New to Homehealth can you give me feedback on this?

SleeepyRN · Aug 9, 2013

[h=3][/h] I have a client who is only on metformin for his diabetes and only occasionally takes his blood sugar. I encouraged him to use his glucometer daily before breakfast. He took it before our visit and it was 380 and in the afternoon at our visit 330 and with no insulin ordered I called the VA clinic( where all his healthcare visits are) and they were unable to see him for a few days but did schedule an earlier appointment. He is part of the VA and where he lives there is only a small VA clinic I encouraged him to go to ER if symptoms increase or blood sugar is above 350. He ended up going to the ER a few days later with a blood sugar close to 400 and now is upset with me because they didn't do anything for him at the ER but since it was somewhere around 385 they did not do anything for him. I feel secure in my suggestions for him to seek help. Was I being overcautious? I don't believe that was the case but I am used to doing med/surg and having a phone call to the hospitalist for any med changes so this is so different. I have also seen patients with DKA and blood sugars the same. I take diabetes seriously.

I'm interested in hearing other's responses. I am unfamiliar with home health but want to try to get in the field. Was it not possible or appropriate to call the physician with a newer update and ask him if he wanted his patient sent to ER if the BG increased to around 400? Or get a one time verbal order for insulin until he saw the doctor next, which was just few days later? I really don't know, I'm genuinely asking what's appropriate in this situation as far as contacting the doctor again. One more thing: remember there is a difference between DKA and HHNK.

I'm glad you posted this. Im looking forward to other's answers.

chrty_knox · Aug 9, 2013

The veterans VA clinic in our rural town is only open 2 days a week and when I called only an RN was there to answer phone calls there. He had no other established physician outside the VA. The closest VA hospital is 220 miles away. So for concerns on the following days the VA clinic was closed so the ER was the only other thing available to him if his blood sugar was almost 400. Calling the VA clinic during my visit the RN I talked to also suggested heading to the ER for any increase in symptoms. He since then has had an appointment with the VA and medications were changed. I see him again today.

chrty_knox · Aug 9, 2013

The VA is also a bit new to me. I made the appropriate calls to his local VA clinic but no Dr. was on staff that day and all the nurse did was make an appointment the following Monday when the Dr. would be in. I followed what the other R.N suggested and from what I understand the VA is a little more complicated than a general office Dr. I am still learning all the ins and outs. Thanks for your feedback!

KelRN215, BSN, RN · Aug 10, 2013

I'm interested in hearing other's responses. I am unfamiliar with home health but want to try to get in the field. Was it not possible or appropriate to call the physician with a newer update and ask him if he wanted his patient sent to ER if the BG increased to around 400? Or get a one time verbal order for insulin until he saw the doctor next, which was just few days later? I really don't know, I'm genuinely asking what's appropriate in this situation as far as contacting the doctor again. One more thing: remember there is a difference between DKA and HHNK.
I'm glad you posted this. Im looking forward to other's answers.

Unless I missed something in the OP, the patient is not on insulin. A one time verbal order for insulin is going to do no good for a patient who doesn't physically have insulin in the home. A pharmacy isn't going to supply insulin, needles and syringes based on a one time verbal order a nurse took.

OP, does the VA not have an on-call doctor for the times when they are closed? I do not work with adults but I'm used to always being able to reach an on-call nurse. I think you made the right suggestion- it's up to the patient if he wants to follow said suggestions and, based on his experience, he probably won't go to the ER again for similar symptoms but it's still right to tell him to go.

SleeepyRN · Aug 10, 2013

Unless I missed something in the OP, the patient is not on insulin. A one time verbal order for insulin is going to do no good for a patient who doesn't physically have insulin in the home. A pharmacy isn't going to supply insulin, needles and syringes based on a one time verbal order a nurse took.

Thanks Kel. I did see that the client was NOT on insulin, but my question proves how little I know about home health. I thought maybe a home health nurse might have insulin on hand. Again, I know NOTHING about home health, but will still be apying for HH jobs along with other types. I can understand my question sounding silly to someone familiar with Home Health, but when you know nothing, hey, I don't mind asking a seemingly silly question. It's how I learn.

That being said, I may not be familiar with Home Health, but I do have nursing judgement, and find nothing wrong at all with telling the OP's client to go to the ER if symptoms arise. So I agree with everyone else. I would actually go so far as to say it may be negligent to NOT advise the client to go to the ER if symotoms escalated. What if the client went into HHNK and the nurse never told him to watch out for those symptoms and seek treatment?