What is right, what is wrong?

  1. I had this pt which was sick and getting sicker through out the end of Jan. and Feb. I sent him out by ems the first time in Jan. He ended up staying in the hospital for five days and when he came back to us they said he had positive stools. OK, but he was sent for his breathing. He came back in worse condition then when he left. The following day I send him to his PCP. The PCP ordered a cxr, which showed he had double pneumonia and was placed on O2 and neb tx and was not readmitted to the hospital but sent back to us (Assisted living facility). :angryfire The next day, I send him back out by EMS for increasing sob, the ems showed sats in the low 80's on 2 ltr (by the way he is a full code). He stayed there another 2 days and sent back in worse shape. They said again GI bleed, but they did not take care of the problem before sending him back. They gave us an appointment for 1 month away for barium and GI work up. :angryfire He then had a hgb of 9.0, and cont to be having problems with his breathing. The third time I sent him out, I called the PCP and told him that his breathing cont to worsen and that I am sending him back to the hospital. This time after day 2, he coded fully, and died. I dont get it? Well then my director said to me that she thought he did not get the proper care in the hospital and that she thought that the PCP was covering something up. She then ask me who to contact in this type of matter with regard to possible malpractice by the PCP. Duh, I didnt have the slightest idea. Any one have suggestions on what I should respond with. I personally believe something wasnt right, but I cant put my finger on it nor do I know what to do next.
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  2. 9 Comments

  3. by   RNPATL
    Quote from mittels
    I had this pt which was sick and getting sicker through out the end of Jan. and Feb. I sent him out by ems the first time in Jan. He ended up staying in the hospital for five days and when he came back to us they said he had positive stools. OK, but he was sent for his breathing. He came back in worse condition then when he left. The following day I send him to his PCP. The PCP ordered a cxr, which showed he had double pneumonia and was placed on O2 and neb tx and was not readmitted to the hospital but sent back to us (Assisted living facility). :angryfire The next day, I send him back out by EMS for increasing sob, the ems showed sats in the low 80's on 2 ltr (by the way he is a full code). He stayed there another 2 days and sent back in worse shape. They said again GI bleed, but they did not take care of the problem before sending him back. They gave us an appointment for 1 month away for barium and GI work up. :angryfire He then had a hgb of 9.0, and cont to be having problems with his breathing. The third time I sent him out, I called the PCP and told him that his breathing cont to worsen and that I am sending him back to the hospital. This time after day 2, he coded fully, and died. I dont get it? Well then my director said to me that she thought he did not get the proper care in the hospital and that she thought that the PCP was covering something up. She then ask me who to contact in this type of matter with regard to possible malpractice by the PCP. Duh, I didnt have the slightest idea. Any one have suggestions on what I should respond with. I personally believe something wasnt right, but I cant put my finger on it nor do I know what to do next.
    This is truly a sad state of affairs with this resident. I would call your local abuse hotline and file a formal report. There are laws that protect elderly people from this type of neglect. I am sure your State has the same protection laws that others States have .... file a formal report for your abuse hotline.
  4. by   mittels
    Quote from RNPATL
    This is truly a sad state of affairs with this resident. I would call your local abuse hotline and file a formal report. There are laws that protect elderly people from this type of neglect. I am sure your State has the same protection laws that others States have .... file a formal report for your abuse hotline.
    What would be my local abuse hot line? Would this be like adult protective services?
  5. by   meownsmile
    The director should have all the information they need to make any and all reports. I dont understand them asking you, since it is part of their job to keep those numbers and information current and usually posted someplace in the facility. I think i would tread lightly here. I dont know all the circumstances, but we all know mud and other yucky substances flow downhill, so be careful how much you say and to whom you say it. Remember as part of this persons care providers, you will also be scrutinized along with anyone else who cared for this patient. Not saying you did anything at all wrong, and it sounds like you did exactly the right thing. Just some food for thought. I think you would send any reports/complaints about the PCP to the state medical board.
  6. by   MEL101
    Yes, a letter of complaint to the medical society is certainly appropriate. Make sure your documentation covers all the specifics....Was this a Medicare bene?
    Could be an abuse case....Sad sad...
  7. by   iiwdn
    You could be my nurse anytime. Good job of fighting for the care of your patient and taking on the system to do it!!
    I think the employer should be responsible for the reporting to the state medical board(granted it will include all your documentation, transfers, etc.) but their direcctor, board or someone should represent the facility not you. Your job is looking out for the best interests of your patients just like your doing!!
  8. by   RNPATL
    Quote from mittels
    What would be my local abuse hot line? Would this be like adult protective services?
    Yes .... where I was from, the abuse hotline was 1-800-96 ABUSE, but you could easily look it up in the phone book or just let your director know that you think the abuse hotline should be called.
  9. by   Rapheal
    As a hospital staff nurse I cannot say if this case was neglect. Please keep in mind that many times we are accused of not properly caring for a patient when in fact we have exhausted ourselves in the effort to do so. I have had patients come in with GI bleeds and sometimes the family refuses to consent to a GI workup or colonoscopy. Or a patient comes in with a dx of GI bleed, exacerbation of COPD, Renal insufficiency, ect, ect, ect, and is basically at the end of their life. I am not saying that this is the case for your patient, but sometimes this happens.

    It sounds possible that this patient may have benefitted more from a skilled nursing home then assisted living. Or does your facility administer meds, and resp tx? He needed his 02 sats monitored and probally needed daily H&H's. Usually they will not transfuse until Hbg is 8 or under. I really hope this was not a case of neglect. Can you ask the PCP for more information?

    I am sorry for your loss.
  10. by   -jt
    <She then ask me who to contact in this type of matter with regard to possible malpractice by the PCP.>

    your State Dept of Health
    Hospital Complaints Unit
    Provide the pt's name, dates of admission and which hospital, and detail your compliant. They will investigate his charts and the care he received (or didnt receive) during each admission.
  11. by   SnowymtnRN
    I agree. If she suspects neglect or something of the sort, SHE needs to follow thru with the paperwork. I'm assuming you had documented all that happened, your documentation is there, that's all she should require. Honestly there's nothing more YOU can do. You were the caregiver at the time, and you did your job. The rest is up to her. Sounds like she's passing the buck to me.

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