Emergency Measues criticized by Pt's mother.

Nurses Safety

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Ok here we go again... New case different story but same old stuff on a different day...

It is 0400 am... working with homecare pt I notice that the vent circuit is leaking somewhere. I can't find the scource... Pressures are hitting 10 at best and the low alarm sounds like Beethoven's Fifth.... No vent circuit ready in the closet... bagged pt and grabbed stuff to make new circuit,... continue to bag pt using Knee with gentle pressure and never missed a beat while I cut pieces off and applied pieces to the new circuit...Had that buzzard together in less than 90 seconds.. like Vents are my living.. I cannot count how many of them I have changed circuits on the last 10 years... I was taught if you don't know the exact scource of the low pressure CHANGE THE CIRCUIT! Better safe than sorry.

Feeling rather proud of myself I told aforesaid pt mother what happened,,,, " Oh well I have NEVER had that happen to me" and "Oh this piece is backwards"...( forgot to turn a inhalation tube right side up) GEEE! SHoot Me!

Well get this... the PEEP on this circuit ( mind you we have a CUFFLESS trach here) is set a 4. Mom notices on a test lung that PEEP is hitting 8. I got yelled at for having it set too high... I was accused of turning the PEEP up to "blow" his lungs. I NEVER touched the dang thing. I too checked it with the lung not 5 miutes before she walked in the room it was hitting 4.

Ok... am I out of line in being angry??? Am I being over paranoid because 10 years of vent experince are being sliced and diced.

:( :( :mad: :mad: :mad:

After she walks out of the room I get the old circuit and tear it apart peice by peice. I found out the Exhalation valve had split down a side. When I showed her that a bit later like 30 minutes ago she said that was impossible"I have NEVER in my life seen that happen"... Now tell me am I crazy or can wierd things ACTUALLY happen that a pt's family hasn't seen before???

Well I'm open for diplomacy and rason so Shoot....

Beth

I used to teach home health aides and nurses and constantly heard talk along these lines : that they were getting into healthcare so some agency would pay them to stay home with an ill loved one. Many were here from foreign countries and were very upset when I told them I felt this was against the law.

Sounds like it must be going somewhere...can't be just coincidence...or can it?:eek:

Shezam!

Who in the world was he going to report them to?

He should have been reported to somebody for attempted fraud.

In some instances,family members can be paid for care. For example,in one state I lived in there was a respite program that issued a certain dollar value of coupons to families who met income guidelines, the family arranged for family members,church members etc to provide respite care,then issued a voucher coupon which was paid by the state. The number of families on the program was limited according to funding. The program was open to recipients of any age. In some instances, home care nurses provided the respite care while off duty. I think it was for a total of about 20 hrs per month so that family members providing the majority of care could attend their own appointments,grocery shop etc.

I think chronic homecare nurses who do pedi cases are saints...I would not have the patience for these parents either. When I get them in the hospital, they want to run the show and actually think they are nurses from their experience (and the nurse in charge). Long term spouse caregivers become control freaks to, but the parents are worst. The power struggle gets ridiculous, and dangerous to the patient when what the caregiver has done is detrimental. I will 'give' in certain situations but it sure gets trying doesn't it.

Specializes in LTC,Hospice/palliative care,acute care.

Will someone please explain to me where the funding comes for these cases? My mother was on hospice and bedridden for 6 months-we had an aide 3 times week for about an hour and a half for most of that time-the last few weeks we did go up to 5 days a week.....Medicare and her bc/bs supp paid to rent a hospital bed but would not rent an overbed table.....Figure that one out...I was grateful for the aid-believe me...The nurse came 3 times a week for about an hour after the intial visit but I seemed to order the supplies myself and call our MD when we needed something......I guess I was "in control" but I remember just doing it and having the impression that I was supposed to...I just don't get the system.I guy I went to high school with had some chronic disease and ended up in a vegetative state on a vent at his mother's house FOR YEARS....She worked every day-he had aides.....She kept him in a hot little room no bigger then a closet...Someone found SOME organization to donate a small air conditioner...I guess I just can't play the game as well as some can.....We paid for the meds she needed and the supplies that medicare did not cover....And I had quit my job....no aide there for me for 8 hours so I coulkd go to work.....

Specializes in ER.

Although I'm not a homecare nurse I do recall seeing some excellent deals on items you might need on Ebay. One stands out- and overbed table for $20. You might find something to help from your local churches too, they often will loan out items, or know of a family that isn't using them anymore who would be willing to sell.

ktwlpn-

Some families have private insurance but the majority of the funding for Peds home care comes from the State. The MD orders a number of hours of care then the payor decides how many it will pay for.

For the most part kids with a trach/vent qualify for skilled nursing, if they were adults they would be eligible for a SNF. There are veryfew Peds LTC or SNFs and it is cheaper to pay for skilled home care than it is to pay for hospitialization.

Specializes in LTC,Hospice/palliative care,acute care.
ktwlpn-

Some families have private insurance but the majority of the funding for Peds home care comes from the State. The MD orders a number of hours of care then the payor decides how many it will pay for.

For the most part kids with a trach/vent qualify for skilled nursing, if they were adults they would be eligible for a SNF. There are veryfew Peds LTC or SNFs and it is cheaper to pay for skilled home care than it is to pay for hospitialization.

hmm-thanks for the info. Canoehead-my mom died way before the pc revolution hit this home.An area LTC actually donated some very nice quilted rubber backed incontinence pads-they looked like they had never been used.It was not the home I was on my family leave from-they would not even give me a hug-much less a mouth swab....or a few plastic med cups.....
Specializes in Critical Care.

So why won't the administration tell the PIA families that there is no nursing care available because of the way they treat the nurses, if they are not satisfied with the care then they will have to do it themselves as there is no staff that will work for them? Why do nurses constantly have to be abused? Why not speak up for yourself and tell the mother or SO that they are intrusive and out of line. I guess that is why I don't do home health, I don't have the patience for the BS.

Families are intrusive and out of line all the time in my ICU. Sadly, if we pizz them off, tell them to back off, be respectful, ask them to follow rules etc...our bosses will take THEIR side. No wonder we are staffed with mostly travelers. Now I LOVE my core staff of coworkers and we support one another as much as we can...this makes it bearable... but if any more leave I will probably have to as well.

I recently began doing pedi home health on a prn basis. I am still confused as to why the insurance companies pay for some of the assignments I have been on. One case is a 2 year old patient that is on a vent only when she sleeps. During my 12 hours the father is at work and the mom is sleeping (she works nights) I cook for the child, play with her, and connect her to the vent during her 2 hour nap. During the nap I give her her nebulizer treatment and CPT. In other words, for 10 hours I am her playmate and baby sitter.

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