I got a call from the answering service tonight from a pt, "needs help with dressing changes for wounds." When I got the name, it didn't sound familiar.
I called the pt, it is 7:10pm here, she reports that she has been going to phila to a wound center for wound care, twice a week, and she is now wearing an una boot, which was put on Wednesday, and they are usually changed q 4 days, but she has a lot of drainage and a lot of pain with it, and she needs someone to come over and help her to change the dressing. She has no una boot supplies in the home, but she has other dressings we could make do with, she is just not able to do it herself.
I confirmed that she was not currently a pt, but has been in the past. She then repeats that she just needs someone to come over and change the dressings. NOW? I ask...nicely. Yes, she says. Now she told me in her first breath where she lived, and it is VERY close to my house. I asked if she had any relatives or family members who could assist her, she says no, but she did continuously refer to "we" in the course of conversation, maybe she meant her and her doctor? Anyway, I explained that I needed a doctor's order to start any care on her, because a nurse in NJ cannot practice w/o a MD rx. I also explained that we do not carry una boot supplies in stock, that usually pt's are sent home with supplies, and then we place a refill order from a med supply company. She was very sweet, and said she understood, etc.. I went inot a mini assessment, foot is slightly edemetous, but no more than usual, yes she keeps it elevated, foot is warm, no discoloration or change in appearance of foot. I asked why she is going all the way to Phila for care and asked is she had been to the wound care center in our town, she said the vascular surgeons and dermatolgists caring for her felt they could go no further with her care , so they referred her out there. (Do they realize how hard it is for these elderly folks??!!) Anyway, I asked her to clarify her pain, saying I was concerned, but she assured me that she has had the pain for quite some time, and she has been using percocet for it, so the pain was not new. All in all, it did not sound life-threatening enough to send her to the ER. Though I offered this as the most likely option if she felt the dressing had to come off tonight. She said she really didn't want to wait around in the ER for hours, d/t the pain, and I empathize, I do, but again I explianed I wished I could help her, but legally, blah blah blah. To make matters worse, she has a managed care plan so we need auth, and that is tough to get on the WE, let alone at 7pm!! She said she would call her doctor tonight, and I offered to have him call me tonight or in the am. Teachnicaly I am not supposed to call for the auth, looks self-serving for the agency, the referring party should obtain auth, ie the hospital or MD office, etc... I know for a fact we are the only HH agency which could accept this insur policy in our area, so if we can't help her tonight, no one can.
I feel like a $hit for not hopping over there to help her. I am so close, and I could
go as a "friend" , but frankly, I have been burned by that in this same situation before. If it was a personal friend of mine, or did not come through the agency, I would go in a heartbeat, but, in this circumstance, I don't feel I can. Not only that, but I get calls from pt's like this, send out a nurse, and I can't tell you how many times someone has sworn there is no one to help them, only to find when we arrive, there are six people living in the home, most of them in the room with the nurse. Even though the lady was very sweet, I feel like 1) Why the he!! did this Phila doctor send her all the way home, knowing she "was alone" and not refer to HH? 2) Why did she wait til 7pm to call us if she knows the dressing needs to be changed on Sunday anyway?? Of course I didn't go there with the woman, b/c she really wasn't the one who should have thought of all these details, so made me wonder how does she get to Phila w/o help? Someone must be available to her, I KNOW her insurance co would not pay for transportation like that, trust me.
This is one of those times I hate to be in the decision-maker's seat. I feel so guilty, even though our agency has no obligation to this woman at this point. If you were me, what would you have done??