Sending Patients to the Hospital

KyPinkRN · Jan 8, 2008

The most critical assessment skill in LTC appears to be responding to either a patient on the floor or a patient feeling sick.
I sure would love feedback from experience LPN nurses to help in making that type of assessment.
Please explain 'don't pick up the patient off the floor' and at the same time time 'send them out if they can't bear weight'.
What do you say when the EMT says "their strip is syncope want us to still take them", and then the pt is admitted. Well you can't say anything I guess because the EMT is long gone but who made them so smart?
Oh, and who does the med pass when you are photocopying medsheets to go with the patient????
AAAARRRRgghhh!! One more patient on the floor and I am going to send myself out!!!!!!!!

As an EMT and new grad nurse, I say moving a patient off the floor, and asking them if they can bear weight is a judgment call... leaving a patient on the floor is a precaution taken in case there are spinal injuries. I have lots of experience with LTC patients as I worked for a private ambulance service for seven years. Moving a patient who has fallen is not without risks, but you must consider how they fell (were they standing, sitting, lots of variables there.) I will say that there are EMTs who don't respect the position you are in as an LTC nurse, that's not me but there are those kind out there. Just know that you know your patients far better than the EMT's ever will as you are with them 40+ hours per week and they maybe see the patient for 10 min. before transporting them. Some will judge you based on that. Have confidence that your assessment is correct and don't back down to them. Hope this helps you. :up:

jerenemarie · Jan 9, 2008

I'm an RN with over 20 years of LTC experience and I still run into issues with bossy/overbearing EMT's! I will remind them that the nurse is still in charge of the resident until they are out of the building. I had one resident in a severe hypoglycemic episode; another nurse had called 911 and then called me down for assistance. I was just about to administer IM glucagon when the EMT's arrived & they threw a fit as they didn't have an order to give it...I informed her I had an order per our s/o's went ahead & gave it anyway; the resident was beginning to come out of this episode as they were wheeling her of the facility. As far as photocopying records, I have one of the nursing assistants do that as I want to stay with the resident until the ambulance arrives. Hope this helps answer your questions! :paw:

CoffeeRTC, BSN, RN · Jan 9, 2008

When multiple situations arise at the same time (you know...full moon) and you and have one other nurse and 3 cnas for 50 pts....A, B, C are your first line of assessment. Then look at the pts LOC, are they bleeding, any obvious signs of trauma? What is the resident's history ....have they just been in for a hip or knee repair or fractures? Did they hit thier head?

I have never practiced as an EMT, but took it as an elective in my BSN studies and passed the tests (I wish I did use it) The training and focused assessments that we were taught are excelent. Do a visual assessment and then an hands on...check ROM on all joints while they are on the ground. Any complaints of pain or deformities or trauma....they be staying on the ground. It is a judgment call, just try to use your best judgement and it never hurts to be safe than sorry.

As far as the paper work......What comes first? Pt safety and well being. We try to help each other out or if able to have a CNA run and copy the basics. All hospitals have a fax, sometimes when things die down and the pts are transported...I will fax them. This should never be inplace of a good verbal report to the ER triage.

CoffeeRTC, BSN, RN · Jan 9, 2008

Yeah...as far as the meds. Guess what? They are gonna be late.

smith1313 · Jan 9, 2008

We got a great team where I work. If the other nurse knows I"m sending she will either help me in the room and/or copy. Usually within 15 minutes the EMT's are here and gone.

I had a full-code pancreatic CA w/mets, the EMT's were not wanting to take him d/t LOC incident. I kept stating he IS A FULL-CODE.

lpn1313 · Jan 9, 2008

If someone falls at my facility, both the lpn and rn assess before moving resident. If they have no s/s of injury, up they go. If then they c/o pain unable to wt. bear, out they go. If they hit their head, out they go-full code or not.

If ems starts to give me a hard time about sending a resident, I tell them "Dr. X wants them sent, would you like to talk to him about it?" That usually gets them rolling out the door.

*Pepper* · Jan 13, 2008

Thanks everyone for the useful advice. I am implementing many of your suggestions! My residents thank you.

sharlynn · Jan 16, 2008

We got a great team where I work......
I had a full-code pancreatic CA w/mets, the EMT's were not wanting to take him d/t LOC incident. I kept stating he IS A FULL-CODE.

Where is your social worker? Why on earth would she not get A DNR on a pancreatic CA with mets?

TheCommuter, BSN, RN · Jan 16, 2008

Where is your social worker? Why on earth would she not get A DNR on a pancreatic CA with mets?

This is probably because a very unrealistic family member, usually a POA, has the silly desire to keep the terminally ill patient on full code status. Some family members don't ever want to let go of their loved ones, even when the chances of a successful patient outcome are nonexistent.

marjoriemac, LPN · Jan 17, 2008

I agree with us knowing our patients best and it is out judgement whether to move a resident or not however I am often puzzled at just how long a resident with a suspected broken hip is expected to lie on the floor before an ambulance arrives. Several times, I have been told by the ambulance service, 'it will be there within 2 hours because you are a nursing facility'. Yeah but we don't have a medic at hand to prescribe high strength analgesia and we certainly don't have heated floors!!!

I agree with most, get a c/a to copy the paperwork, if they get stuck, they can come ask.