Published Jan 18, 2002
what is everyones view on this?
A Resident attempts to stand from W/C and fall forwad, resulting in a laceration to the forhead. The nurses on the floor cleaned and dressed the wound called MD and obtained order to transport to the ER ( 3 miles from facility) for sutures. Bleeding had stopped, Resident was alert, responsive and oriented at normal, no N&V, color normal flesh tone for Resident, PEARRL, VS at baseline, hand grasps etc. norm for Resident and in no apparent distress. Approx 1/2 hour prior to fall had recieved AM insulin ( regular and NPH ) and had not yet eaten.
Supervisor was called to the floor as nurses prepared to 911 resident to hospital, assessed Resident, got a breif report from nurse on floor and told them to cancel 911. (facility has a van with W/C lift for non-emergency transport) Resident was stable and in no distress, would most likly be triaged in ER for several hours before getting stitched up and would not be fed until return to facility(100% gaurenteed by experience) The Resident was given breakfast, inc. brief changed and warm clothes applied and transported to hospital by van in stable condition and with out distress to return 6 hours later in stable condition with sutures to laceration.
Another Resident calls adult protective services and reports abuse/neglect for cancelling 911 on a Resident in immediate need of medical treatment. Now adult protective investigates if $cost$ of ambulance ride or medical condition was primary reason for use of van. (PPS does not apply)
what is your take on this???
canoehead, BSN, RN
Sounds like the supervisor prioritzed the patient's needs correctly and he did not do without treatment so all should be OK.
Looking at it differently, the on site RN performed the initial assessing and triaging that would have happened in the ER.
Probably the complaining resident is not aware of all the facts- like insulin was given without breakfast yet, and could not judge the severity of the wound and I assume that because of confidentiality you cannot discuss it. Let them investigate, you have nothing to hide.
I agree. You say the order was to transport to ER for sutures, not how he should be transported. He was stabilised first.
Sounds right to me!!!!.................. DONMURRAY...Love your quote!!!!!
From reading the post I think and feel that all the right treatment was taken at the time of the fall. She was treated as soon as possible. Without any stress to her. So I believe that that was the right thing to do. Did it look as though she needed hospital treatment? Cause I feel that the journey may have caused her worry and again stress, and that is with out sitting the the A&E department for hours on end, which for her would have been worrying and again stressfull.
I believe that you took the right precaution at the time.
I agree....the supervisor assessed correctly.....the res. received necessary care.....you have nothing to hide ---- if all is documented properly then there's nothing to worry about. Most likely our facility would have done the same thing. Fortunately, we are across the street from the hospital and clinic. We can transport res. to and from the doctor for reg. appt. and ER as well, via w/c. If it's cold, rainy, or snowy we do actually load them in the van and transport them (someone who may have pneumonia, bad cold, flu, etc). We have had to call the ambulance to transport too though ---- for example, one evening after dinner a gentleman fell and after assessment a hip fracture was suspected. Although we have a gurney of our own, we do not have enough staff to transport a res. this way on afternoon shift (we are required to transport by gurney with 3 staff members). So we call the ambulance.
I worked > 6 years in SNFs. The patient needed breakfast and stitches in that order. He didn't need an ambulance, in fact medicaid and some insurances may have refused to pay as it wasn't medically necessary. Was it a weekend? Out here many of the Doc's will have them come into the office or urgent care for stitches if they are open...have even had a few 'pop by' the facility and do the stitches (and no, I'm not in a small town).
From an ER standpoint you did exactally the right thing. The chances (in a busy ER) that the fact the patient had insulin and had not eaten could have well been missed.
It also saves the EMS system for calls that really need it. The night my father died there was a long delay in the response to the house. The medic that arrived had to come from a different county. There was nothing anyone could do as he was in cardiogenic shock after a long illness so it wasn't the medics delay that caused the death .
However since I work in the same ER I did a little research. There were 5 ambulances based closer to my house. The calls they were out on were 1) a nose bleed that had stopped 2) a broken finger 3) a sore throat x 2 weeks 4) an intoxicated person who wouldn't leave a bar 5) An "I just can't sleep"
In our county the medics can not refuse transport to anyone as opposed to city medics who can. As I said, in our case the time would not have mattered, but in the case of an acute MI, head bleed, cva etc. Time can make all the difference.
I am just glad that we have an on-call MD/PA who comes out and sutures after hours aand is in house during "normal business hours"
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