inappropriate patient placement

[butterflynurse03, RN]

Yesterday when I got to work and received my assignment, I noted that I had a patient that was admitted to the hosp with back pain. This patient came in through the ER and as part of her workup, they did a pregnancy test. The test came back positive with a quantitative number of 67,000. The patient did not know that she was pregnant because she had been on depo shots. Anyway, she was admitted to our floor and arrived to the floor at about 0200. The ER did not do a pelvic ultrasound and apparently did not assess the pregnancy in any way. When I came in, my CNA told me that the young lady was in tears and in "A Lot of pain". I went down to the room to assess her and take the only pain med that was prescribed (tylenol). When I got there she told me that her pain was increasing and coming in waves across her back. I settled her in bed and went to notify the md of her status. After being given an order to get an OB on consult and then talking to the OB and getting her orders, I was entering the orders in the chart. At this time the CNA came back and said, "you need to come now, something is wrong". I went back to the room after tapping a doctor on the shoulder and saying to please come. When I got there I did a non-invasive lady partsl assessment and lo and behold there was the head of a baby in my view. I called immediately for an ob nurse and got the md to move faster. We transferred the patient to the ob floor and the baby was born less than six minutes later, very premature. She was intubated shortly after birth. I felt very fortunate that I was able to get this patient to the right location in time, but felt that had she been properly assessed in the ER, she would not have been placed on our floor. Does anyone else have any comments on this? Anything I could have or should have done differently? Any comments or suggestions will be welcome. Thanks in advance. :stone

[sharann, BSN, RN]

Sound like malpractice to me. Back pain is how my labor started. Sad.

[butterflynurse03, RN]

Sound like malpractice to me. Back pain is how my labor started. Sad.

To add to her story, her first child was also a premie...

[leslie :-D]

i am flabbergasted that the ER is where she was dx'd w/pregnancy, presenting w/back pain (duh) and NOT sent to the OB floor....absolutely incredible. so to answer you question, YES, she was sent to the wrong floor. major faux pas.

leslie

[jkaee]

Anything I could have or should have done differently? Any comments or suggestions will be welcome. Thanks in advance. :stone

It sounds like you kept your wits about you and got the pt transferred quickly to the OB floor, and your quick actions saved her from a potentially disastrous delivery on a M/S floor. Good work!

[butterflynurse03, RN]

i am flabbergasted that the ER is where she was dx'd w/pregnancy, presenting w/back pain (duh) and NOT sent to the OB floor....absolutely incredible. so to answer you question, YES, she was sent to the wrong floor. major faux pas.

leslie

Honestly speaking though, I shouldn't be surprised since they have "duh'd" before. Personally, last August I was placed in the hospital with a diagnosis of viral pericarditis. I presented to the ER, during my shift, with chest pain and these brainiacs did not place me on tele. Go figure that. Chest pain, SOB, dizziness = no tele. I don't know. I guess I got lucky or something that it wasn't more serious. Not to say that pericarditis isnt serious, 'cause it is.

[UM Review RN, ASN, RN]

It sounds like you kept your wits about you and got the pt transferred quickly to the OB floor, and your quick actions saved her from a potentially disastrous delivery on a M/S floor. Good work!

Absolutely, great save! :yelclap:

Frankly, I think that should've been written up as an incident to Risk Management, with a copy to each of the Unit Managers involved, because:

1. the care to both patients was inappropriate and unnecessarily delayed, and

2. it could result in a lawsuit at some point.

That way, if it was a systems error, it can be fixed pronto. This is one problem you wouldn't want to see again, I'm sure.

[leslie :-D]

that's great advice angie.

and butterfly, this same ER didn't hook you up when you c/o chest pain and sob????????????????????????????????? that's really scary. and yes, pericarditis is serious. i'm glad you're ok now. anyway, what angie said: report this to risk mgmt w/cc's to each unit mgr.

leslie

[UM Review RN, ASN, RN]

presented to the ER, during my shift, with chest pain and these brainiacs did not place me on tele. Go figure that. Chest pain, SOB, dizziness = no tele.

Oh, that's because MEN dx'd you, I'll bet. :angryfire

They need to forget what they learned in med school (i.e., the root of all women's illnesses is hormonal) because heart disease is the leading killer of US women.

http://www.nhlbi.nih.gov/health/hearttruth/whatis/index.htm

[butterflynurse03, RN]

It may yet be that way. I actually went home early yesterday and today is my scheduled day off. So I don't know what my manager is doing about it. Before I left yesterday the major reaction was "wow, can you believe that?" Not, OMG, how could this have happened?

I feel fortunate that I have a great CNA that I work with and that we were able to move quickly. If the doctor that I tapped wasn't in the same group as the patient's primary, they may have been hesitant to go to the room. Thank God for small favors. And may all his grace be with that poor child and her parents.

[butterflynurse03, RN]

Oops, double post

[suzanne4, RN]

Sounds like the ER doctor wasn't paying attention........... But usually if a woman is of child-bearing age they are asked when there last period was, and that is done by the ER staff.......Especially with back pain as there are usually x-rays involved. Someone should have picked up on it, didn't the nurses even get her undressed and notice an enlarged abdomen? Unless the patient was quite large-sized...............

Sounds like a problem with that facility on all ends.............And the patient as well.................