Does your LTC get mad when you send patients do the ER? - page 2

by Blackcat99 3,257 Views | 16 Comments

At the nursing meetings, we are told to always try to keep the skilled care medicare patient at the LTC by suggesting to the doctor that he order lab work, antibiotics etc etc etc instead of sending the patient to the ER. I don't... Read More


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    Yeah, pretty much. We have to call at the very least and get approval and I have had what you described, a very unstable patient who had family staying the entire time and I was called frequently into the room assessing and discussing care. I got nothing done and my entire shift was run around that one resident. I also wonder why I am getting these types of people admitted to our facility, we are not staffed for that type of care, but it has become frequent. I stayed after on my own time to do some charting the other day and discoverd that none of the Q shift charting or Careplans had been charted on in 2 days and I have no doubt that it was due to the new admits we had who kept us very busy. I ultimatly ended up sending that resident back to hospital but I got a lot of resistance and was told by Nurses who had been there longer, they are always hesitant to send anyone out.
    Blackcat99 likes this.
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    One thing that always confuses me in these discussions is when we say we send the resident out, as if it were our decision.

    The nurse calls the doctor, gives him their assessment data, and the doctor decides whether to ship out or treat in place.

    How can anyone be mad at nurses for the decision to send someone to the ER?
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    Quote from BrandonLPN
    One thing that always confuses me in these discussions is when we say we send the resident out, as if it were our decision.

    The nurse calls the doctor, gives him their assessment data, and the doctor decides whether to ship out or treat in place.

    How can anyone be mad at nurses for the decision to send someone to the ER?
    Just as a general response, there are plenty of situations where "we" can and *should* send out a resident without waiting for the doctor to return a phone call (at least on an 11-7 shift, this is often the case) (some ex: acute decrease in LOC, respiratory distress, suspected CVA, chest pain) I assume you didn't mean any "emergencies" when you state that the doctor decides? At the end of the day, patient care is #1, but you cannot provide any patient care if your license is revoked!
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    Right, I didn't mean emergencies.
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    I would see nothing wrong with suggesting to a doc "well you know we can XYZ here" such as "you know dr. we can do IV antibiotics here if that is what you want." But if you're doing it out of pure financial motive that is terrible.
    Blackcat99 likes this.
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    I have experienced this unfortunate situation all too often in my short time as a nurse in LTC. Docs appear to believe that LTC facilities have the same resources as a hospital...on-site labs and pharmacies, access to necessary equipment, etc. Unfortunately, that is not reality. "Stat" labs can take hours, and essential equipment can be impossible to procure. With this in mind, I will transfer a patient to the ER in a heartbeat if I believe they will receive better care there than I am able to provide at my facility. Reimbursement worries are the problem of administration, patient worries are mine. I may get in trouble, but if the patient receives what they need, that is what matters.
    Blackcat99 likes this.
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    Company money situations should not figure into the nursing care we provide for our patients. I would and have in the past while working LTC, let these types of management edicts go in one ear and out the other. Do not be bullied by administrators. They are looking at the financial bottom line, you are looking at the patient. Provide the most appropriate, competent care to your patients. Think of it this way; if something happens do you want to say to the DON or the BON you did the best you could in your judgement for a patient by sending them to the hospital, or would you rather say that you were trying to save the facility some money by keeping a patient in-house against your clinical judgement?
    It is not unethical though to suggest to the Dr. that the patient be treated at your facility IF the patient's clinical status warrants AND the Dr. is informed about how long it may take for Xray, labs, etc.
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