I'm a home health RN for another week or so (getting the he** out of healthcare). This readmit thing is getting bad. The reality for those of you in bedside nursing and PCP offices is that I can only do so much with a stethoscope and a blood pressure cuff. Most PCPs don't go into the hospital anymore so when I call an MD with an adverse finding at a HH visit, I expect an intervention NOW, not 24 hours from now. And the intervention should not be "send them to the ER I haven't seen this patient in 4 months." For example, 2 weeks ago, visit to Mrs. "Smith", she was feeling kind of weak, took her BP, sitting 110/70, standing BP 68/46. Ok Mrs. Smith, let's call your PCP. Her doctor was a family doctor connected to a hospital system. After I spent 15 minutes on hold waiting to speak to a live person, I spent another 15 minutes telling the operator why I need the MD/NP/PA to call me back. I waiting another 30 minutes or so with the patient, no call back. So I gave her the intervention myself, have a can of chicken noodle soup (all of it), drink 2 tall glasses of water and I'll be back in an hour to check on you. And don't take anymore BP meds (physically took them out of her pill box). Went back in an hour and she had improved but I did not receive a call back from the doctor until the next day.
I cannot stop a stage 4 lung cancer patient from developing pneumonia, nor can I head off that case of steroid psychosis r/t steroids at chemotherapy. Here's a news flash, patients are non compliant, especially in their own home. Crappy food, poor living conditions, and limited caregivers make for a difficult environment keeping these people well in the home.