Keep my patients out of the hospital!

It seems as though all of my patients are winding up in the hospital! I'm newer to home health, it's been about 5 months; I've been a nurse for over 4 years. I am case managing under supervision.

In the past two weeks, I've had one stroke recurrence, one perforated diverticulum (ok that wasn't anything I could have stopped and I caught it during a visit and called EMS appropriately), one CHF'er relapse, and one COPD'er just went back in, too. The CHF and COPD patients, for each one I was getting this feeling that all was not right, they were each just a little more tired, just a little decrease in appetite, no huge changes in vitals or general assessment. Just a feeling. For each of those patients I called the PCP during the last time I visited hoping for some orders, but I didn't know how to say, "Hey, this lady/gentleman just doesn't look so hot."

I am reminded of Charlie Brown in the Christmas special when he says, "Everything I touch gets ruined."

What is a good way to get the message to a phone nurse and from there to a PCP that you don't have a whole lot of change in your assessment other than increased fatigue and decreased appetite and you just have That Feeling that All Is Not Right?

Maybe I just need to accept that end stage CHF and COPD patients will visit the hospital?