OK...major ranting about to go on here.
PUH-LEEZE explain what is happening to my facility's ER. Here are just a few problems lately.
We got an admit last night of a 51 year old male, N&V, diarrhea, dehydration. No co-morbidities. Labs were straight down the line, couldn't even prove the "dehydration" dx by them. Non-tele (thank goodness). Why was he admitted? He was "too sick to make it back home" (patient statement) and the wife said she "just couldn't handle him at home anymore". (I am serious - that was her statement) I am saying this guy was A&O - wife just didn't want to listen to his whining anymore. Guess what SHE does for a living? She is a Home Health RN at our hospital! Do ya think the authorities will have a field day w this admit? What about the "meeting criteria for admission"? We were told to admit on observation status b/c the wife wanted him admitted!!! Well....the next time *MY* hubby has the flu and I am tired of dealing w it, I guess I know what to do...
Crap - 3 months ago I was in to ER w what I found out later, was pyelonephritis and bronchitis. Had SEVERE lower back pain (Yes you dumb a$$ - it's a *FREAKING 10 ON A 10 SCALE*) had dysuria, hematuria w frequency. N&V w diarrhea. Fever of 103.4F oral. Know what *I* got in the ER??? A FREAKING TYLENOL and a po BACTRIM and a script for Bactrim, and got told to go home! Never even got my fever below 103 while in the ER, never got an IV for fluid replacement, etc. My MD was furious. I was asked, "Why didn't you tell him (the ER doc) you wanted to be admitted?" I nearly blew a gasket....I don't think that was *MY* call! I WAS TOO SICK!!!
The ER has sent patient w FUO and then orders *NOTHING* for a fever!!! *****!
Two weeks ago, I admitted a 93 year old female who had fallen at home. This is a very A&O lady who is actually a volunteer at our hospital. She had fallen at home and had this **HUGE** hematoma over her left eye. CT of head and Xrays revealed no fx, bleed, etc. She was there for observation. Well, we walked her to the bed from the hallway, stood her to weigh her, etc. Got her into bed. I went in and did my assessment......Lo & Behold: She has this *ENORMOUS* swollen, bruising, solid hematoma injury as big as my outstretched hand over her left hip. Ahhhhh jeez...I'm thinkin' hip fx here, and I allowed her to walk...NO ONE said anything to me in the report I took about a HIP injury. I looked at the records and there was NO note about it, nor were any xrays done.
I called the ER supervisor, asked who examined this patient. She said, "Well, actually, I did it and Dr. XYZ. Why? What's the problem?"
I tell her what I found, and she said, "Well, the patient never said she was hurt anywhere except her head."
Has anyone ever heard of this new thing called an ASSESSMENT?? I said, "Since when do we just take a patient's word for what their problem is? (I can see it now: "Hey Doc? I believe I have an intracranial bleed here...") What about undressing the patient and doing a physical exam, for crying out loud?
And do ya think the fact that she is *94 YEARS OLD* that she FELL and that she is FEMALE and takes FOSAMAX just *MIGHT* tell ya to have a look-see at something other than her bloody head?? DO YA'THINK, HUH????
I had to call her MD and get orders for a STAT set of hip xrays. Thank God she had no fracture.
These are just a FEW things......I could go on and on....
It is not just one MD down there. It seems to be mass stupidity. We have several new MDs working ER and everyone is talking about this. I have written several incident reports, but nothing seems to be changing.
All I feel I can do is to continue to assess my pts carefully when they present to my floor and to document, document, document...
Well, thanks for allowing me to go on and on with my diarrhea of the mouth. I will get off here now.
I love my job...I love my job...I love my job...
Jan 7, '03
The guy with abd. pain/N/V/D could have been admitted to observe for things that may have shown up hours later. And if the pt. was feeling really sick, would have had problems caring for himself, and had no one willing to help him at home, then you have an unsafe discharge situation. It does seem ridiculous, but what if he went home, was alone, tried to get up, was dizzy, fell, hit his head, had a bleed...do you see where I am going with this? It does seem dumb, I agree.
The other pt., what can you say. Things do get overlooked, and if she came in saying she just hit her head, things in the ED were busy...I can see how that might have happened (not that it makes it right). Also, I can't tell you how many times an alert/oriented pt. will tell us one thing, then tell the doc another, then the doc comes back and says, "Why didn't you tell me about XYZ?"
Every department misses things; we're human. It's hard to believe that everyone there is a goofball, but, I don't work there, so I don't know your situation. Did you fill out an incident report on the elderly woman? Have you discussed your concerns with your NM?
Also, the ED does not decide admissions; that's up to the attending.
Sorry if I sound a little testy, but I do get tired of the ED being blamed for everyone's woes. Most of us are trying to do the best we can, and we don't have the luxury of telling an ambulance to wait to bring a pt. in because we're busy; often we are also holding pts that should have been admitted, so we're trying to do floor nursing and ED nursing at the same time. As far as assessment, if a pt comes in c/o a sore throat, I don't do a head to toe assessment...I don't know any ED nurse who does. You do what is pertinent; if we did head to toe assessments on everyone who came in, we'd still be working on pts. from 4y ago.
Sorry you've had such bad experiences.
Last edit by fab4fan on Jan 7, '03
Jan 10, '03
My daughter, who's an asthmatic, walks into a Kaiser ED. I parked the car while her boyfriend went in with her. She's audibly gasping for air and in panic mode because she can't breathe. Her inhaler isn't doing crap. When I walked in, to my utter and complete shock, there she and her boyfriend was sitting in the waiting area, both with looks of complete fear in their faces! When I asked what the hell was going on, the boyfriend told me that the triage area took her vitals and then they were told to go and have a seat and to let them know if it got any worse!?!?!?!?!?!
WTFFittyFF? And that's EXACTLY what I said to the triage person. Of course after that, they immediately took her back.
Don't get me wrong, I'm a nurse, I totally feel for my overworked, stressed out, unappreciated, underpaid, disrespected, etc., etc., colleagues out there, but this was just plain negligence and unbelievable stupidity on the part of the triage person!!!!!!!!!!
Last edit by Sally_ICURN on Jan 10, '03
Jan 10, '03
Last edit by Flo1216 on Jan 10, '03