Don't call 911

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I work in assisted living. There are 2 residents who complain of chest pain once in awhile. The families are telling us not to call 911 when they complain of chest pain because they believe it is just "anxiety" However, with my luck, the day I would not call 911 would probably be the day that they would actually have a fatal heart attack. What would you do? We have no crash cart here-nothing for emergencies.:confused:

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Specializes in ob/gyn med /surg.

i take chest pain seriously... i don't care what the families say.. i call 911 for chest pain.... the family is not a dr and cannot dx ... i would make the DON aware and also adminastration and let them talk to these families... it's your license... protect it

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Yes, I agree.:up: The DON is the one who told me about the families requests. The DON didn't actually say if I should or should not call 911. However, unless I have a doctor's order specifically stating "Do not call 911 when resident complains of chest pain" I am going to call 911 period. The families/DON can get mad at me. I don't care.

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Specializes in LTC, Hospice, Case Management.

Does the resident have any advance directives in place? Is the family member the legal health care representative?

If the resident or LEGAL representative states to not send to the hospital.. then do not send. BUT, if there is no LEGAL paperwork to cover your orifice.. you better send them to the hospital.

In the end, it is not really the Dr's call either. This all depends on what the resident or legal representative wants done. They have the right to refuse care.

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If the resident doesn't have a DNR in place you can bet your sweet bippy I'm calling 911.

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Specializes in Gerontology, Med surg, Home Health.

Unless it is crystal clear that the resident or responsible party does not want the transport to the hospital, I would call 911 and send them.

Also, people have the right to change their minds. Last week they might not have wanted to go...this week they might.

When in doubt ship them out!

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umm...about the chest pain....we have several residents with angina...when they become diaphoretic don't feel well or complain of chest pain they get nitro SL ...I am not sure how you contact your residents doctors or if you have a house doctor..we usually fax unless we need it now... but I would definitly CMA before it happens again ..also for there sakes..jiminy cricket yer the nurse they count on you!!...I would call or fax is even better...so and so has been having episodes of recurring chest pain..etc etc...MD informed.....then chart in the nurses notes that you have done this informed md via fax regarding past episodes of chest pain......... by adding the MD informed to the fax you are throwing the ball in there court.....then they will fax back either for diagnostics or just 'noted'..but at least you will have let them know ...thats your job right? ..what does the advanced directive say??.......most say treat for treatable conditions....and angina and MI are treatable....:up:

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Don't these people have NTG ordered? Generally, NTG is given 3 times, 5 mins apart before calling 911.

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Actually, even if they HAD a DNR I'd call. DNR just refers to resuscitation, not treatment.

People in an ALF aren't covered by nurses. If they need that kind of care they go to LTC.

I'd call.

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Our ALF and Independent Buildings ALWAYS call 911. Our policy is to let them refuse the paramedics.

It doesn't matter what the residents OR the family says.

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Specializes in Urgent Care, Step-Down, and ER.

Let me give you a great example. One night I receive a call from a nursing home that a patient had chest pain but it went away after nitro x1. The nurse said the patient has frequent bouts and it usually goes away after nitro. So she decided not to send the patient to ER.

I work at an urgent care clinic and have to follow up on all urgent matters with the nursing homes. I call the nurse and request her to send the patient to ER, she says that it really wasn't chest pain. She was testing my patience so I just told her, if the nitro relieved the chest pain, what does that tell you? She really didn't say anything, I just wanted her to realize it was a cardiac problem.

So I made sure the patient was tx to ER for further workup... Cardiac enzymes were elevated!

Bottom line is, the nursing home nurse wanted me to be held responsible since she made me aware of the problem. If I hadn't forced the treatment, they could had said well, so and so didn't give us any orders.

I didn't know the patient so I'm not going to agree with anyone's assumptions clearly when the nitro relieved the pain so it was indicative of cardiac problem.

Better safe than be sorry. So what if they go to ER and everything is negative. You wouldn't had known any other way. Just because EKG is normal, doesn't mean there is no damage to the heart.

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Specializes in Urgent Care, Step-Down, and ER.
umm...about the chest pain....we have several residents with angina...when they become diaphoretic don't feel well or complain of chest pain they get nitro SL ...I am not sure how you contact your residents doctors or if you have a house doctor..we usually fax unless we need it now... but I would definitly CMA before it happens again ..also for there sakes..jiminy cricket yer the nurse they count on you!!...I would call or fax is even better...so and so has been having episodes of recurring chest pain..etc etc...MD informed.....then chart in the nurses notes that you have done this informed md via fax regarding past episodes of chest pain......... by adding the MD informed to the fax you are throwing the ball in there court.....then they will fax back either for diagnostics or just 'noted'..but at least you will have let them know ...thats your job right? ..what does the advanced directive say??.......most say treat for treatable conditions....and angina and MI are treatable....:up:

:banghead::banghead::banghead::banghead:

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