call the ambulance?

Specialties Home Health

Published

Hasn't happened. What if pt needs ambulance but doesn't want to go bc of the cost, or whatever? Can I still call if I feel it is warranted? Bc the pt can refuse the ambulance, therefore I covered my A, along with documentation. Or should I just call supervisor, and Dr, and document.

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In one instance my pt pcp requested pt to travel to ER by ambulance non emergent for eval. he refused. i called back and documented this bc he was urgent (requiring assessment d/t SOB and hemoptysis but no change in VS). and let the MD know. other nurses have had to call ambulances for pts, when EMS arrives the pt can turn them away, they document, and you document, and then you always call PCP to let tthem know. Another situation I have heard from a coworker is a pt, DNR, requiring ambulance to ER for severe SOB with decreased O2Sat. pt did not want to pay, but of course this did not fall in his DNR and living will orders and we are required to act. took a while but the nurse needed to call the doctor to inform of his refusal who then could legally section him, therefore using legal force to require them to go to the hospital (while explaining they can refuse certain treatment there, why etc.) i believe the police came to assist with EMS (they were nice, calm, it was not a forceful situation but rather a mediation), PCP and nurse faxed orders regarding this and social work assisted. HOwever, i do not know much how billing would work in situtation like this, it does sound terrible a patient would be forced to pay for a service that we almost legally must force them to take

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As always thanks for input, we help each and learn from each other.

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Specializes in Geriatrics, Home Health.

In my job, if the nurse feels EMS transport is warranted, or the MD requests it, we have to call EMS, despite any patient or family objections. The family or patient can refuse transport when EMS arrives.

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Specializes in Homecare, Public Health.

I have had an assortment of situations when I felt EMS should transport a patient but as long as the patient is of sound mind they have the right to refuse. I make the appropriate calls and document. Sometimes it's a matter of cost I have a nice patient with CA and when she needs to go to the ED her husband takes her because they are responsible for 50% of the cost. They can not afford it. I've had patients that I felt needed to go and refused because they were not of sound mind and simply notified EMS to send a police officer who usually found a way to convince the patient to go. Document, document, document! but also throw in some teaching, education and compassion and most patients will gladly get the ED tx they need.

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if the patient is of sound mind and able to make decisions, then I think its a complete waste of resources to call an ambulance to cover yourself, and it isnt necessary in order to prove the pt refused, just report it to the md and document.

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I had a patient that really needed to get to ED, sats in the 80's, resps 30, tachycardia. Called MD from pt apartment, MD refused to allow patient to come in and told me not to call EMS because patient had been in hospital inpatient less than 30 days ago. So I called him a taxi, paid for it myself, sent him on his way to ED.

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Ding! Ding! Ding! You are the winner! Call the ambulance and let your patient refuse. You not only have 2 more witnesses, but patient will need to sign some AMA document. If you think the patient needs 911 even if he might possibly refuse you should be on the phone with supervisor, MD and family (if appropriate) anyway.

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calling the ambulance when the patient and family has said no is ridiculous. for one, you are forcing a service on someone who has made it clear they don't want that service. and 2. you are costing time and money of the emergency service that is not needed or wanted and possibly making someone who really has an emergency to be held up.

why do you guys do this, and more importantly, why would a healthcare business make it a policy to waste the resources of emergency services?

Calling out emergency services because you need a witness that the patient refused to go to the e.r. is like killing a flea with a shotgun.

however, if your patient is having a true emergency, and I do mean TRUE, as in bleeding profusely, or obviously experiencing cardiac or respiratory arrest, and the patient has refused but you know in your best judgement that the patient is not thinking clearly or clouded, call 911 by all means.

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I recently had an episode in which a Home Health client was experiencing SOB, tachycardia and abnormal lung sounds. I instructed him that he needed to go to the ER related to his s/s and wanted to call 911 but he refused. He agreed for me to call his daughter, which I did and she arrived shortly. I explained and instructed the daughter regarding her father's condition and she ensured me she would take him in to the hospital. I learned he did go to the ER by ambulance which the daughter had called. The daughter is now threatening to sue because I did not call 911. Per my supervisor, whether or not to call 911 is a nursing call, however; I am now wondering whether that is correct. This client has recovered fully and is home but we are no longer seeing him due to the obvious issues. Any advice would be appreciated.

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Specializes in Complex pedi to LTC/SA & now a manager.
I recently had an episode in which a Home Health client was experiencing SOB, tachycardia and abnormal lung sounds. I instructed him that he needed to go to the ER related to his s/s and wanted to call 911 but he refused. He agreed for me to call his daughter, which I did and she arrived shortly. I explained and instructed the daughter regarding her father's condition and she ensured me she would take him in to the hospital. I learned he did go to the ER by ambulance which the daughter had called. The daughter is now threatening to sue because I did not call 911. Per my supervisor, whether or not to call 911 is a nursing call, however; I am now wondering whether that is correct. This client has recovered fully and is home but we are no longer seeing him due to the obvious issues. Any advice would be appreciated.

Call 911 then daughter. Let patient refuse EMS. Then you documented your assessment and intervention (activate EMS & notify family). EMS has their assessment and AMA refusal documented. Then the ball is in the patient family court. I've had to do this with pedi patients. Family doesn't want to deal with hospital but my documentation was covered, called EMS, notified my clinical supervisor and both documented family refusal.

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Thank you for your input.

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