Rudeness from EMTs and Paramedics

longhornfan1 · Dec 31, 2007

Pt is DNR but A/O on Tube Feed. Usually absent family in for holiday, wants to DC Feed. Pt on Hospice, but expresses desire to live. Family has POA. What now

morte, LPN, LVN · Dec 31, 2007

Pt is DNR but A/O on Tube Feed. Usually absent family in for holiday, wants to DC Feed. Pt on Hospice, but expresses desire to live. Family has POA. What now

POA only comes into play when patient UNABLE to make decisions (sp)

perhaps a social worker is needed? and a new POA?:angryfire

flightnurse2b, LPN · Dec 31, 2007

Hospitals and EMTs don't have to make sure the paperwork is completed when they are coding someone to my knowledge.

just an FYI, hospitals, no matter what dept, as well as EMS, have a paperwork to do when someone codes. theres an arrest log sheet with rhythm strips, code log with meds, compressions, defibs, etc., theres a respiratory sheet with hypnotics admin and who intubated/when..... and of course notes. LTC nurses arent the only people who have paperwork to do when someone codes.

steven1534 · Dec 31, 2007

This will also show how EMS and In-Hospital Care differs - in that situation, if I am requested as the Paramedic to come to assist the patient in a medical emergency, if the family has a POA but no state DNR, I can not acknowledge it. Now if they do have a DNR but the patient is lucid and requests assistance, well then I would consider the DNR rescinded and would be under a legal obligation to treat and transport...and anyone who interferes could be subject some bad times afterwards.

I'm not going to get into a fight over it and would rather talk it out...but I'm not going to "abandon" a person requesting help.

longhornfan1 · Dec 31, 2007

Pt has no advocate in this situation. Spoke at length with primary MD and even he was hesitant to write order. Was told by Hospice and family that if he wouldn't write the order that the Hospice Med Director would do it. An MD who hadn't even seen the pt. Understand the difficult decision, but why not stop treatment in Sept when pt had Pneumonia, and septicemia instead of revoking the DNR and insisting we send her to ED. She was there for 2 months improving to her baseline state and now that she is better and cognitave they want her to suffer through malnutrition and dehydration!!! Have called the state ombudsman to get a neutral opinion and evaluation of pt's current mental status.

withasmilelpn · Dec 31, 2007

just an FYI, hospitals, no matter what dept, as well as EMS, have a paperwork to do when someone codes. theres an arrest log sheet with rhythm strips, code log with meds, compressions, defibs, etc., theres a respiratory sheet with hypnotics admin and who intubated/when..... and of course notes. LTC nurses arent the only people who have paperwork to do when someone codes.

I wasn't referring to charting what takes place, we do that too. The transfer sheet needs to be filled out, the face sheet gets 2 copies made, one for the ambulance, one for the hospital. Then copies are made of the history and physical, complete diagnosis sheet, immunizations, Power of Attorney and Living will (sometimes 20 pages!) Physician orders and medication administration sheets, recent nurses notes and labs and studies. The doctor has to be called, family needs to be notified and report given to the hospital ER. All of this hopefully needs to take place simultaneously. If I am making copies I try to get the info the nurses need in order to take care of the patient done first. Copying the chart to put it in the EMTs hands can take some time and that is what doesn't have to take place in the hospital or on site.

As far as charting goes, we have document that we did all the above in addition to what when and why. We have Emergant care sheet that we have to fill out in order to prove we did everything feasible for the patient before we sent them out (proof to the bean counters of why that bed is now empty, and they still will question it), and a verbal order from the MD is done that we could send them.

If they are admitted, you must document the reason why and count, document and return all the meds(which can be 100s), notify all depts by filling out another sheet and make copies to place in each of the 15 bins for them, also fax said sheet to the pharmacy to notify them There is also a lovely 'Recapitulation of Stay' sheet that needs to be filled out summarizing their stay and what was all involved in their care, that is repetitive and vague and annoyingly time consuming! All of these actions must be documented as well in the nurses notes, it is endless. So any nurse that wants to 'dump' her patient on a hospital like another poster stated, is in my opinion, crazy! (Got to remember I still have my 20+ -or 30 on the LTC floor, other patients to take care of in the midst of this madness.)

flashpoint · Jan 1, 2008

I wasn't referring to charting what takes place, we do that too. The transfer sheet needs to be filled out, the face sheet gets 2 copies made, one for the ambulance, one for the hospital. Then copies are made of the history and physical, complete diagnosis sheet, immunizations, Power of Attorney and Living will (sometimes 20 pages!) Physician orders and medication administration sheets, recent nurses notes and labs and studies. The doctor has to be called, family needs to be notified and report given to the hospital ER. All of this hopefully needs to take place simultaneously. If I am making copies I try to get the info the nurses need in order to take care of the patient done first. Copying the chart to put it in the EMTs hands can take some time and that is what doesn't have to take place in the hospital or on site.

