I work in a rehab/LTC facility. I just have to tell yall about a patient I received last friday. I'm still in shock about it.
We were expecting this patient for strengthening and gait training.He is able to shower himself, dress himself but his dementia is progressing fast. He and his wife had made the decision to move him to an ALF and she was going to move in with him after selling their home, etc.
4 days after admit to the ALF, he and his wife both caught a horrid virus. He ended up in the hospital from the dehydration.
He has been monitored by a geriatric behaviour program for his dementia. has been stable on seroquel 25mg tid.
While in the hospital with the vomiting, diarrhea, and dehydration his confusion got real bad. they transferred him down to the geriatric psych unit. the ALF had sent him to this hospital due to closeness to their facility but his doctors are at another facility so these people knew nothing about him.
Due to the dehydration, etc. his confusion got worse, he became combative at times and agitated. While on the behavioral unit they increased his seroquel to 50mg tid and 100mg qHS. they didnt gradually increase it either...just did it.
when he couldnt/wouldnt take the seroquel they gave him IM Haldol and also had him on IV benadryl. they also had him restrained.
so his dehydration, etc had resolved, the diarrhea stopped so the hosp. told them they needed a SNF to get him stronger and back to his prior level of functioning before he could return to the ALF.
so on the day of transfer, I got no report from the hospital, and he just sorta showed up (happens all the time doesnt it?). Before the EMT's would transfer him from their stretcher they came to me and asked that i see him before they did. (im the suprvisor).
What I found was a completely nonresponsive male. not even responsive to a very hard sternal rub or other painful stimuli. I looke at the EMT's like "wth???". they took me out in the hall and told me that when they picked him up at the hospital they were shocked when they saw him. here they were supposed to be transferring him to a SNF for therapy and this man was totally nonresponsive. they told me that in front of the wife and daughter they asked the nurse to reassess him and told her they were not comfortable transferring him out of the hospital. the nurse refused to reassess him, told them he was "just sleeping due to the seroquel" and he was fine.
i went straight to the phone and called the nurse that had him and asked her for a report. she tells me that he is "just sedated" and if we were smart we'd keep him that way. she said he was very combative, "especially when you change his brief". I questionedher over and over on his condition and the fact that he was nonresponsive. Eventually I ended up talking to the charge nurse because the floor nurse got angry at me when i told her i couldsnt believe they had transferred him in this condition and that i was probably sending him right back via the ER.
so the charge gets on the phone and she tells me he's just sedated as well. she tells me "if you dont believe me, get your CNA to go in there and change his brief...that'll perk him up!". I'm like "omg, are you serious? this man is COMPLETELY nonresponsive!". she then says "well he was sleeping so we held his 2pm seroquel". geez. so i asked her exactly what meds he had had that day so that when i sent him to the ER i could relay that to them. she faxed me his mars for that day. he also takes dilantin for seizures.
i ended up talking to the nurse, the charge and the CNA that had him. seperately, they all told me the same story. "up until 2 days ago he was severly combative and had to be restrained". um...ok, what happened 2 days ago that made him change? "the seroquel kicked in" (i swear to all that's holy the charge nurse really said that)
i grab the administrator and go back to the room to talk to the wife and daughter. needless to say the wife was very aprehensive about sending him back to the hospital. she kept telling me "i told them 2 days ago something was wrong with him but the ywouldnt listen and just kept giving him drugs".
his VS were decent. i put o2 on him. his wife really didnt want to transfer him so i told her that we would CLOSELY monitor him until morning. at that time, i would draw a bunch of labwork and we could go from there. that way if it WAS the seroquel, he should be more alert. i also put all of his psych meds on hold. not that it really mattered becuase this man was out of it.
early the next morning i drew his labs and sent them to the hospital. the results? dilantin toxicity(45) and hypernatremia (165), BUN ~98.
i sent him straight to the hospital but not the one he came from.
he ended up in ICU as you can imagine. i spoke at length with the doc when he got there and he told me that he didnt think he would make it.
the whole thing has made me very angry. if I had transferred him to the ER like that, the hospital would have called CMS on us in a second!
they all said he'd had a change 2 days ago. his granddaughte is a neurologist at Emory and she questioned the doc at the hospital over the huge increase in seroquel but they kept telling her how combative he was and he "needed it". his wife said she hadnt left his side for 2 days and he kept getting worse and worse. their daughter told me that they had questioned the nurses and doctors for 2 days asking them what was wrong with him and they kept telling them it was the seroquel. they would shake him awake and pour the meds, mixed in liquid, in his mouth.
i told the charge nurse that the EMTs had asked the nurse to re-eval him prior to transfer and she refused saying "there aint nothing wrong with him, get him out of here". she said that in front of both EMTs, the wife and the daughter. when i told the charge that, she asked the nurse while i was on the phone. the nurse adamantly denied the conversation took place. i told the charge i wasnt going to call anyone a liar but that i had 4 people telling me the same exact story.
Can yall believe this? Can you believe that he was sent to a rehab facility in this condition? I am by no means perfect. I've missed things too. But, IMO, this was just a case of gross neglect. this is also the first time in my whole nursing career that i have ever said that about another facility. i'm still in shock over it.
His wife called me the next morning thanking me over and over for taking care of him. i spoke with the doc when he called to ask me some questions and he told me "you saved that man's life, i hope you know that".
What are your thoughts? Have yall ever had a patient transferred to you like this? What do you think about it?
