The correct way to send a patient out to the hospital...

Nurses General Nursing

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just for clarification. regarding LTC facilities. ok, lets say you have a patient having SOB you check the O2 sat. and it's 84% you give 2 liters of o2 via NC and it's about 86% now, pt. is a code, patient is a&o X3 how would you go about sending this patient out? would you first get an order from the MD first to send the patient out, or do you use your nursing judgement and send out patient then call the doctor after the ambulance picks him up? do you call 911 at all? curious to see your answers.

Specializes in Peds, Hospice, Home Health, Dementia.

Sorry about my HORRIBLE typing!

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first situation needed 02 and breathing treatments and if that didnt get the pulse ox over 90 then i would have placed that patient on a non rebreather and then called 911 if the patient is symptomatic(obviously would have already placed a call out to the doctor)

whenever a patients O2 drops and just by giving some o2 via nc .....always is a non reabreather at 15 liters of o2 that will perk up the o2sat real quick, but its a quick fix..... also if hes COPD then all of this is null and void, just call md cause he is probably on the 02 low side anyway

for pain management no way!!! never 911! always call doctor in LTC there is dilaudid and all that good stuff unless the pain brings on other symptoms i would never call 911 FOR PAIN!!!!

just my judgement hope it helps goodluck!!!

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If I am the patient, how's about more than 2L of O2, please and thank you. :rolleyes:

NO! If the patient has certain medical conditions the oxygen should never be above 2.0 lpm because of acid base imbalance. Poor nursing judgement and possibly dangerous. Know the diagnoses first!

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Specializes in CCT.
NO! If the patient has certain medical conditions the oxygen should never be above 2.0 lpm because of acid base imbalance. Poor nursing judgement and possibly dangerous. Know the diagnoses first!

Considering that oxygen has very, very, very little to do with acid base, I would say THIS is poor nursing judgement.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
whenever a patients O2 drops and just by giving some o2 via nc .....always is a non reabreather at 15 liters of o2 that will perk up the o2sat real quick, but its a quick fix.....
The OP works in LTC.

I've worked in many LTC facilities, and not one of them has ever had a nonrebreather in stock. LTC is the land of nasal prongs. If I'm lucky, I might be able to find a venturi mask.

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I finally got them to order non rebreather masks for us. (we have so many more acute pts that are full codes now and how silly would it be to have just NC?)

Anymoo...are you a newer nurse? These are all great questions to review with a preceptor or more experienced nurse in your facility.

As far as the initial first question.....What is the big picture? What is else is going on with your resident? Do they have breathing tx ordered? Is this a new problem? HOB up, deep breath and coughing tried? I would titrate it up to more than 2L to start. While you are doing all of this, you or another nurse could be making calls to the family and doc (of course this is if the resident is stable) Are they in distress? Sometimes you will have folks that are long time copdrs with low sats and they look just fine.

As far as the pain question...........Please do not send them out just for this. What other interventions have you tried? Do they have a break thru med like tylenol or motrin you can give along wtih the narc? have you called the doc to get the med increased or changed? Have you done all of the non med interventions for pain?

Another part of the intial question "what do do before sending a patient to the hospital?" (these are all things you should do unless you are 911 red lighting them out)

Get your paper work in order..face sheet, dx list, current H and P, list of meds and tx and note what you gave last, list of labs or xray that are pertinant and your facility prob has a trasfer sheet that has other info about ADLs, last bm, glasses etc. Get the order to transfer, call the family/ POA, call EMS or transport company, and call the ER and give report.

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The OP works in LTC.

I've worked in many LTC facilities, and not one of them has ever had a nonrebreather in stock. LTC is the land of nasal prongs. If I'm lucky, I might be able to find a venturi mask.

Wow, seriously? That's scary. I work on a rehab floor of a LTC and I can't count the number of times I've had to apply 15L via non-rebreather in emergency situations while waiting for EMS to arrive.

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Anytime I've sent a res out with SOB and o2 sats below 90%, the ambulance comes lights and siren, no matter if you call 911 or non emergency. Tha ambulance companies, weather I was working in Detroit or in a small town in the thumb region, consider any o2 sat under 90% as resp distress.

Dee

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Specializes in Critical Care.

Let me address my opinions to COPDers. Yes, some of them may stay at a low o2 sat, as low as maybe 88%. At least in the hospital, the MD will write an order stating what he is okay with. If a COPD has a sat of 84% as mentioned, I would give as much O2 as needed.

To the comments of not turning the O2 above 5 or 6 liters. Would you rather kill your patient from lack of O2? Yes, high flow O2 can cause them to lose their drive to breath. But it isn't an instant thing. Without the O2 they're dead. If they lose the drive to breath, that can be fix much easier then dead.

I've never worked LTC, but I've picked up enough patients from LTC when I worked EMS. Lots of LTC don't have O2 at all unless the patient was currently prescribed it. (Or else they never used it in my years of working EMS). If you have O2 give as much as needed to save the patient's life. If your patient needs high flow O2, and isn't normal for them, then you should probably be calling 911 AFTER you start them on O2. What do you think EMS is going to do for a COPDer? GIVE THEM O2! As much as they need to live.

Where I live, a non-emergency transport was only used for scheduled transports. Things that were scheduled hours or even days in advance. If they had an acute reason to go to the hospital, no matter how minor or severe, it was a 911 transport. When you call 911 and answer the dispatcher's questions, they will prioritize the call appropriately. This sometimes makes the call a non emergency response, but it is still a 911 ambulance coming. They come right then, but without lights and sirens and are allowed a longer response time. They may also easily get diverted to a higher priority call on the way, and another ambulance should then be dispacted to your patient.

And lots of the times, even stupid things are still a lights and sirens response. Headaches being one, since they could be at risk for ICH. But when you call for the patient who has the sniffles for 2 weeks and the MD "just wanted them checked out" then it would be dispatched as non emergency 911.

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I encounter this scenerio often in LTC.First I would try all nursing interventions to bring up O2 (raise HOB,increase O2 per protocol,any ordered Nebs,etc) If the patient is still a/o and in no acute distress (using accessory muscles to breath) I would call the doc in case there is something else they may suggest. If theyre quickly declining call 911 first. Using nonemergency transport should be reserved for like a broken finger not SOB.If theyre not getting enough oxygen thats an emergency and 911 is appropriate.

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One more thing to add...If you are an LPN and have the charge nurse or supervisor in house and availble...use them. Give them a call and have them come and assess.

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Specializes in LTC.
just for clarification. ok, lets say you have a patient having SOB you check the O2 sat. and it's 84% you give 2 liters of o2 via NC and it's about 86% now, pt. is a code, patient is a&o X3 how would you go about sending this patient out? would you first get an order from the MD first to send the patient out, or do you use your nursing judgement and send out patient then call the doctor after the ambulance picks him up? do you call 911 at all? curious to see your answers.

Continue nursing interventions; raise HOB, have pt lean forward on the arms, calm deep breaths

Phone MD for further instruction/orders, remind MD pt is a code, on that alone I try for a 'send to ER to eval and treat as indicated' because a resp distress code can be avoided. When in doubt, send them out- they are a code for a reason. Labs & X-ray can be done in house, but even a stat order is a wait in which that pt could crash on you.

The a & o x3 would prompt me to call AMR (non emergent) transport.

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