We keep a transfer packet in each chart...it is just a bunch of important papers stuck in one of those plastic sheet protectors. It contains two copies of the face sheet that lists the resident's name, DOB, SSN, contact information, doctor, dentist, mortuary, pharmacy, etc, allergies, diagnosis list, code status, insurance information, etc...I can't remember what else. It has two copies of the CPR / No CPR form and one copy of POA, POA-H, living will, guardianship papers and things like that. The face sheet is updated every 60 days after their 60 day review and as needed and the other information is updated as needed. So...usually the only thing that needs copied is the MAR and TAR. The transfer sheet needs filled out, but can be faxed later if we call a good report to the ER and the doctor. Sometimes we get lucky and the doctor is in the ER, so they will just put us on speaker phone and everyone gets the same report all at once. Sometimes it is a pain to put the transfer packets together, but it saves a ton of time when things go belly up. If a resident transfers out, we make a new packet as soon as they return.

steven1534 · Jan 1, 2008

We keep a transfer packet in each chart...it is just a bunch of important papers stuck in one of those plastic sheet protectors. It contains two copies of the face sheet that lists the resident's name, DOB, SSN, contact information, doctor, dentist, mortuary, pharmacy, etc, allergies, diagnosis list, code status, insurance information, etc...I can't remember what else. It has two copies of the CPR / No CPR form and one copy of POA, POA-H, living will, guardianship papers and things like that. The face sheet is updated every 60 days after their 60 day review and as needed and the other information is updated as needed. So...usually the only thing that needs copied is the MAR and TAR. The transfer sheet needs filled out, but can be faxed later if we call a good report to the ER and the doctor. Sometimes we get lucky and the doctor is in the ER, so they will just put us on speaker phone and everyone gets the same report all at once. Sometimes it is a pain to put the transfer packets together, but it saves a ton of time when things go belly up. If a resident transfers out, we make a new packet as soon as they return.

Just Remember, not all facilities are as with it as you may be (been to them....say their name on the watch list for abusing patients).

Keeping stuff ready so it flows smoothly takes pro-active healthcare providers and there are a bunch in all fields of healthcare who just aren't. (I'm hopefully not talking about anyone here!!!)

facetiousgoddess · Jan 1, 2008

I'm glad all the EMT/Paramedics contributed to this thread......Now that being said....Who wants to take a crazy redhead on a "ride along" for one shift?? I'm fascinated by what ya'll must encounter in a shift.

Tres

steven1534 · Jan 1, 2008

I'm glad all the EMT/Paramedics contributed to this thread......Now that being said....Who wants to take a crazy redhead on a "ride along" for one shift?? I'm fascinated by what ya'll must encounter in a shift.
Tres

I would love to...you need proof of completing Blood Borne Pathogens training within the last year, fill out a few pages of paperwork, submit and get approval...etc.

Plus I'm in Maryland, where are you? Oh, and we tend to be kind of slow as I am in a rural system....

Medic04 · Jan 1, 2008

I know MOST major cities and smaller ones have "ride a long" programs. I know the Military sometimes sends RNs out with the rigs to get a idea, plus MANY hospitals are starting to do this also so RNs understand more the levels of training and howthings work in the OUTSIDE world as compared to the inside.

I think it is a real good learning tool for many RNs( the thought of carrying a 350-400 lb pt down 2 flights of stairs and all the equipment to go with it), to see it is not all driving and picking someone "up" and how some LTCF are great and some just SUCK and the dread going to that place knowing what you will get and I am not talking pt I am talking about the staff that works there.

Many ideas and attitudes have changed after say a 3 day ride a long, and both parties have learned from it, and many times for the better of BOTH healthcare worlds.

withasmilelpn · Jan 1, 2008

Just Remember, not all facilities are as with it as you may be (been to them....say their name on the watch list for abusing patients).
Keeping stuff ready so it flows smoothly takes pro-active healthcare providers and there are a bunch in all fields of healthcare who just aren't. (I'm hopefully not talking about anyone here!!!)

I've worked places that do this, and it's great, but they staff the place I work so bare, its difficult to see how it would get done here, we struggle to complete the necessities often times, and the corporation seems to delight in loading us down with redundant paperwork. I work weekends, and since they phased out our resp therapists, no one has been in charge of making sure our crash carts are stocked. So now I check and restock and have even placed a sign to please restock when used (dated it as well), thats my contribution to being proactive I guess, but I do wish as a whole our facility will be proactive as well!