Frustrated and feeling responsible...

[NrsJena]

I am so frustrated and feel totally responsible! Have been doing HH for two years now- and love it. I do skilled visits and just started seeing this new client, only one visit so far. Per inital report from RN and Therapist- client is inapproriate for homecare. VERY sick lady-with a psyc history to boot. Had been septic prior to discharge, in hosp for over two months. Got a call yesterday from husband that client became "weak" in shower in am (it was after 1:00 when I got the message and called back). BS ok, denied SOB. Had blood cultures down a few days ago, clean, but he took her to the Outpatient lab for a low calcium follow-up. New order to take suppliments and had a DR appt for today. Told him I had not gotten those levels and was unaware of the levels, but that she should limit her activity and drink plenty of liquids (Dr. questioned dehydration last week). I also told him to take her to the ER immediately if she got worse. Found out late today that her husband found her "doubled over the bed" this morning and she was admitted to the ICU for the low Ca. I am shocked, first of all. I saw her last week- all VS WNL, no arrythmias on auscultation- denied all problems except for feeling tired (which went with the possible dehydration, or so I thought) When I called the RN sup, she told me that she was not suprised since the client has been noncompliant with meds (this was news to me). I really feel like I dropped the ball on this one. I should have made the connection between the possible low calcium and the "weakness". I know that the Dr was aware-had prescribed the suppliments and was re-checking, but I still feel like I should have seen something more here.The Dr was aware, but the weakness should have red flagged the cardiac symptoms in my head. I don't know- but I am very frustrated with myself right now for missing the connection. I'm frustrated with the way we never know things untill after the fact-never know those lab levels that could turn so critical-and have no clue what's going on with our patients in between visits. GRRR....Thanks for letting me vent.

[Jo Dirt]

I have a patient who was referred to us under Medicare. She had pressure sores on her sacrum and had orders for an occlusive dressing 3x weekly. I went out there for over a week when I was told she did not have medicare and the family health center who referred her made a mistake.

So just like that we were out of there. And her pressure sores had not only not healed but she had developed a heat rash on her bottom which made it worse. She is paralyzed from the waist down and she is up in her chair most all day. Says she can't lay down, she has too much to do. I made a discharge visit but I still feel responsible. I tried to call the medical center that told us she had Medicare but they are out of the office all week. How convenient.

So that has left ME holding the bag. She is a long drive away but I feel like I should at least call and see if she needs me to come by anyway.

That is one of the things I don't like about HH.

[NrsJena]

I can relate. I love HH- but it is a juggle most of the time. In the hosp, you have virtually immediate access to lab values and other important info. The docs actually communicate with you! In HH- it is difficult to give good care with half information most of the time.

[jenrninmi, MSN, RN]

I have a patient who was referred to us under Medicare. She had pressure sores on her sacrum and had orders for an occlusive dressing 3x weekly. I went out there for over a week when I was told she did not have medicare and the family health center who referred her made a mistake.

So just like that we were out of there. And her pressure sores had not only not healed but she had developed a heat rash on her bottom which made it worse. She is paralyzed from the waist down and she is up in her chair most all day. Says she can't lay down, she has too much to do. I made a discharge visit but I still feel responsible. I tried to call the medical center that told us she had Medicare but they are out of the office all week. How convenient.

So that has left ME holding the bag. She is a long drive away but I feel like I should at least call and see if she needs me to come by anyway.

That is one of the things I don't like about HH.

That's a shame...don't you ask the patient for their insurance cards at the admission visit?

[Jo Dirt]

That's a shame...don't you ask the patient for their insurance cards at the admission visit?

Since I had a ss number complete with a A for the type of medicare she had at the end I did not aske for the card.

But it's a mistake I won't make again. I'm not going to be hard on myself, I'm still fairly new at this and I am doing remarkably well, especially considering I got NO orientation.

But that hasn't helped this woman's butt.