Sometimes it doesn't seem worth it (then I remember the nursing home)

jenrninmi, MSN, RN · Jun 3, 2006

I'm at my wits end today. First of all, why does the hospital d/c patients who apparently are not stable enough to go home, much less send them home with these outrageously complicated orders on a Friday evening?????
Yesterday, got a patient sent home who had orders for gentamycin every 12 hrs with a dose of fortaz to be run through his PICC line afterward. Labs must be drawn every morning for gentamycin trough. Since this patient lives in a very rural area this means his labs have to be driven on a 100 mile round trip daily by the home health nurse, on top of the nurse having to stay with the patient in his home for more than two hours while the antibiotics are run through the PICC line, twice a day.
Well, then apparently he had the order changed to every 8 hrs. and this new order was faxed to the wrong home health agency and we didn't get the new orders until after we had started the old ones...so this has messed the schedule up.
But now I am on call this weekend and I'm expected to travel to the patient's home every 8 hrs. around the clock for the next ten days and stay with him at least 2 hrs. each time. With the patient being in such a rural area it would be mroe sensible to have someone stay with the patient around the clock, especially considering I have about 100 other patients I need to be available for in case there is a problem (I'm on call all the time, BTW).
Is it just me, or does anyone think this set up is not very reasonable?
I mean, home health is supposed to be for the convenience of the patient and family, but really, home health can only do so much.
Sometimes, the hospital is the only sensible option.

No one lives with this person, or is the patient not able to be taught infusions?

Jo Dirt · Jun 4, 2006

No one lives with this person, or is the patient not able to be taught infusions?

Patient is alert and oriented but paralyzed. He has a 24/7 private duty LPN but they are not allowed to do PICC lines.

vanillaskye · Jun 4, 2006

Is there any way to concentrate the iv med so that it runs on a CADD pump? Levels daily? Jeez! Any co-workers who live closer to his home?

I feel for you.

Jo Dirt · Jun 4, 2006

Is there any way to concentrate the iv med so that it runs on a CADD pump? Levels daily? Jeez! Any co-workers who live closer to his home?
I feel for you.

No other coworkers nearby.

This is the worst weekend I've had in a long, long time and I am seriously considering giving my notice. Between running my a$$ off, being yelled at by the agency that monitors his gentamycin trough levels (yesterday they were in normal range, today they are twice what they should be), feeling like I have to leap out of my skin everytime the phone rings (did I mention I'm being paid $75 to do this????)

And I still don't know why this man was sent home if his condition is this precarious.

I get burned out easily enough, but I have had my fill this weekend. To add to the stress I have a husband who rides my a$$ about keeping the job and insisting on more money (I'm about ready to ditch him, anyway)

I was looking forward to this job because there were no weekends and holidays. Fool I was.

SUNSFAN_RN · Jun 5, 2006

I'm at my wits end today. First of all, why does the hospital d/c patients who apparently are not stable enough to go home, much less send them home with these outrageously complicated orders on a Friday evening?????
Yesterday, got a patient sent home who had orders for gentamycin every 12 hrs with a dose of fortaz to be run through his PICC line afterward. Labs must be drawn every morning for gentamycin trough. Since this patient lives in a very rural area this means his labs have to be driven on a 100 mile round trip daily by the home health nurse, on top of the nurse having to stay with the patient in his home for more than two hours while the antibiotics are run through the PICC line, twice a day.
Well, then apparently he had the order changed to every 8 hrs. and this new order was faxed to the wrong home health agency and we didn't get the new orders until after we had started the old ones...so this has messed the schedule up.
But now I am on call this weekend and I'm expected to travel to the patient's home every 8 hrs. around the clock for the next ten days and stay with him at least 2 hrs. each time. With the patient being in such a rural area it would be mroe sensible to have someone stay with the patient around the clock, especially considering I have about 100 other patients I need to be available for in case there is a problem (I'm on call all the time, BTW).
Is it just me, or does anyone think this set up is not very reasonable?
I mean, home health is supposed to be for the convenience of the patient and family, but really, home health can only do so much.
Sometimes, the hospital is the only sensible option.

