cmcervantes63

I'm not really sure, but according to the chaplain that we spoke with, since he was pronounced in the ED, it became a case for the medical examiner, and an autopsy would be performed. This was news to me, too.

I'm sorry that you think that I am lashing out, and if it sounds like that, I apologize. That is not my intention...I know that I cannot ever guarantee that it doesn't happen again, but if meeting with administration can help iron out some procedures in a new facility, I am glad that we can do that. I said in my original post that I did NOT want retribution...and I repeated it in a reply, that I am not looking to get anyone in trouble. Retribution is a waste of energy that can be better spent in other efforts, and I was never looking for that.

There isn't a need for negativity or sarcasm. You can learn from every experience in your life, and I intend to learn from this one. Again, thank you to everyone for your kind words and advice.

Thank you very much. I know that he was dead before he got to the ED, but in my family and culture it is important to be with your loved one at the time of death. A dead body is not just a corpse to the people who love him.

Thank you so much. I hope so too.

I couldn't agree with you more. I am so sorry about your father, and I am glad that you have had the opportunity and strength to make peace with it.

No, it was not like this. It was most definitely a case of improper procedure.

I agree completely. One benefit of having to endure this situation is that I will keep it in my heart every day, and use it to better my communication with my patients and their family as long as I am a nurse.

You are absolutely correct, luvthegsp-- We just want answers. We don't want anyone's head on a plate or job in jeopardy. We just want answers. We spoke with the DON, and we got those. Knowing that the facility knows they had a deficiency in their procedure will hopefully change the way they operate, and our experience would not have been in vain. I am so sorry about your father, and am glad that you have found some peace with what happened.

If this is not why you come here, then ignore post the and move along. Why is it even necessary to respond? Do you respond to EVERY post that doesn't specifically apply to you? I am on this site because I am a nursing student, will be a RN in a matter of months, and I enjoy communicating with other students and learning from nurses who are obviously more well-versed in matters of patient care than I am. In this case, it was a failure to communicate and notify next of kin upon a patient's death, which IS the nurse's responsibility in this scenario. I wanted to get feedback on what is proper protocol and to see if anyone had any ideas on what steps I should take to ensure that this doesn't happen again. I have received a number of responses from amazing and compassionate nurses who did see the relevance of my post, and have given me guidance to take the proper steps. If you are not one of those people, don't care, don't see the point, or don't come here for this, then leave well enough alone. All you've lost in reading my post is 10 minutes of your time. Thank you again to everyone's kind words and condolences. We have taken your advice we met with the DON. There weren't certain procedures in place that should have been, and hopefully there will be changes in the way this facility conducts incidents such as these.

I'm not blaming anyone for my uncle's death. At this point, we don't know how he even died. I'm blaming them for not calling to tell us to get our butts to the ED. There's no reason that after he got on the ambulance, they couldn't take thirty seconds to notify our family.

Thank you sooo much for this. I feel like I have gotten a lot of judgment from others regarding my anger and frustration with the situation. I don't feel like there was ANY excuse that a 30 second phone call couldn't have been placed so that we could have at the hospital when or shortly after he died. You learn in nursing school that justifying an error with "we got busy" or "we were short-staffed" is never an acceptable response. We only want for someone to accept responsibility, render a HEARTFELT apology, and fix whatever breakdown in the system that currently exists. Thank you again, from the bottom of my heart.

No, you aren't missing anything. As I said in my previous post, he was already ill, and we understand that people can die suddenly, and without warning. We are absolutely brokenhearted that he died...make no mistake about that. We loved him very dearly, and were involved with his care; to that end, we weren't naive to the fact that he could go at any time, and we were prepared to handle it and be there when he died. Until the autopsy results come back, we won't even know how he actually died, and am not placing any blame on anyone in the facility for that. He was ill, and we don't know if there was anything done that could have saved him. What I AM placing blame for is that my mom did not get to hold his hand, give him a kiss, say a prayer, or even lay her eyes on him before he left to the morgue. There is an obligation on the staff to notify the family of a change in his status; you would think that if they can call us to let us know he needs a change in his medication, they would call us to tell us that he is in respiratory failure and we need to go to the ED STAT. Thank you to EVERYONE for your kind words. Prior to this post, we had already spoken to the director of the funeral home, and he told us that though my grandmother, mother and uncles can perform a witness and identification prior to the cremation, they will not be able to be in the same room as he is. I agree that they probably wouldn't want to anyhow, considering his is four days postmortem and had an autopsy performed. I am not looking for a lawsuit, monetary payout for emotional distress, or even retaliation. I understand that mistakes happen, but they also need to be reported, reprimanded, and recurrences need to be prevented. Sweeping this under the rug is not going to prevent it from happening again, and that is essentially our ultimate goal-- that no family whose loved one is in this facility loses their last chance to be with them as a result of a complete breakdown in communication. It is a relatively new facility, and if there is no protocol regarding such incidents, there will hopefully be one now.

