Influenza Precautions

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How would y'all have handled this situation.. Yesterday we took an admission that had been hospitalized for the past week with influenza A. The hospital tried sending her on Tuesday but she was still being treated with Tamiflu and per our facility policy we can't take a flu pt. until they've completed the Tamiflu and are asymptomatic x 48 hrs. When I saw her name on the board for Friday I voiced my concerns. Social services said if she's been sx free then we could take her, When I took report I asked about symptoms the answer I got was "afebrile since last Friday" I asked about a cough and was told "no cough". The patient shows up wearing a mask.... She had a loose, productive cough from the moment she rolled in. She was placed in a room with another elderly lady who is quite mobile. The rooms are small so they are in close proximity. This a.m. I kept the curtain pulled as a barrier. Needless to say, room mates family came in found out their mom's new roomie had influenza and were not happy (to put it mildly). We have no open beds to move someone to. They wanted to speak with our administrator. I had no idea how to rectify the situation. We have no way of knowing if this new patient was still shedding the virus, but is it worth it to risk it? We already had a flu outbreak in the facility and actually had a resident die from flu related complications.

What would you have done? How do you properly follow droplet precautions in a semi-private room? Also how do you go about protecting the roommat's visitors without violating anyone's privacy rights?

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

I just love when social services in LTC tries to run the place....good luck

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Specializes in Pediatrics, Emergency, Trauma.
I just love when social services in LTC tries to run the place....good luck

THIS...making clinical decisions with NO clinical experience...ugh...

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Specializes in retired LTC.

Social Services? I thought it was the Admissions Coordinator, making sure admission quota was met so to get quarterly bonus. :sarcastic:

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

Oh,yeah,the two headed monster.....And ours are both the loudest Monday morning quarterbacks ever.Neither ever offer a kind or encouraging word.Three admits on a single unit in 7 hours?Oh,well-"that's your job"......

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Specializes in Gerontology, Med surg, Home Health.

In Massachusetts, having the flu is not a reason to deny someone admission. While we don't like taking people positive for the flu, Tamiflu or not, we do because we like to fill the beds because we like to get our paychecks. How small are your rooms? Droplet precautions are usually 3 feet. Does your staff HAVE to get flu vaccines in order to come to work?

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The rooms are that small that yesterday morning I went into the room and the room mate was sitting in her w/c after breakfast and she was maybe two feet from the new resident's face because the new resident hasn't been out of bed since she was admitted to the hospital, ect to be transferred to us.

We arent obligated by the state to accept any admission, we get referrals and can decide whether we'll take them or not. And because we have pretty much a full house (only one open male bed) so we aren't hurting to fill the beds..

All employees were required to get the flu shot in the fall, anyone who declined is required to wear a mask from Nov 1-April 1st. (Out of probably 100 employees, only 2 declined the shot!).

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And how nice to see other LTC social services are much like ours! It used to be part of our social services job to actually go over to the hospitals and evaluate any referrals before accepting them. Nursing also reviewed any referrals and made the decision whether we'd take them or not. That's not the case anymore. Social services will accept 4 admissions in a day and schedule the worst possible admit times.

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Specializes in LTC.

Our social worker makes the decisions on admissions also, taking people as skilled when we can't justify the need for skilled. Taking residents with a history of behavior issues and then saying "they can't be that bad".....umm yes they can/are that bad and we are left holding the bag......need a bang head here sign!

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Specializes in LTC,Hospice/palliative care,acute care.
Our social worker makes the decisions on admissions also, taking people as skilled when we can't justify the need for skilled. Taking residents with a history of behavior issues and then saying "they can't be that bad".....umm yes they can/are that bad and we are left holding the bag......need a bang head here sign!

Yes! It's almost a badge of honor for ours to admit people into STR pending LTC for us to get maximum $$$ but many were unable to participate in therapy due to end stage diseases,they tanked quickly and we had a Heck of a mess with the family in denial and rehab services refusing to d/c to enable us to get hospice on board.

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Specializes in LTC.

We just recently had 2 residents pass away.....one had been skilled then fell, broke her hip and a very sudden decline....she was skilled even though she was on comfort care. Another was declining gradually and over the course of a month she just faded and passed and she was skilled. It has got to be the almighty $$ forcing this issue. However we have had many skilled that rehab and go home......but a few, oh my!:wideyed:

Sorry OP for hijacking your thread....if it was my resident I might call her MD for a course of Tamiflu??

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The patient was actually admitted back to the hospital that next day. Her family was upset that she had been discharged from the hospital in the first place and the on-call MD agreed that she could still be shedding the virus so he arranged for a direct admit back into the hospital. been off since Monday so I don't know if she came back or what.

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