Lessons on why not to "Assume" things.

[TigerxLiLy]

Got to work at 11AM and read over our facilities "Communications" board. Noted that one of the Part A residents had a medical decline over the weekend according to some of the notes ("Ms.X is noted to be more lethargic", etc)

I went and read some of the nurses notes for over the weekend.. "11/29-Ms.X refused to eat/drink. Scheduled med pass bolus via peg tube and fluid flushes provided. Resident is noted to only respond to tactile simuli at this time, noted increased tremors in extremities due to Parkinsons"

"11/30- resident continues to be lethargic, vitals 130/64,89p, 19r,97%o2 sats, 97.9T, no changes in residents status."

I say to myself "No MD was notified!? maybe she isn't that bad..."-- went down to look at the patient myself..

1. The resident does not have a active Dx of Parkinsons, Her tremors were only noted to be in her BLE when she was sitting up in her w/c most of the time prior to this weekend.

2. Resident is usually very vocal, yelling at staff to empty her colostomy constantly-- if not the colostomy always pain or to tell staff to "go away" after she calls them in.

The patients baseline is vocall. -- just for background.

I called the residents name, no response-- she is supposedly "HOH" yet, hears perfectly fine when you say "How is your pain". So I say "Are you in pain?" No response.. resident is just looking up at ceiling. Touched residents arm and shook her a little. No response. Did the sternal rub, she turned her head- stated "Ow" and looked at me, but then went back to looking up at the ceiling with a vacant look. Did note that she was twitching in her BUE, which I did not think was her normal. Asked the charge nurse what she thought was going on, Charge nurse was clueless "What you mean? She looked like that all weekend." I told the charge nurse, "Yes.. but that is not her baseline...What have you guys been doing differently for her?" "Oh, Well I just got in report they just held her scheduled pain meds due to lethargy Friday, so That should be going away soon." ..me: "have you took her vitals yet?" .....charge nurse: "yeah, They were WNL, nothing to worry about."

Go to the computer to look and see if the MD/NP saw the patient recently. MD saw on 11/26--Orders for RFP 12/1 ( today! yay! ) Our lab draws on Mondays/Thursdays. So I go and check the lab results in the computer..big "CANCELLED" on the RFP. Look for the reason why ( not enough blood? couldn't get the stick? hemolyized? ).. Go and check our lab book to see what the lab sheet said... Technician signed that she got the blood..hmmmm... weird.

Call the Lab, Ask "Why did the RFP on Ms. X get cancelled?" Lab tech response, "Well, It looks like the blood was obtained through a line, or something other then venipuncture, because -- well the results are incompatible with life, so we cancelled this one and scheduled lab to draw on Thursday instead.." *pause* *blink blink* I state, "Well, Ms.X does not have any "Lines" on her, the only other way to get blood, and I'm assuming that your tech got blood, is through a venipuncture .. My patient looks pretty ill over here, Why didn't you call us first to make sure that the patient wasn't in distress or just notify us that we needed to redraw the lab?"

So, I notify my DON of the issue, I notify the supervisor of the issue and the supervisor states she is going to draw stat labs. Attempted to get blood 2x, She would Twitch/jerk even with someone else holding her arm still and dislodge the needle. So the supervisor gets her vitals. 84/56, 113 pulse, 79%- cant remember the rest.. but those were the ones that stuck out to me..

Supervisor calls MD and reports the vitals, current situation, and regretfully tells MD that we were unable to get any blood to run a RFP panel, that Lab drew blood this morning but is reporting that the numbers are wacky and incompatible with life. You can hear the MD cursing on the other line, literally. So of course we send the patient to the ER. They get the blood with their bad selfs :).

BUN= 235 ( baseline for resident is 35), Cr= 8.9 (BL 0.9), Chloride= "

The supervisor then had the nerve to ask me, "What made you look into all this? I looked at the patient at 8am and didn't seen anything wrong with her." ARE You Kidding me!?

[FranEMTnurse, CNA, LPN, EMT-I]

When I had my MI, I was transferred to a level 1 trauma center, then the docs kept canceling my tray. They couldn't make up their minds whether to perform open chest surgery or stent placement. This went on and pff for 6 days, I and the nurses both got frustrated.

[firstinfamily, RN]

If your lab is by contract, I would definately bring up to the DON the inconsistency with the lab and their lack of providing critical lab results to the staff which would have gotten the pt to the hospital much earlier. This is a definite lack of communication on the labs part that lead to a decline in the patient's condition. It does not matter whether they believed the results or not, what matters is that they did not report them to the facility. There should be an investigation on that part of the lab's inability to follow through, and possibly a new contract with another lab. Money talks.

[firstinfamily, RN]

If your lab is by contract, I would definately bring up to the DON the inconsistency with the lab and their lack of providing critical lab results to the staff which would have gotten the pt to the hospital much earlier. This is a definite lack of communication on the labs part that lead to a decline in the patient's condition. It does not matter whether they believed the results or not, what matters is that they did not report them to the facility. There should be an investigation on that part of the lab's inability to follow through, and possibly a new contract with another lab. Money talks.

[FranEMTnurse, CNA, LPN, EMT-I]

My records were transferred to this unit along with me. This is a physician training hospital and has an excellent reputation. When I did have the procedure, the instructor performed the procedure, and the P{physicians were amazed at how well she performed the procedure. I went home the next day.