Procedure when family or pt does not answer phone or door.....

[AtlantaRN, RN]

For home hospice nurses--does your company have a procedure when family or patient does not answer phone or door...

Hospital sent a patient home by ambulance who, on report, nurse was told patient oriented X2, history of falls..... transport got patient home, family was not home....ambulance left patient home alone..... Our nurse got to patients home in the afternoon-attempted to call repeatedly, knocked on door, no answer and no response.......nurse called sisters cell phone repeatedly, no response....... On call nurse, went over there, found door unlocked, went in--patient was there----call nurse got patient to sign consents.....................(come to find out, while call nurse was there, sister/pcg called home collect-from local jail--she had been arrested). Patient told nurse she had family in a neighboring state--nurse called family and they traveled to patients home--------she waited until family arrived.

Does your hospice have a procedure for such a situation....my thought is ambulance should have NEVER left patient home alone---------nurse should have never entered the home......I would have been concerned for patients' well being, but that never superceeds my own safety...

((((once, I was called to a patients home because patient was "breathing funny," when I got to the home the front door was open, I called 911 and was told that an ambulance had transported patient to local hospital.....I NEVER enter a patients home unless familly/patient opens the door, or if a patient who has answers the phone tells me to enter....))))

Thoughts?

thank you for your help.....Management gave major kudos to nurse for going "above and beyond", but I would have never entered home without a police officer/sheriff investigating the situation prior to my enter.

Thanks again.

Linda

[annacnatorn]

I got into trouble for staying 18 hours with a patient. He had no family in the state, lives in the house alone, he had no one, his breathing was irregular all night needed MSO4 q 4 hours for pain. He was a Veteran of WW2. I stayed with the patient until He was transferred to the VA Hospice unit and His dog, his life was given to a neighbor who loved the animal. I got into trouble "because I stayed" I told them the situation, I even tried to call my DON, NO ONE Answered, I stayed. I felt good to have stayed with this man. I was in the room when His son called, He told his son, I love you and you know where things are. Thankyou for the life you gave to me and your mother. I have to go now son, don't you worry, I have a nurse at my side"...when I left for home, I cried, I went home, showered went to the office, got yelled at then yelled back (it felt good, they were yelling cuz I stayed, but I stayed because HE was alone)...I don't think any agency has any protocol for such things as this, they need to.

Further more, The Ambulance company needs to be reported for "Patient Neglect or abandonment" He clearly was not able to care for himself.

just my 2 sense worth.

[Hospice Nurse LPN, BSN, RN]

I have 2 pts I see that I knock and walk in. This was decided when they were first admitted. Both have an elderly spouse at home with them during the day and it takes them a while to get to the door. But I would NEVER just enter someones home that I had never met before (ie another nurses pt or a new pt). Some of our pts live in shady areas and I think it's a safety issue. If I call a pt and there is no answer to the phone or door, I call it a "missed visit" and call my DON and a family member to tell them about it. You never know if something happened like a fall or they simply forgot it was the day for the nurse and went out with a friend or family member.

[caliotter3]

Clearly the ambulance personnel abandoned the patient. It was dangerous for the nurse to enter the home, but I probably would have done so, unless I had reasonable reason to suspect. In that case, I would have called the local police; she probably should have done that before entering because of the unusual circumstance.

[pielęgniarka, RN]

It's not hospice but our local meals on wheels has this type of situation listed on their initial interview. Most of the people getting meals on wheels have medical issues and can't always get up to answer the door promptly. The question is what is the recipients request: should we knock then it's ok to walk on in with the food... or knock and wait for someome to let us in.

[tewdles, RN]

These are difficult situations...and similar things happen rather routinely in field hospice work.

Just yesterday I received calls from the volunteer, the HHA, and the supervisor because one of my patients was not answering his phone or his door...and the doors were locked (unusual for this man). It happened to me recently with him as well...he was off on a day trip to the casino!

Typically, we make every attempt to contact the patient or family to determine that the patient is safe. We document the situation in the record.

If the door is unlocked, and there is no response to phone or knock, the clinician may use their own professional judgement about entering. It may be wise to contact the police before doing so dependent upon the area and circumstances. I know that for a patient that I have been visiting, I would stick my head in and shout my presence, then I would enter. If this were a new patient I would probably not enter uninvited, but I would certainly be looking in the windows, particularly if they were expecting my visit!

It sounds like this was an initial visit...so I would not likely have walked into that persons home without a police escort...wouldn't want to be charged with B/E by a disgruntled relative who is sure that the silver is missing since that visit. Both the family and the ambulance company dropped the ball here, in my estimation...

[Hospicetex]

If it was a new patient, I don't think I would have entered. There are a few neighborhoods I am leery going in to begin with. If my patient doesn't answer the phone our protocol is we still attempt the visit with a knock on the door. If no one answers we omit the visit.

I have several patients that won't answer the phone, I leave a message letting them know I am still at the office and to call back if they need any supplies. It is frustrating at times to go to a home 55 miles away and they need supplies and would not answer the phone. I try to have "the usual" supplies in the trunk for just that reason but meds are another thread...when they won't answer your call and live that far away.