rainie11264

I recently moved from a vent unit to an assisted living. I work on a floor where the people are very fragile, the doctor is in at least twice a week and the nurse practitioner is in on the other days. These people are skilled care at ALF costs. One of my patients has an order for an H&H monthly and procrit if the HCT is below 30. His HCt on 9/15 was 28.7 and I gave him the procrit. Over the last couple of weeks he has had increasing fatigue, shortness of breath with exertion, and his color has become extremely pale. I called his son in law, who is also his doctor, and asked if we could do another CBC. He agreed, and it came back with an H&H of 7.4 and 22. I spoke with the daughter, who works with her husband. She said she would bring the procrit in after 5 30 pm. She asked me to let the 3 - 11 nurse know. I gave all this information to the oncoming nurse and asked her to be sure the procrit was given. Saturday I came to work and the nurse giving report told me the procrit wasn't given. She didn't know why, and there was no documentation. The doctor called me a short time later to be sure the medication had been given, he told me the procrit they had was expired and we were supposed to order the med from our pharmacy. The patient is 87, a DNR and didn't want to go to the hospital unless there was no other action to take. I told the doctor I would track the med, make sure it was given, and let him know when it was done. The medication was not ordered so I ordered it. Meanwhile, the 3 - 11 nurse left me a message saying she didn't know why I was confused, the daughter didn't bring the med so it wasn't given. She hadn't done any follow through because it wasn't necessary. i had trouble getting pharmacy to STAT the med to me but I finally got it at 2 pm and gave it. The doctor called me back right after I gave it because he didn't want to wait any longer for the med. I let him know it was given, and he then ordered niferex for the patient. My problem with this whole situation is that where I come from those labs and the petient's presentation were significant and required action. I gave the info to the 3 - 11 nurse and she did nothing, she didn't even document. If I hadn't heard from the doctor/family by 9 pm or so I would have called to find out what was going on. The doctor told me they were in and spoke with the 3 - 11 nurse so she knew what was going on. I feel like she neglected to provide appropriate care for our patient. Am I wrong?

tobys mum: i just meant to say that we are in the middle of relocating to the baltimore area also. my husband has been there since february and the rest of us will go as soon as school lets out for the year. i don't know if you have children in school or not but if you do i found this site helpful: www.greatschool.net for checking out different school districts. if you are looking for apartments i found this site helpful: www.rent.com . there was also a site i found that related crime rates and types of crimes for different areas but i can't remember what is is. i might have searched -- wait i think i found it: www.baltimorepolice.org . on the left in the blue box i think you will find "bpd districts" and also, "resources" in the same box. i thought there was a baltimore county site also but i'm not seeing it right now. hope these help