Patients who "cheat" and drive home

[Lilme04]

I work at an endoscopy center (and a freestanding surgery center). A few times, we've had patients lie to us about how they are getting home, and they've ended up returning to their cars, and driving home. Of course we find this out too late to get a license number. Once, myself and another nurse walked around the hospital across the street to see if we could locate the car, but the patient had already left in it, after giving us vague directions as to where he had parked.

I am responsible for my patients' safety, and ultimately that of the general public, as I mostly work in recovery/PACU.

Any ideas on how we can combat this problem?

[RNsRWe, ASN, RN]

the bottom line, to me, is that if these patients require this much attention after the fact of the procedure, the procedure should not be done on an outpatient basis. Problem solved.

It's not that simple...it's not that they require actual nursing care, it's that the anesthesia meds make it so they cannot safely/legally drive themselves. Standard is no driving for 24 hours, although I'm sure you'd find variations in policy in different regions or States. Our anesthesia group has them sign the DC form for no driving for 24 hours. Do people ignore that and drive hours later? Of course. Some stupidly so (I read about one in the paper recently, actually). And some navigate quite well, despite the meds.

They don't need inpatient care. They just need someone to take the wheel.

[theantichick]

They don't need inpatient care. They just need someone to take the wheel.

Then what's the problem with a taxi??

[calinicumurse]

Then what's the problem with a taxi??

I think the issue with a taxi is trusting that the patient will be taken home as opposed to a car off-site or some place else. It's a safety issue - hopefully a friend/family member would be taking them directly home.

[trufflelilyRN]

Don't let people put their monkey on your back. We as nurses tend to be caring and nurturing. If we are to survive over a 40 year career as happy, well adjusted nurses it is because we have learned to set our boundaries. When a patient comes under our care, we develop a professional relationship with that person. They are not our friends--though perhaps a few will become so in a different, personal relationship. As nurses, we learn how to establish a professional relationship, develop rapport, gain trust, empathize, listen, provide care and also how to end the relationship professionally. When we begin to accept personal responsibility for their problems (taking their monkey on our back) we are emotionally involved. When this happens we are no longer functioning in our role of the professional, and we lose our ability to objectively problem solve.

I am not in any way saying we should not care. But, our interventions need to reflect our professional role. Perhaps in one community a professional might approach emergency services or a city council for a possible solution to the kind of problem we have been kicking around. Perhaps Red Cross might make drivers available in another community. For the Medicaid/Medicare population it has usually been possible to arrange transportation for patients in communities where I have worked. Is advocating and community efforts going to solve all of the problems? Never! Like the situation with Fuzzy's oral surgeon, glitches will always occur and will tax our imagination. I, personally, have driven patients home on a few occasions. However, over 40 years as a registered nurse, it has been only a VERY FEW times--probably 2 or 3 times.

Our employers have policies in place for very good reasons: Business practice and avoiding litigation. In day to day operations--most people can get themselves home appropriately.

As a young nurse this was a steep learning curve for me. I wanted to help solve all of my patient's problems. I made many mistakes by becoming too involved with patients. Fortunately I gained a balance and have succeeded. I could just as easily have burned out by accepting too much personal responsibility from patients.

Thanks for reading my ranting!! Enjoy every day of your nursing career.

[RNsRWe, ASN, RN]

Then what's the problem with a taxi??

At one time, anesthesia did allow this....and then, of course, "something" happens that now makes it no longer allowed.

A taxi driver is responsible only to stop at the curb and let someone out. They aren't taking responsibility to make sure that person safely navigates the steps/staircases, or even if they can manage the key to get in the door. Or even if the person can find their key.

Once in awhile someone will go home by taxi, WITH a friend or relative or whatever next to them, who is making sure they get safely in their home, etc.

On the two occasions I mentioned, the drivers did sign on the line that they would do those very things (again, the patient/customer was already known to them). Did they do those things? Who knows. But, once again, it's a legal issue; it's not up to us to follow them and see if they did.

[RNsRWe, ASN, RN]

I think the issue with a taxi is trusting that the patient will be taken home as opposed to a car off-site or some place else. It's a safety issue - hopefully a friend/family member would be taking them directly home.

Yup. -

[morte, LPN, LVN]

If they are SO compromised by the drugs administered, yes they need/deserve/require nursing care. We have allowed insurance companies to increasingly decide these things in their (ins co) fiscal favor.

[trufflelilyRN]

That is a good point. Insurance companies are the ones making these decisions.

Certainly, taxi is an option. I have had conscious sedation a couple of times. After being kept in the unit a couple of hours I was not at my best, but with an ethical taxi ride I could have been safely home, found my key and paid the taxi.

[ClearBlueOctoberSky]

A taxi driver is responsible only to stop at the curb and let someone out. They aren't taking responsibility to make sure that person safely navigates the steps/staircases, or even if they can manage the key to get in the door. Or even if the person can find their key.

