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.
Specializes in Complex pedi to LTC/SA & now a manager.
Olthe CCN told me different. She said trach/vent kids have to be transported with an Ccn and Emt's. She said a Pdn wasn't sufficient because we don't have a defib or any meds like Atropine if his heart stops.[/quote']
She's stretching the truth. EMTs are useless with trach vent as it is out of their scope. They are there to drive only.
The odds of a trach/vent kiddo's heart stopping (without a cardiac abnormality, arrhythmia, or other cardiac condition) is no greater than an asthmatic child going into cardiac arrest. Cardiac drugs are not out of the scope of a PDN if ordered by the attending physician. Just like if a trach/vent had an anaphylactic allergy to bee stings PDN can ABSOLUTELY administer an epi pen if it is on the 485 just like we can administer PRN albuterol and suction PRN or use a BVM if the vent fails.
Don't believe everything you are told. She wanted to justify her job. The standard crew for a CCT ambulance is a MICN or EMT-P(medic) and 2 basic EMTs (a total of 3 crew members).
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.
I am not even sure how to respond..a defibrillator in the home? I am SURE that even in South Jersey woods you are close enough to 911 that it isn't necessary to have a defibrillator at home. IF the family wanted to purchase one they are called a AED Automatic External Defibrillator.
My experience, which I admit is limited, with home care was one agency that catered to critically ill children at home. We were ALL critical care RN's and the parents had a mini ICU in their homes. Even I had to call 911. I had drugs...but no defibrillator. I was required to go to ALL appointments, however, when it came to the ER, once I turned her care over to a critical care team my responsibility ended.
IF the call was non ACLS worthy and the patient could be cared by the local ED...I was PAID to go along and stay with the patient until I had relief by another critical care nurse. Many times IF the patient could be cared for the local ED we stayed as an agreement was reached with the facility, agency, and parent for the agency RN to stay due to the complexity of the patient but only if the home vent was used during the patient visit.
As an emergency department nurse....if there is a private duty nurse the care of the patient is the responsibility of the home care nurse for the equipment/vent/patient for routine care/suctioning/cleaning unless they ask for assistance. Why on earth would the PDN need assistance of the ED RN when this is their patient and they are the ones familiar with the equipment/patient...that is what YOU are being paid for...care for the patient in transition until the patient is admitted and placed on hospital equipment. Which can easily be 2-3 hours.
However, I have never had the PDN take supplies without asking as you have indicated in another thread.
So basically you are saying the PDN is responsible until the pt gets admitted to the hospital?
Specializes in Complex pedi to LTC/SA & now a manager.
So basically you are saying the PDN is responsible until the pt gets admitted to the hospital?
Not always. If it was a regular ED without critical care nursing her agency had an agreement to supply critical care PDN to care for the patient provided the home vent was used.
It depends on agency policy. There is no double reimbursement. As the ED is a higher level of care they are paid not the agency from the time the patient is admitted to the ED. (Not necessarily the hospital). Some agencies elect to send nurses to the ED with patient whether of not a parent is present and pay from non- billed funds. Others send the nurse home once ambulance departs with patient.
As a paramedic, let me put this out there for you. Most 911-based and lots of private paramedics are completely and utterly useless when it comes to trachs and vents, g-tube emergencies, colostomy emergencies, port/IV access emergencies, etc.
911-based (and I was a paid professional for 14 years and volunteer for 19) paramedics rarely come across trachs/vents and when they do they, unless they are ones like I was that are very interested in learning "extra" things, they can't really deal with it. While paramedics are ACLS trained, many, many locales do not require PALS, NRP, BTLS, PHTLS, PEPP, etc.
The only paramedics that are truly experienced with trachs/vents are the ones that work for a company that specialize in critical care transports.
Unless a child is prone to severe cardiac or respiratory episodes when being transported, I honestly can't see justifying the expense of using a CC ambulance transport for every routine doctor's appointment.
Specializes in Complex pedi to LTC/SA & now a manager.
I always thought paramedics(and not EMT's) could place a endotracheal tube on the spot. I also thought they could give drugs to restart the heart rate out in the field.
Paramedics can do an emergency intubation but a trach vent kid is beyond an emergency intubation They cannot replace a trach. Most are not qualified to operate a ventilator. When an ETT is placed in the field the crew manually ventilated with a BVM. They can follow PALS & ACLS protocols for cardiac dysrhythmias. But most trach-vent kids are relatively stable and are not likely to need PALS/ACLS intervention than a typical child with asthma on any given day. Has any of your pedi trach vent patients ever required epi, adenosine, or any of the other PALS drugs due to VT, SVT, bradycardia while on a routine transport to a follow up MD appointment.
As far as staying in the ED you need to follow your agency policy but if not getting paid, why stay?
The issue in the other thread was that you never asked for help or asked for needed supplies not that you needed supplies. Polite requests go a long way just like please and thank you. You are the one who stated you steal supplies because your patient/family needs them. Responders went by what you wrote in your posts. You never stated that you asked for assistance just that you thought the staff should " know" that you needed help. Nurses are not mind readers
Nope,never had a pt that needed heart stabilizing drugs.
As I've said,I don't see the need why the CCRN has to be on transport with us.
According to the CCRn I was speaking with,she said the state of Nj got sued because a child had died en route to a DR appointment(and he was with his Pdn and parent)and from since then Emt's and a CCRn is required to go to routine DR appointments with trach/vent clients.
She also said that Pdn wasn't enough because I don't have any drugs to restart the HR.
I also don't have a defib.
I stated in my opinion that its overkill.
So on a typical trip there are 3 EMT's,2 nurses,and Mom.
The Pdn should be enough.
I also said I think compressions are enough.
Besides,kids usually have respiratory issues,and then cardiac arrest occurs.
Whereas in adults,cardiac issues usually cause respiratory arrest.
smartnurse1982
1,775 Posts
Ol,the CCN told me different.
She said trach/vent kids have to be transported with an Ccn and Emt's.
She said a Pdn wasn't sufficient because we don't have a defib or any meds like Atropine if his heart stops.