Today I made the longest visit in my VNA history, and I hope to never have to do it again!
Bedbound man with new trach new peg w/ feeding pump, texas cath, and as an added bonus, NOT on the referral, EIGHT decubs!! I did not have enough wound care supplies to dress all eight. The two big duoderms on his back I left alone, they were dates with today's date. The six on his legs, including a stage 4 on the ankle, I did the best I could with the limited supplies sent from the hospital and in my bag (now empty of all spares!)
Trach, O2 supplier did haldf set-up. Family had no idea where to put things, etc. That is how overwhlemed they were. They needed to be directed in everything from how to place his hand on the bed to how to arrange the room, equpiment in the room, where to plug things in! I felt for them (I had to right, I stayed almost 4 hours!)
Walk in and first problem is pt head is at the foot end of the electric bed, so we had to gather the forces, and it was a process to switch him around in this room that was barely big enough to fit the bed, let alone four people trying the manuer a tall man completely around in the bed!
Next, they sent a nebulizer with face mask attcahment...hello, this is a trach. No t-connector or any such device. I had to call the O2 company 3 times, suctionwas weak, they told me how to correct that and it worked, then they never set-up the compressor humidity unit. so I figured that one out, then I called when it was time to review the neb again, and demanded they come and double check the set-up. I siad "I just spent two hours here, most of that time setting up your suction, and equipment which you should have done, you need to do a neb teach in person, b/c I still need to teach the feedings and do his dressings and meds, and I will no accept no for an answer. I have no mroe time to spend fixing your eqipment! They agreed to come back. Man, why do they have to fight?? These poor people need support!!
Then we couldn't get the feeding to go vis pump. The supplies included Ross feeding bags for a flexiflo pump. I think the problem, no flow alarm, was due to the bag is such a "crinkly" and cheap plastic, it kept kinking up where the tubing connected to the bag, and no matter how I tried to rig it, it kept folding over and I think the pump was in effect sucking air, and wouldn't run. Called that company, they were close and volunteered to come out, even tho I said I would teach bolus feeds for the night. So then we had to do bolus feeds, crushing meds and giving meds via peg, etc.....
Then I got to the dressing on his feet. 6 decubs!! Family was SHOCKED!!! They were never told he had decubs! So they said, I have to wonder why they didn't ask about the dressings on his feet. He was hospitalized for 4 months!!! In that time thought, SOMEONE should have discussed this, and we definitely should have had wound care orders. Got the doc, got an air mattress ordered for the bed, not even an eggcrate was sent!! And I wanted a second opinion on the stg 4 decub, so we will follow up with improved wound care orders tomorrow. I asked our wound expert to see him.
Then of course there was trach care and suction teach and general care of bedbound client!!
Lovely people, but HYPER!! The poort wife was trembling. The son kept turning and talking really loud and repeating every single thing I said, "Ya hear that Ma? Ya gotta flush the ube before AND after the feedings? Are you writing this down?" I sent him to the pharmacy around the corner for the meds, just to give his mom and me a little break!! LOL!
3 hours and 45 minutes later I came home. Hubby was PO'd I missed dinner. Worked on charts til 10pm. Got majorly dumped on today. 5 revisist (one a D/C), a new admit, and this new admit since I was late call.) I am just waiting for them to c/o about my OT. I don't believe in working for free. I think they are using me to open every trach case! Each one is a disaster. The kicker is, I do not understand why this particular company was used. The pt has Medicare, and there is a GREAT O2 company in the area that is soo reliable and responds to pt needs without hesitation, b/c they know if they invest the time in correct teaching, eventually, they will be independent, and the pt does well. This company just wanted to do everything by phone, and that is not always cool when epople are freaking out.
I'm off tomorrow, and I fear what they have instore for me since Thursdays and Fridays usually are BAD days!!
Anyway this vist was 3 hrs 45 minutes. What was your longest visit and tell about it.
