Hospitalizations and Pdn

Specialties Private Duty

Published

When you pts have an emergency and need to go to the hospital,does your agency make you go with the parents and child? Most agencies tell us to go,but follow the ambulance in our own car. Some say don't go anywhere;you have to go home because its the caregiver responsiblility.

Agency M tells us to stay until the kid gets admitted or discharged,because leaving would constitute "abandonment". The kids aren't the hospital's responsibility until either admission or discharge.

Another agency says as soon as the kids are in the hospital or ambulance,its the hospital's responsibility and the parents responsibility. You must leave as there is no reimbursement by the insurance companies.

What are your agencies rules?

I'm curious, because I have stayed in the hospital with some of the kids until admission or d/c and none of the nurses who worked for the hospital didn't do any actual hands on care, but they did take vitals.

I had to do all the suctioning of the trachs and changing the diapers.

Almost all of the parents have said when they wait in the ER(about 4 hrs around here) if the Pdn wasn't there that they would have to do everything themselves.

There are other arrhythmias than just the heart stopping. The critical RN was probably referring to having a defibrillator and ACLS drugs on hand for those other arrhythmias.

Yes,I'm aware.

None if the peds pts have been diagnosed with arrhythmias,however.

Plus,usually in Peds pts,if the heart stops,its usually related to respiratory issues,

unlike adults where its mostly related to MI's or another heart realted cause.

That's what is taught in basic Cpr classes anyway.

Even then,some of thse children go to school,and the only health professional is the Pdn on the school bus.

I'm wondering why the ambulance or CCN doesn't ride with them then? Some kids have an hr ride to school.

We are not allowed to go to Dr appointments with out a parent.

I think that's the difference between my cases and Beachy's cases.

I have never heard of a nurse going to Dr appointments without a parent or legal guradian around.

For my cases,the Pdn,3 EMT's,Mom,and the cc nurse goes to the appointment.

Plus,everyone has to wait with them at the Dr appointments.

The ambulance service cannot leave at all.

The cc nurse told me the state of Nj got sued because a trach/vent child had died during transport to Dr appointment and because of that a CC team had to be present with Dr appointments ever since.

Specializes in Complex pedi to LTC/SA & now a manager.

Majority of children in the two major agencies I work for DO NOT use critical care transport for routine appointments as the parent drives, even the trach/vent children. Most of these children have wheelchairs fitted to carry the vent, oxygen and other necessary supplies (feeding pump, TPN pump, suction , go-bag) so they can safely travel in an adapted van or school bus. Any appointment where the parent or competent caregiver is not available the transport team is called (state protocol requires a minimum of one CCT medic & one EMT-B )

If a trach/vent child needs emergency transfer or evacuation an ALS/medic unit must be used (it was easier to use ambulances to transfer child, one parent, & equipment/supplies via scheduled ALS ambulance (most 2 medics son medic & CCRN) with the mandated evacuations pre-hurricane Sandy. Most were transferred to alternate locations by early Sunday before the storm hit land)

There are other arrhythmias than just the heart stopping. The critical RN was probably referring to having a defibrillator and ACLS drugs on hand for those other arrhythmias.

Well then,maybe every home with a trach/vent peds pt and Private Duty nurse should have a defibrillator and PALS drugs on hand?

Maybe it won't be a bad idea,esp here in the woods of South Jersey.

Specializes in Pedi.

Agency M tells us to stay until the kid gets admitted or discharged,because leaving would constitute "abandonment". The kids aren't the hospital's responsibility until either admission or discharge.

I seriously have no idea what you are talking about here. The children are not the hospital's responsibility until "discharge"? No, once they're discharged, they're no longer the hospital's responsibility. Do you think ERs are not responsible for their patients? If you are transporting your patient in an ambulance, the minute they are loaded into the ambulance and report is given to the paramedics, care has been transferred and your agency cannot bill for any further time. From a billing standpoint, if the child is being transferred via ambulance, the PDN agency's time ends when the ambulance time begins. If the parent is driving the child in, you could theoretically accompany them and provide care to the child on the ride but then it'd be up to you to figure out how to get home. I wouldn't be expecting to get paid if you hang out in the ER with the patient, care has been transferred at that time and you are not a nurse in the ER.

Specializes in Complex pedi to LTC/SA & now a manager.

That must be your agency's policy then as there are times when the parent cannot get off work to attend a routine or follow up appointment. Many children qualify for PDN because one or both parents work full time. (Number of parents working full time, number of siblings, complexity & fragility of medical condition all factor into the number of skilled nursing hours a child qualifies for)

If an ambulance/medical transport is used for a trach/vent child it must be certified at the ALS level. BLS (EMT basic only crew) cannot transport an adult or child that has a trach or is vent dependent as it is out of their scope of practice.

A parent can choose to drive their child to an appointment and not use an ambulance.

Its amazing to see how different states and even different agencies handle these cases.

I can't remember the last time I've rode in a car or van with my pts for Dr appointments nor to the ER.

Since I'm a Noc nurse I get to skip most Dr appointments.

Thank goodness.

Specializes in Pediatrics, Emergency, Trauma.

I had cases where the nurses did accompany the children to their appointment; I actually had a case where it was routine; I took the child on public transportation and accompanied the child without the parent; the parent worked long hours.

I would be there for accuracy of orders; they would call the parent to inform them of any changes or no changes.

No issues; actually to be involved with the plan of care and be able to coordinate care is why we do.

Specializes in Pedi.
Just to add,I wonder why she thinks compressions aren't enough if his heart stops?

Because CPR in and of itself is grossly inadequate. CPR is highly unlikely to restart the heart. That's why there's such a big focus on early defibrillation these days.

Specializes in Complex pedi to LTC/SA & now a manager.

The only time I accompanied a patient to the ED (following the ambulance in my own car) was with supervisor approval as the child was going into status epilepticus and the parents would not agree to transport unless I went along. I stayed until

child was transferred via CCT team to the regional children's hospital PICU. My agency didn't bill insurance from the time the ALS team took report & transferred the child and I was paid out of discretionary funds my regular rate.

Specializes in Complex pedi to LTC/SA & now a manager.
Because CPR in and of itself is grossly inadequate. CPR is highly unlikely to restart the heart. That's why there's such a big focus on early defibrillation these days.

This was reviewed extensively when I renewed my BCLS last year.

I seriously have no idea what you are talking about here. The children are not the hospital's responsibility until "discharge"? No, once they're discharged, they're no longer the hospital's responsibility. Do you think ERs are not responsible for their patients? If you are transporting your patient in an ambulance, the minute they are loaded into the ambulance and report is given to the paramedics, care has been transferred and your agency cannot bill for any further time. From a billing standpoint, if the child is being transferred via ambulance, the PDN agency's time ends when the ambulance time begins. If the parent is driving the child in, you could theoretically accompany them and provide care to the child on the ride but then it'd be up to you to figure out how to get home. I wouldn't be expecting to get paid if you hang out in the ER with the patient, care has been transferred at that time and you are not a nurse in the ER.

Maybe your agency does it differently then.

Some of my agencies told me to follow the ambulance in my own car so transport wouldn't be an issue for me.

Others will pay for your transport via a cab if you went on the ambulance with the parent and child.

I was just wondering if the hospital assumes responsibility,and I'm in the ER with Mom,why he staff nurses won't change him nor suction him if they are assuming care?

Some agencies told me the hospital doesn't assume care until admission,which is the reason why I'm still doing the nursing care. I've always gotten paid the times I was there in the ER with the kids.

Others have said as you written.

I'm not sure who to believe,but the times I did stay with Mom in the ER she was very happy.

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