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Discussion

Am I the only one

I have a patient with CHF, she lives at a ALF. THey take her weight daily,(Friday) today she had a 4.5pound wt gain. When I was at the ALF patient was getting a CT of her shoulder and would not be back till after 2. SO I got there at 3:30 verified that the wt was taken with same scale same time and naked pt stated yes. Had some DOE and increased ankle edema. By the time I called the cardio they left so I paged MD. She has an appt scheduled to see him on Monday. He gave me an order to give extra Lasix 40mg BID for 2 days. I talked to the ALF they said it is too late and they would need a script and since pt gets pills delivered in a mediset no bottle with extra lasix. So I paged MD again to explain. He was back at his office and can fax script. BUT by this time ALF nurse left. So I told MD to fax order to pharmacy. Phamacy can not deliver till after 1pm sat. I called ALF on call nurse told her I will go pick up the med give her the first dose and could they give her the extra dose the rest of the weekend. She said yes.

My question is do other nurses go to this extent for there patients? Made about 6 phone calls back and forth from MD to Pharm to ALF. ANd I will go pick them up in the AM so she can get the extra AM dose.

What would you have done

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    • Featured Replies

    Your patient you do it? what does the ALF nurse do? I don't understand how she could be your patient if she lives at a ALF

    unless you work agency, if you do isn't that your job, to give her extra care. if you aren't agency how can she be your patient?

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    • Author

    The ALF is considered a personal care facility. They do administer meds by med techs has one RN and one LPN. When they need skilled nurses for assessing, wound care, in this case patient is open to our CHF protocol. I work for a home health care agency. Was just wondering if others pick up meds, make several after hours phone calls go on weekend when not oncall? My oncall nurse would not go to pharm, so I am doing it since I am the patients nurse/case manager.

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    • Experts

    One of the nurses on a case, the one who has been on that case for over a decade, decided not to come to work the night that the patient was so sick that the primary caregiver said they almost called 911 (the agency sent no nurse that night). Patient taken to the hospital the next day. Now that is dedication for you, when the caregiver does not come to a scheduled shift, just possibly, because they fear having to do something for a sicker than usual, patient.

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    • Guides

    It's not unusual for the HH nurses who have patients in my ALF to pick up prescriptions and bring them to us, especially if it's a STAT order. We don't have E-boxes in assisted living, and the med techs know they cannot take telephone orders. As the only licensed staff in the building, I can take a T.O. and direct staff to give the med, but I always make it clear to the prescriber that there MUST be a written order faxed to us within 24 hrs. I've been known to give MDs my personal phone number so they can call with a T.O. in an emergency during weekend or nighttime hours, then instruct them to call it in to the pharmacy of the resident's choice. If no family/friend is available to pick up the med, I'll ask for a volunteer to pick it up during their break or after their shift, and my staff is always willing to do that.:) I live too far away to be of much use in that department.

    But with residents on HH or hospice, it's expected that the agency nurse will obtain the medication. I don't know how else it can be done legally, as 'borrowing' from other residents is prohibited, and the med techs won't give even plain Tylenol without a written order.

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    The ALF is considered a personal care facility. They do administer meds by med techs has one RN and one LPN. When they need skilled nurses for assessing, wound care, in this case patient is open to our CHF protocol. I work for a home health care agency. Was just wondering if others pick up meds, make several after hours phone calls go on weekend when not oncall? My oncall nurse would not go to pharm, so I am doing it since I am the patients nurse/case manager.

    Now that you explained it. I have down it. No matter our title, some of us remember the oath, " ...and dedicate ourselves to those placed within our charge." You were just being a nurse.

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    Having been a Home Health Nurse for over 28 years, I can tell you, yes!!!! I have not dealt a lot with Assisted Living Facility patients in recent years, since I have been in Pediatrics for over 16 years, but even there, I have had to go way "above and beyond" what many would consider the normal just to be sure a child got what they needed in care and were safe in home!!! It is the difference in Home Health Care from Hospital Care (where it feels like everything is right there and the chance for something to not get done seems so much less). Before working in Home Care I spent 15 years in Hospital Nursing, and the other big difference was that on "most days" I went home and never worried because my patients were in the hands of another Nurse! In Home Health Care, they still feel like they are in my care even once I get home, to the point that I have had to, on occasion, do follow up calls over the evening to be sure the child was still responding as I expected! I have also had to do instructions of very complicated "procedures" to non-medical Parents who live out of State from where our Home Care is located to set up equipment to deliver everything from IV Fluids to TPN and IL to Feeding pumps that the parent was only able to tell me what the machines "screen" looked like when I have been "on call". So, it is most definitely a whole different world!!!!

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    hmm...could you have the cardiologist order up a bottle of say 30 20mg lasix tabs to be kept at the ALF? then they would be available to give at any time.

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    Years back I had a military veteran as a home health patient. I saw him on a Monday & was told by the live in care giver that he'd been given an Rx for oral ABT at the ER over the weekend. (Dx Pneumonia @ ER, sent home w/ Rx) Pt's scripts were filled & delivered to his home by VA. Problem was in order for VA to fill his scripts he needed to be seen by VA doc (I don't even remember how many hours on the phone w/ the VA it took for me to find that out). Caregiver was a family friend who was POA, the guy had no living family. She wasn't willing to take him to the VA, or go to the local pharmacy to have it filled. In the end, I spent 4 hours at the VA hospital waiting to see the MD. He was so shocked that I'd done that he wrote the Rx for the antibiotic, had it filled (I waited another hour to have the pharmacy fill it). I would've been better off just taking it to the local pharmacy & paying for it myself. I was new to home care & only had a couple years experience in nursing. If that ever happened again I would report the care giver to the state.

    I really like that you put the extra effort in. It's hearing from nurses like you that makes me proud to be in this field :)

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