I work in a regional hospital, surrounded by around 6 towns. Each town has its own nursing homes, residential care facilities, retirement parks... each of which claimed to provide nursing care.
One nursing home is wonderful... their residents come to us clean, skin in great condition, papers and med lists in order with all the important information. And we ALWAYS get a short report while the paramedics are loading up the patient so that we atleast know who the patient is, and what the compliant is. We never have to call to ask extra questions, because they are so organized.
The other nursing home in the area are NOT so lovely... their residents have matted hair, skin breakdown, peri-care is really neglected, caths are crusted, it's just nasty.... They send these patients to the hospital at 1pm, having never fed them breakfast. (we didnt know what time they would be leaving, so we didnt want to get them set up for a meal and then have to undo all of that work). Even the diabetics. Attends are not changed because "we figured that they would soil them on the trip, so why bother".
and you know what... that all sucks, but we in the ER can handle that... we will do what care they neglected to do, feed the patients, provide baths, and peri-care...even though we are short staffed, over-timed to death, never get breaks....we do it because it is part of providing proper care.
but have a little courtesy to pick up the phone and call freaking report! Do NOT put your train wreck of a patient in a van, or cab, or ambulance, tell the paramedics nothing, send no papers, no next of kin information, smelling of their own bodily waste and then have an attitude with us when we call you to ask what is going wrong with this patient you just sent to us.
We have the courtesy to call you when we are returning your patient to you... we clean them up, send copies of lab work, and a copy of their chart for that visit. We call you to say what we have done, how they have tolerated it, and what the next steps are going to be. Return the favor!
If you work in a nursing home that notifies your ER of patients you are sending their way, thank you so much! we can call and have family notified and medical records present prior to arrival, which better facilitates care. We know what to expect when they walk in the door, can have a room ready for them, etc.
If you work in a nursing home that neglects to notify the hospital that you are about to send us an stable patient that has been a train wreck, which you push out the door so that you have less people to deal with... think about it next time... your hospital may just drop a new patient off at your door, and let YOU figure out what is wrong with this little old lady.
Call REPORT! provide some professional courtesy! Not to mention help US care for your patient properly!
I don't work in either of the fields of nursing being discussed in this thread, but I have to say I can see no possible justification under the sun for such a comment as:
Attends are not changed because "we figured that they would soil them on the trip, so why bother".
The " marks tell me that is the actual excuse offered up by the LTC facility. Now this is disgraceful.
All things being equal (funding, supply of staff etc.) There are always places that function better because the staff are willing to kill themselves all that much more for the cause. The second care home which doesn't call in the report probably has much more problems than you are seeing. You are seeing the tip of the iceberg as the dysfunction trickles down. This place is NOT representitive of LTC in general, this is representitive of a toxic workplace.
Not calling report is bad... happened to me a few times.. When I was the only nurse for 48 residents and a few went bad at the same time... 911 responds to us within minutes and they like to scoop and go.. I ALWAYS make sure their is enough written info and chart copy to go... sometimes it is difficult (1 nurse 2 cnas and a few major emergencies at the same time) but I will ALWAYS fax or call the ER ASAP and apoligize like crazy. During days or evenings I will make office staff or anyone else help me during a transfer. EMS always gets a detailed report too.
As far as the neglect and abuse of residents (yes that is abuse)...could the ER staff get a hold of the department of aging and report this? That kind of stuff wouldn't float where I work...
How about having someone contact these facilities and speeking with the administration about proper transfer of residents to hosp ER? Might work?
no offense, I have made the same sequence mistake...I have found a better sequence for non-911 patients:
1) assess pt
2) decide to send/not send
3) call family
4) call doc/np
5) call transport
6) make copies
7) give report to transport
8) ALWAYS, ALWAYS, ALWAYS call the ER (while patient is still being loaded into ambo at your facility)
9) no need to call DON unless she is soooooooo anal that she needs to know NOW!!!!!!!!!
Leave her a voice mail in her office.
For 911 patients:
1) assess pt
2) call 911 at bedside
3) have someone else get facesheet, MAR and H&P copies
4) give report to FD
5) call the ER
6) call the family
7) fax anything you forgot to the ER
8) call doc/np
I have done ER (8 years, hated many LTC nurses for not calling), and LTC (7 months, life on the other side is just as hard)
sean
Well, when I typed it up, it wasn't really in the sequence that I actually did it. I more or less did it all at the same time, sort of multitasking. I've worked in LTC for 14 years as a LPN and this was the first time I forgot to call. (Have never worked in the ED, but I bet if I had I wouldn't have forgotten to call!!) I do know it is important...how can the resident recieve quality care, if not? I feel bad, but it happened, and there is nothing I can do about it now...except remember it for next time!! Thanks for the feedback though.
and yes... that was actually what the nurse told me when I called to ask about the patients condition (the "we didnt change them because they would have be soiled on the trip, so why bother".
As far as the division of aging... they have been contacted multiple times. it seems to help for a while, but soon it slides back into poor care and neglect.
I understand that sometimes calling report can be forgotten when you are so busy trying to load up an unstable patient. Its ok, just dont make a habit out if it
There are good hosp and bad hosp too. I work in a LTC and we send papers, call report etc. But the one hosp we use most often, calls us most often and ask questions that are answered in the paperwork. Come on, we are trying to be efficient, but it has to go both ways.
PMHNP10
1,041 Posts
I don't work in either of the fields of nursing being discussed in this thread, but I have to say I can see no possible justification under the sun for such a comment as:
Attends are not changed because "we figured that they would soil them on the trip, so why bother".
The " marks tell me that is the actual excuse offered up by the LTC facility. Now this is disgraceful.