Discharged at the point of death.

[DixieRedHead, ASN, RN]

Are you getting lots of residents admitted from hospitals that are breathing their last breath or still sick as a dog. Hospital sent me a lady, that went back in 16 hours and died, one on 10 lts of 02 (hello, how high do your concentrators go?), he went back before getting off the stretcher, one who lasted like 5 hours before complaining of chest pain (she was in the hospital for an MI) who we sent back and she died.

I thought the new medicare stuff was supposed to stop some of this.

[Nascar nurse, ASN, RN]

I am the DON in my facility...I stopped 2 scheduled admissions in the past couple of weeks before they even left the hospital.

First was admitted to the hospital with a hgb of 10.0+. Don't even remember what the admitting diagnosis was but was not for anything related to GI bleed or anemia. When looking thru various labs I happened to catch that within 7 days or so the hgb slowly dropped and was currently only 7.6.

Second one had a WBC of 25,000 following a recent ortho surgery. Was not receiving any antibiotics.

It can be very frustrating.

[SuesquatchRN, BSN, RN]

I'm doing hospice now and they get discharged home to die. Sad. "Impending death" is no longer covered by Medicare.

[mazy]

Yes, it happens a lot. Although I think it depends on the facility because it happens less where I'm working now. One place we were getting people right out of the ICU. They were DNRs and way too sick for ICU and I can understand the hospital wanting them to be somewhere else, but it was very upsetting to have these patients come in and die before we even got the admission completed. Especially when the families were still in the process of catching up with the whole change of cor status/change of events and did not expect the inevitable to happen quite as fast as it did.

Also have gotten full-cor patients that crashed within hours of coming into the facility and had to go right back out again. It's a huge, massive waste of time and emotional energy to start an admission and then halfway through turn right around and have to send the patient back out again.

Very frustrating.

[CapeCodMermaid, RN]

It's a shame these patients are put through this. I think sometimes the transfer and ambulance ride is what kills them. I am a bit puzzled as to what the precious poster meant by "way too sick for the ICU". Isn't that where the sickest of the sick are?

[brandy1017, ASN, RN]

I am the DON in my facility...I stopped 2 scheduled admissions in the past couple of weeks before they even left the hospital.

First was admitted to the hospital with a hgb of 10.0+. Don't even remember what the admitting diagnosis was but was not for anything related to GI bleed or anemia. When looking thru various labs I happened to catch that within 7 days or so the hgb slowly dropped and was currently only 7.6.

Second one had a WBC of 25,000 following a recent ortho surgery. Was not receiving any antibiotics.

It can be very frustrating.

Good to know that you are keeping the hospitals on their toes and making sure they care for the patient. There is a rush to get the patients out which is definetely not in the patients best interests. I let all my patients know they can file a medicare appeal if they feel they are not ready to leave. At the very least it buys them some time. Sad to know that you are having to remind the hospital to adequately treat their own patients! The doctors and nurses are neglecting these patients in the rushed assembly line healthcare system we have today. This is not acceptable, but thank God people like you are looking out for the patients and advocating for care when it slips thru the cracks!

[EmergencyNrse]

Hey! Guess what? People die.

What about death with dignity? A hospital isn't

necessarily a place to go to die.

Give some palliative care and let them just sail on out.

Quit sending people to the ER to make their last

moments on earth a living hell. Yes we'll code them

until they glow in the dark but should you keep doing

that to people? ...think about it.

Gramma & Grandpa might not want you to do that to them.

[Nascar nurse, ASN, RN]

Hey! Guess what? People die.

What about death with dignity? A hospital isn't

necessarily a place to go to die.

Give some palliative care and let them just sail on out.

Quit sending people to the ER to make their last

moments on earth a living hell. Yes we'll code them

until they glow in the dark but should you keep doing

that to people? ...think about it.

Gramma & Grandpa might not want you to do that to them.

Umm..to much turkey got your belly in a knot?

Neither of the patients I refused to admit until the hospital addressed their issues were previously my patients. These were referrals being sent to me by the hospital discharge planners.

I've seen your posts before in regards to this issues and you just refuse to get the fact that WE DON'T DECIDE WHO DOES AND WHO DOESN'T go to the ER. That is decided by the Dr and sometimes a very insistent family. I can educate til I'm blue in the face but some families just don't want to hear that their 95 year old Mommy is going to die. Just ask them and they will tell you that the patients always wake up and eats lunch just fine after being coded on TV.

Maybe you need to think about it.

[1968cowgirl]

In our facility of 103 only 37 are DNR or do not transport. This means we have no choice but to send them out. Most families don't get it.

[Nascar nurse, ASN, RN]

And exactly how is it anymore dignified to be admitted into a strange nursing home hours before death?

[mazy]

It's a shame these patients are put through this. I think sometimes the transfer and ambulance ride is what kills them. I am a bit puzzled as to what the precious poster meant by "way too sick for the ICU". Isn't that where the sickest of the sick are?

I was talking about the patients I get from ICU who are only days away from dying, but the families are still caught between wanting to do everything (when there is nothing more to be done) and coming to terms with reality that the end is near. I had a patient like that who crashed before the family came in to sign the DNR paperwork, it was just a mess.

[maelstrom143]

I think the biggest problem is that in our society we have stopped believing that death is a natural part of life. Families are loathe to admit their loved ones may be dying or that they may actually be doing the right thing in allowing them to go versus fighting it with all they've got:sniff:. Don't a lot of the newer facilities advocate "survivors" and telling people how much longer they might have if they go w/so-and-so's facility? We live in a world where dying is not acceptable and therefore dying with dignity is virtually unheard of and unacceptable.

The new norm is to fight death no matter that you are terminal, miserable, and just ready to go. We as healthcare providers can advocate for the patients and their families, we can advocate for what is best for the patient when all their bodies' resources have been exhausted, and we can point fingers at the hospitals/EDs/LTCs until we are blue in the face.

Until we as a society can become more accepting of our limitations and the fact that sometimes we just need to let go of our loved ones, nothing will ever change. Fighting each other and throwing blame does not help. We are all in it for the patient and we all care what happens to them.

Unfortunately, we cannot always make families/doctors/patients see what is all too plain to us/docs/etc. as healthcare providers. All we can do is the best we can do with the resources given and with what we are allowed to do/not do by those we care for and their families.

And yes...I have had to (against my better judgment:crying2:) send patients to the ER from the LTC AND patients back to LTC from the hospital.

As long as, at the end of the day I can say that I did my best for the patient, sometimes that has to be enough.:redpinkhe