What's to say that the patient's friend or family member isn't doing the same thing or even saying "Hey! Let's celebrate your clean colon tonight at the bar."? In the litigious world that we live in, someone, somewhere is going to find a reason to sue.

The responsibility for the patient has to stop somewhere.

[RNsRWe, ASN, RN]

What's to say that the patient's friend or family member isn't doing the same thing or even saying "Hey! Let's celebrate your clean colon tonight at the bar."? In the litigious world that we live in, someone, somewhere is going to find a reason to sue.

The responsibility for the patient has to stop somewhere.

Agreed. But they won't be suing US....WE told the alert, oriented, aware patient when they made the appointment that they'd be required to find a responsible person to drive them home. We asked them when they arrived if they had a responsible person to drive them home, and asked the patient to provide that person's name and phone number (in case they wandered away from waiting room).

If the patient chose poorly and went home with someone stupid enough to say "hey, let's celebrate at the bar", that's on them.

And THAT'S where our responsibility to the patient ends: when we've had someone the PATIENT has CHOSEN sign them out. Done.

If there's a reason to sue, it's going to be against their "friend" who did something stupid, not the person who discharged them safely.

[redhead_NURSE98!, ADN, BSN]

I think the issue with a taxi is trusting that the patient will be taken home as opposed to a car off-site or some place else. It's a safety issue - hopefully a friend/family member would be taking them directly home.

Home? Why does it matter where I go and what responsibility is it of the facility to ensure where I go? If I want to hit up a dance hall and get my money's worth out of that Versed what's the facility got to do with it?

This is what I don't get about our fabulous country. There is absolutely no personal responsibility to be assigned to Joe Smith. There ALWAYS has to be someone caring for us. At this point I'm shocked that we're allowed to discharge a patient "to home" without a cab ride, a sack full of pills (we can't expect them to go get prescriptions filled!) and a voucher for a full fridge worth of groceries, since their food has rotted while they've been in the hospital. OMG, what if we discharge them to home and they have nothing to eat that night? They will starve to death and their family will sue! At what point is the facility allowed to let go? I'm with a pp, if it's that big a deal then maybe they should be staying the 24 hrs till we're absolutely SURE the sedation is worn off. Oh what? That's too costly? Oh, well then I guess we can abdicate our responsibility and pass it off on a total stranger layperson to take this person home and monitor them for...whatever it is you want a layperson to control.

I once had very basic oral surgery with IV sedation. They told me I'd need someone to drive me home. I showed up and they asked where my driver was. I said "I'm going to call him when I'm done." They said that they had to be there before I was sedated and said "if something happened during the surgery we need that person to make decisions for you." I ALMOST didn't have the surgery when someone on staff says something that stupid. Yeah, my neighbor Biff is going to make DNR decisions for me because he's the one who's going to drive me home, that's genius right there. So, the surgery had to be delayed for an hour waiting for my husband to get out of work and come sit for ANOTHER hour waiting on me. Sorry, other patients! And no, it was not made clear to me that he was supposed to be there at the start of surgery. "Someone to drive you home" means someone to drive you home.

Meanwhile at the hospital across town, my husband had hernia surgery while I was an hour away in court. They called me when he was awake and I came and picked him up. Wasn't required to sit there and wait on hernia surgery, but hubs had to sit in a waiting room for something to be cut off my gums. You know, just in case I coded.

I don't mean to be smart, but OP you guys sound like you have a lot of free time on your hands! Following patients around? Just let it go! I mean, we discharge inpatients back into their crappy semi-neglectful home lives (the ones that caused the admission) every day. Are we supposed to be responsible for the poor lady whose husband spends all the welfare money on gambling and doesn't buy any insulin or test strips for her? I feel for her, but no, we're not. How far do we take it?

(Sorry, I know this post is a little old but it's a sore spot for me because I'm one of the ones that doesn't have a lot of people sitting around waiting to pick me up. I don't feel that I need a ride home when a cab would suffice.)

[medresearch2011]

Lots of things were problematic during my last colonoscopy (unauthorized students, srna etc) who were not supposed to participate etc; but everything was straightened out when I went across town to a different for-profit hospital with my endo doc travelling to do my case with an anesthesiologist not a student or a nurse. We specified propofol only and that's what was used; the exam was completer with moderate sedation and 30 minutes later, I was dressed and my endo doc and I left the facility. I made it clear that I was driving myself back to the university hospital; the endo doc could not drive my stick shift car. The endo center had a hissy-fit about my driving until we got the anesthesia doc to explain why I couldn't drive home safely 30 minutes after propofol..and we don't care about policies, only safety. the anesthesia doc told me that driving 1 hr after propofol (about 300mg) was totally safe as I had insisted. my endo doc said that most of the docs got their colonoscopies with no meds or propofol only and returned t work in the endo suite or operating room within 1 hour of their colonoscopy. Why the BS thta patients are given about not driving themselves home? if they go only propofol, driving 1 hr afterwards is fine