This past week has been a very difficult one for my family and me, and I thought I would enlist the help of all you wonderful and wise nurses out there. I'm in need of a little guidance. Just a little background: my uncle was 57, and he had down's syndrome. He has been in group homes most of his life, and was pretty functional until about two years ago. He started to decline cognitively, and then physically. My mother moved him to a SNF closer to us in Dallas a few months ago, so that we could visit him and monitor him a little more closely, since he didn't get the best care in the small town SNF he was in. At the time of the move, he was pretty much debilitated d/t contractures he developed at the last place he was in, had multiple decubitus ulcers, had a peg tube, and was septic. The SNF we moved him notified us immediately that they were transferring him to a hospital nearby. He improved after a couple of weeks and went back to the SNF. My mother was very involved in his care, and was generally notified if anything was changing. The past couple of weeks she had not gotten a chance to visit, but got report from other relatives that he was doing well. On Thanksgiving, however, things took a turn for the worse. He was found at about 0300 by a CNA, with vomit on himself and shallow breathing. When the nurse came in, he had stopped breathing altogether and was sent by EMS to a hospital nearby. He died at 0413, and the nursing home was notified at 0423 of the death. I'm guessing he aspirated, though we will not know for certain what the COD was until the autopsy results are back. Now, this is where it gets bad. When he was transferred to the ED, no one in my family was notified. The hospital did not receive next of kin information from the SNF when he was sent. When the hospital pronounced him, notified the SNF, and requested more information on him, someone said they would have the nurse call... no one ever did. At 0715 on Thanksgiving, my mother received a phone call from a nurse, who didn't even have the right name, to notify my mother of the death. My uncle died alone in the ED on Thanksgiving, and was sent to the morgue. When I cried and screamed and asked why no one even called to tell us he was being rushed to the ED, all she could say was "Sorry." No explanation. After we gathered my grandmother and my other uncle together to go see him, he had already gone to the ME's office for autopsy. We never even got the chance to say goodbye. My mother can't afford to have a viering and a burial, so we are doing cremation-- she still hasn't seen her brother, never got to hold his hand, and will only be able to see him through a window before he gets turned to ash. We got a call at 10 pm that same day from another nurse, who sent her condolensces, but still could not offer an explantion. There is no explanation. There is no excuse. There is no reason on this green earth that my family should not have been notified that he stopped breathing and was en route to the ED. There's no reason the ED should not have been given next of kin info. There's no reason that the woman who notified us could not get his name straight before she called to tell us he was dead. There's no reason that she asked to put me on hold to get another line while I cried and asked for answers. There's no reason that our last chance to see and hold him was so horrible taken away from us. Needless to say, we are furious and hurt. This was a complete miscarriage of trust in a facility that was supposed to care for my uncle. We understand that people fall ill and can die suddenly, and without warning. Obviously we are upset about the death, but more than that is the break in communication that followed. I just needed to see who I should report this to, and what actions I can take. I'm not looking for retribution, though disciplinary actions is most definitely warranted. Nothing is going to give us that time back, but I want to make sure that this doesn't happen to another family.

I wasn't necessarily looking for fluff, just kind of hoping it would have more information than it did. Maybe an itinerary of what orientation would cover and a list of the books and stuff we could go ahead and start getting together for the first semester...you know, for those of us who are overly-anxious and didn't want to wait until orientation. As for immunizations, I would call the health department, but I'm not really sure. If they don't do it, I am sure they can refer you to someone who does. I'm thinking that since I work at a hospital, I already have everything I need, or they wouldn't let me work here...if not I hope they can give me whatever I am lacking. If they can't, I'll find out whatever the most cost-effective place would be and let you guys know!