Discharging disheveled patients from the hospital

UM Review RN, ASN, RN · May 28, 2005

I agree, there's really no excuse. It only takes a couple of minutes to clean someone up and give a little shave and a swipe of the comb. I understand your anger.

fluffwad · May 28, 2005

This is one of my pet peeves, too. I work in LTC and we occassionally get snitty calls from some ER nurse who thinks she is just the last word about 'why did we send this patient to the ER....they are a DNR after all! BTW....for any of you out there who don't know this (and you have no excuse for not knowing this)....DNR does NOT mean do not treat! I've found that the inpatient psych units have been the worst about keeping the LT patients clean.

susannyc · May 29, 2005

I've seen both sides of this situation. I was an ER/ICU/Med-Surg RN for years, then a geri-psych RN. Sometimes the patient REFUSES to allow the staff to assist with ADLs, and is incapable of performing independently. I truly disliked sending out psych pts who were dirty, but I disliked getting hit and scratched too! Many times, in the ER, the staff have no facilities to clean up a patient who has been brought in from the street. Other areas of the hospital are overworked and understaffed; if one patient refuses care, the staff always has 5 or more other patients willing to accept assistance. Additionally, the patients have rights--I've had social workers tell me that a patient had the RIGHT to choose whether or not to bathe--it was none of my business as to how clean he was! One of my personal favorite patient rights--the right to remain dirty!

CapeCodMermaid, RN · May 29, 2005

I've seen both sides of this situation. I was an ER/ICU/Med-Surg RN for years, then a geri-psych RN. Sometimes the patient REFUSES to allow the staff to assist with ADLs, and is incapable of performing independently. I truly disliked sending out psych pts who were dirty, but I disliked getting hit and scratched too! Many times, in the ER, the staff have no facilities to clean up a patient who has been brought in from the street. Other areas of the hospital are overworked and understaffed; if one patient refuses care, the staff always has 5 or more other patients willing to accept assistance. Additionally, the patients have rights--I've had social workers tell me that a patient had the RIGHT to choose whether or not to bathe--it was none of my business as to how clean he was! One of my personal favorite patient rights--the right to remain dirty!

PUHLEEEEEZE. I'm in favor of patients' rights, but the man whose mouth was full of food was comatose and therefore couldn't refuse anything.

flashpoint · May 29, 2005

There is no excuse for leaving a patient with a mouth full of food...I question why a patient who was comatose was getting food in the first place...sounds like a potential airway problem to me. As far as the patient who was not shaved...when I have seven or eight patients who are total care, shaving is usually one of my last priorities. All of my patients are going to get baths and oral care, but sometimes life threats and other things have to come first.

Also...it isn't only the hospitals who sometimes lack in taking care of ADLs. I once picked up a patient in respiratory distress from an LTC. Once we got her tongue unstuck from the roof of her mouth and cleaned out all of the Ensure or whatever supplement she was getting she could breathe! Pretty expensive and traumatic for the patient and family to have to take an ambulance ride to the hospital for oral care.

leslie :-D · May 29, 2005

i must be missing something- where did it state the patient was comatose?

and i have NEVER heard of a comatose person receiving food.....they're in a coma for crying out loud! i need to read the posts again, for that scenario is just plain incredulous.

leslie

rntg · May 29, 2005

PUHLEEEEEZE. I'm in favor of patients' rights, but the man whose mouth was full of food was comatose and therefore couldn't refuse anything.

I agree, why would a comatose patient be receiving food for any reason?

Carlos Casteneda · May 29, 2005

This week we have had 7 admissions to the building....4 of whom came from the same hospital. Two of the patients were actually dirty when they arrived!!! One looked like he hadn't been shaved in a week (and, no he wasn't trying to grow a beard), and the other poor soul had so much food and dried mucous in his mouth the speech therapist couldn't even look in. What is the matter with the people working at the hospitals? As a health care professional, no wait...as a human being, I would be mortified to discharge someone that unkempt. It's bad enough that 3/4 of the people we send to the hospital come back with pressure sores, but to send someone who has dried food in his mouth is too much.

I used to feel exactly the same, it seemed as though everybody we admitted from hospital was either constipated up to their eyeballs or completely doped up and covered in pressure sores, mrsa etc etc. The patients we receive now are pretty much in the same state but I have developed a different attitude, I know feel that what they do (Acute Care) they do very well but that also what we do ( picking up the pieces and implementing long term management strategies ) we do very well . I try not to be critical but to try to work in collaboration it does annoy me however when i do have to refer patients back to hospital and the nursing staff seem to delight in telling the relatives how dehydrated the patient was on admission, in UK LTC facilities or nursing homes do not have licenses for IV therapy and as such electrolyte inbalances are sometimes difficult to avoid but the word dehydration from a healthcare proffessional can quickly destroy any kind of relationship and trust that nursing home staff have built up I think we should think of the consequences before we start criticising other nurses/institutions

Antikigirl, ASN, RN · May 30, 2005

Now, we have that probelm too, but it isn't as bad as the fact the majority of our residents come home with NO information on what was done, what their Dx is, or even post treatment!!!! We just get some scribbled discharge orders on...I swear..the third sheet of carbon so you can't read it...and we get to call the MD and ask and hope they don't give us a confindentiality speach!!!

Tweety, BSN, RN · May 30, 2005

Outrageous. Just as outrageous as the condition we recieve patients from nursing homes into the hospital sometimes. Human beings deserve better.

Judee Smudee, ADN, RN · May 30, 2005

Part of it could be due to the fact there is very little staff in the hospital. When we had 6 on med/surg to care for 24 patients these things got addressed. When it went down to 5 for 24 it was a struggle but it got done. I don't know what is happening now that it is 4 for 24 because as soon as staffing got that bad I cleared out. I shudder to think of the things that are going on at my old unit.