New to homecare and I need some help

[spartan_nurse]

I'm relatively new to geriatric care and definitely new to homecare and I have a question for you all. A client lives at home with her husband and grown son. She is in her late 50's with a complicated medical hx. Hx includes hx of myelodysplasia syndrome, GvH in her lungs (lung function ~30%), Avascular necrosis in right hip, COPD, GERD, Aortic insufficiency. She is on a million meds including beta-blockers and steroids. She has a past history of falls which leads to my question. She was found on the ground the other day at home. She had fallen 10 minutes before I had found her. Her husband was out of town and her son was at school. She stated that she tripped over her oxygen tubing. She has a home concentrator with 50 ft of tubing. I drove her to the ED where they did x-rays of her right arm and hip. She has been diagnosed with a simple fracture and an avulsion fracture at the greater trochanter. She has a difficult time doing ADLs but with good family support manages well (although reluctantly -- she is not ready to give up independence). Since the fall, we have removed all trip risks including clutter and throw rugs (the bane of my existence). We have done all the things we can do right now, but what can I do about the darn tubing? She likes having so much because she can go anywhere in the home (a 1 story ranch style) and out to her car to get groceries. We've discussed carrying her cell phone with her at all times incase this happens again, but that tubing is still a major tripping hazard.

[Libby1987]

I stunned that you drove her. I would have been fired and who knows what else. (You're in the US?)

What about a portable cylinder with a pulse dose conserver?

[JustBeachyNurse, LPN]

Driving a patient in lieu of calling EMS set you and your agency for a lot of professional liability. I would have been fired on the spot.

[toomuchbaloney]

I am also shocked that you put the patient in your vehicle and drove her to the ED.

The best way to avoid the tripping hazard is to have oxygen that can travel with her (tank) to the desired location.

My maternal aunt died from COPD and she used oxygen continuously for quite a spell.

My uncle had oxygen tubing strung along the walls from concentrator to different areas of the house. They were labelled at the concentrator end. Consequently, when aunt Irene ambulated to the living room she used her E cylinder to get to her chair and once there she put on the cannula there which was attached to the concentrator. Similarly, when she wanted to go to the kitchen she removed that cannula, used the tank, and went to the kitchen while uncle Frank hooked up the kitchen tubing.

That worked well for them and saved both of them the hazards of having tubing on the floor thoughout the house.

[spartan_nurse]

Not in my personal vehicle. I worked for an ambulatory home health service. We have a specially equipt vehicle and stamard protocol for transporting patients using a partner. Simply we're home care nurses with ems training.

[KelRN215, BSN, RN]

Sounds like the patient could use a HHA during day time hours when the husband and son are not home. And add me to the list of people flabbergasted at the idea of a HH nurse driving a client to the ER.

[spartan_nurse]

Sounds like the patient could use a HHA during day time hours when the husband and son are not home. And add me to the list of people flabbergasted at the idea of a HH nurse driving a client to the ER.

We've talked about a HHA, but she is really resistant to the idea. I didn't drive her in my personal vehicle, it's part of an ambulant care. We have a protocol, a partner, and EMS training on how to transport patients. I appreciate the suggestion and concern.

[Libby1987]

I've never heard of that service.

[JustMeRN]

Interesting the driving thing.

I see people have the most luck with coiling tubing as they go, circling around the arm or in a walker basket if she has one. It's slower going, but safer.

[momofm1998]

This is a spectacular idea!! LOve it!! am I reading correctly that tubing is available in each living area and the client simply hooks on to the area tubing when in that area??

[caliotter3]

I also like the idea of running tubing along the walls to various areas of the house and having the patient use their E tank to get to the other rooms, then hooking up to the concentrator lines once they are situated.

[JustBeachyNurse, LPN]

I also like the idea of running tubing along the walls to various areas of the house and having the patient use their E tank to get to the other rooms, then hooking up to the concentrator lines once they are situated.

Is it sad that this made me think of my most coveted home remodel the central vacuum. So this would be like a central oxygen set up with "cordless portability" I think you could easily sell this idea to your patient & family!