hotline. you can do that anonymously.
  7. by   webblarsk
    Quote from Dixiecup
    In a LTC setting, it is legal for the administrator to go above the MD's head and send the pt to the ER. Also, if the Pt's doctor is not the facility medical director, the medical director can also overide the pt primary physician.
    I agree. I know at the facility I worked in there was a medical director. And there was a instance when the medical director had to be contacted regarding a patient. Good luck to you. Thanks for being a advocate for the patient. Keep us posted.
  8. by   lovingtheunloved
    Quote from LadyMadonna
    What does the DON have to say about this?
    I have no idea. He's a nice guy, but he's worthless as an administrator. This is baffling to me. My facility is one of the best in the state, this is SOOO not something that usually happens. The nurses on my unit are excellent nurses, and I have a great deal of respect for them. So I'm appalled. Someboy better have some satisfactory answers tomorrow. If the nurses won't "grow a backbone" as others have said, then I will. I hate to think that I'd have to report my facility, because I love it, but my number one responsibility is to my resident, and I'll do what I have to do. She's 95 years old, and I don't want her to spend whatever time she has left in excruciating pain.
  9. by   ktwlpn
    Quote from lovingtheunloved
    I have no idea. He's a nice guy, but he's worthless as an administrator. This is baffling to me. My facility is one of the best in the state, this is SOOO not something that usually happens. The nurses on my unit are excellent nurses, and I have a great deal of respect for them. So I'm appalled. Someboy better have some satisfactory answers tomorrow. If the nurses won't "grow a backbone" as others have said, then I will. I hate to think that I'd have to report my facility, because I love it, but my number one responsibility is to my resident, and I'll do what I have to do. She's 95 years old, and I don't want her to spend whatever time she has left in excruciating pain.
    I've always liked your screen name by the way......Sometimes you are "loving the UN lovable,aren't you?-it's a tough job but thank goodness there are people like you to do it....My best advice to you---keep quiet tomorrow and observe-if she is still in pain and you know that x-rays have not been obtained place an anonymous call to the obbudsman....Don't call attention to yourself-those residents NEED you---Admin will find a way to boot you fast if they think you placed the call...A call like that has to be followed up on within 48 hours .. We were told by the state last year that PATIENT needs must be considered BEFORE families wishes ....If she is IN PAIN and the nursing staff are documenting it something has to be done...Portable x-rays,heat therapy,pain meds...I can think of several instances in the past 3 yrs that the ombudsman has been called to our facility-by staff..I have had a few cna's come to me about problems they perceived on their units.I have encouraged them to quietly follow through.It clears the air-we all know that sometimes families,docs and the staff get into pizzing contests and an unbiased eye is needed...Usually no fault has been found but everyone is assured that everything is being done for the resident..Good luck and up date us when you can
  10. by   Marie_LPN, RN
    The last LTC i worked at had the policy that if a resident fell or anything like that, they automatically went to the ER.
  11. by   ktwlpn
    Quote from Marie_LPN
    The last LTC i worked at had the policy that if a resident fell or anything like that, they automatically went to the ER.
    yikes-I bet that got expensive.-who paid for transport when medicare and/or private insurance did not? Kind of a slap in the face by the administration,too...They are effectively stating that not one nurse in that facility is capable of performing a complete and accurate physical assessment and calling the doc and reporting the findings....What an insult...I bet the local hospitals were thrilled with that too---when one after another un-injured old lady or gent rolled in...with no apparent injury-just found on the floor....I have a gal that is routinely found on the floor during the night-after the 6th or 7th incident someone finally asked her what she was doing (she is an old schizo) she said she was "praying" and" don't we all do that on our knees,too?"...got to love her......
  12. by   stn2003
    I was wondering as well if an incident report was made and followed up on. If a fracture or injury DID occur and the place of care did not properly investigate it could come back to bite them in a lawsuit big time.

    Also, isn't there a way to circumvent the admitting MD? Maybe call in the House DR when the MD isn't available and see if he could write and order for an X-Ray based on his assessment of her?
  13. by   Nurse Hatchett
    What if the son has POA? Do we legally have the right to over ride his decision? Just a question. There are many things I don't fully understand re: POA of medical and financial. Not that I agree with the decision, I myself would probably send the pt to ER and pay the consequences, at least I could sleep at night, knowing that I did what was best for my pt. Just curious about the whole POA thing, as I said before the whole POA thing is confusing for me.

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