Welcome to the world of home health. Sorry to hear that you're having a bad weekend. I did HH for about 10 years before I got out and went to work for an insurance co. as a complex case manager. The reason that he went home early is that the insurance co. more than likely told the d/c planner that the insurance co would no longer cover any more days. At the TPA I work for if the computor system will not cert any more days we send a consult to the Medical director and let them say yea or nay. But when I did home health the goal was always to find someone to teach the iv therapy to. Too bad this person did not go to a snf or ltac for the iv abx, but maybe they did not have the benefit. Also it sounds like your agency should have passed on this person. But maybe they have a contract they must honor. I have been reading your posts for the last couple of months and if I were you I would get as far away from this agency as I could. Good Luck Mark

beautifulb · Jun 5, 2006

No. This is definitely not reasonable. So many things are wrong with this picture. And you only get paid $75 -- and your on call?! That is way too much to do.

I know you have been having a hard time with your job. Is there any way to split these cases btw. other HHC nurses? Also, I think I remember you posting before about your director and her occasional antics. If you really like your job then try to work it out with your director, towards something a little more realistic. Otherwise, for sanity sake, you may need to check into other options.

Keep us updated as to how everything goes.

Jo Dirt · Jun 5, 2006

No. This is definitely not reasonable. So many things are wrong with this picture. And you only get paid $75 -- and your on call?! That is way too much to do.
I know you have been having a hard time with your job. Is there any way to split these cases btw. other HHC nurses? Also, I think I remember you posting before about your director and her occasional antics. If you really like your job then try to work it out with your director, towards something a little more realistic. Otherwise, for sanity sake, you may need to check into other options.
Keep us updated as to how everything goes.

The $75 is for the on call pay. Since I was "on call" this meant it was my duty to go out to this guy's house every 8 hrs..

Now, his sister is with him but I'm still getting that I have to be out there every 8 hrs. I could understand in the am to draw the blood but why the other two times? She says she is perfectly capable of giving his meds through his PICC line and has done it before.

How would I be expected to see other patients like this?

BTW, the crazy DON has been dismissed, along with the army of friends and relatives she brought in and "created" jobs/titles for. I don't know the details but something is up because the police came through the door today and lawyers have been calling....boy oh boy. I really like the new DON/admin but I'm afraid she is swamped right now. Don't know if she could really help me at this point. She is still trying to get adjusted as well.

beautifulb · Jun 6, 2006

Hopefully when the new DON is caught up with everything things will begin to fall into place.

Pretty freaky when the police and lawyers are involved.

MaryCW · Jun 8, 2006

Our agency has dozens of patients on home infusion therapy (including dobutamine and other inotropics) and we verify up front that the pt or CG is willing/capable of learning to administer the medication and have them sign a contract to that effect. We use primarily CADD pumps that are able to administer multiple doses of medications. We also insist that pt/CG agree to learn to perform wound care also. This policy is much different from an agency I worked for previously- where I spent many weekends like the one you have described. Good luck.

Jo Dirt · Jun 8, 2006

Our agency has dozens of patients on home infusion therapy (including dobutamine and other inotropics) and we verify up front that the pt or CG is willing/capable of learning to administer the medication and have them sign a contract to that effect. We use primarily CADD pumps that are able to administer multiple doses of medications. We also insist that pt/CG agree to learn to perform wound care also. This policy is much different from an agency I worked for previously- where I spent many weekends like the one you have described. Good luck.

I hope the sister will do the dressing changes to the PICC line. The house is very old and dirty and even using sterile technique it's bound to be dirty. Don't want that liability.

Tomorrow is the last day of this gentamicin business. I can't wait.

Home Health Columnist / Guide · Jun 8, 2006

I hope the sister will do the dressing changes to the PICC line. The house is very old and dirty and even using sterile technique it's bound to be dirty. Don't want that liability.
Tomorrow is the last day of this gentamicin business. I can't wait.

I've never been with an agency that permitted family to do PICC dressing change (usually weekly) due to RN need to assess insertion site for complications since non sutured line. Only permitted those with Hickman/Broviac caths. Portacath dressing also RN changed when Huber needle changed weekly--if sweetypt, family chould change it other days.

Please check your agency's P+P regarding this procedure---should be in there!