Question about patients from SNF/LTAC

[smf0903]

We are a small rural hospital (just for background to this question). We've recently run into an issue with patients coming from SNFs/LTACs in our area.

Anyone with something we didn't stock (our first issue was with trach supplies different from ours) that the SNF/LTAC refused to send over so we had replacements.

Second issue was with odd-ball meds. Meds the patient has to have compounded or just something that is not available to us in our pharmacy the SNF/LTAC refuses to send with patient. This has resulted in our facility having to call around our area to find a pharmacy who carries said meds and can get them to us. This seems ridiculous as these meds are sitting at the other facilities.

Is this his common practice everywhere?

[BBP42]

I have never been asked to send supplies or medications when my LTC patients went to the hospital. I don't know if it would even be allowed. If the hospital did not have their meds available, the hospitalist would order something they had in stock that was a similar medication and substitute that.

[Wuzzie]

With the trach patient at you talking about the trach itself? Or trach care supplies?

[KatieMI, BSN, MSN, RN]

It is, unfortunately, a norm of life. Facilities cannot send patient somewhere with supply of disposables for unknown period of time. The stuff costs $$$$.

In LTACH, a few times we collected all necessary stuff for difficult wound dressings or line changes for limited time, particularly if patient was discharged on home care with a family member or home care RN trained to use specifically those types of supplies just to avoid confusion. It always took some movements to avoid being blamed for "excessive waste". Otherwise, Shiley #8 is Shiley #8. It doesn't matter what pads or holders or ties are used with it.

Re. compound/not available meds, pharmacies have to be contacted, preferably 24h before. In most cases, meds can safely be substituted for dose equivalents. Patients who must be taking something life-sustaining for them (transplants, mineralocorticoids, etc) must be identified before transfer by providers (as well as nursing staff) on both sides to assure correct transfer orders.

If your facility cannot provide/use medication which is life-sustaining for the patient (for example, pharmacy doesn't care anti-rejection meds and staff is not trained to administer them), then the patient must be admitted only for emergency stabilization and sent to higher level of care ASAP.

[Wuzzie]

Otherwise, Shiley #8 is Shiley #8. It doesn't matter what pads or holders or ties are used with it.

That's kind of what I was getting at. However, two things stand out. Some patients have specialized trachs and trach patients should always be transported with a backup anyways.

[smf0903]

That's kind of what I was getting at. However, two things stand out. Some patients have specialized trachs and trach patients should always be transported with a backup anyways.

This is what I was referring to...we carry the standard stuff and care supplies but we had someone come with a specialized (I don't recall what exactly the deal was) and the facility the patient came from refused to send a just-in-case replacement. I guess I don't get the whole issue because if we didn't end up needing the replacement or parts then they'd go back with the patient when they went back to the ECF/SNF/LTAC.

And as for meds, in the past if we didn't carry them in our facility then the facility the patient came from would send those meds. All the sudden that came to a screeching halt. I just was curious if this has been the norm in other places and we were the weirdballs :)

Thanks for the responses! :)

[YUKONrn]

The SNF facility pays for the patients meds, not the patients insurance. In fact the facility pays for everything on every SNF resident right down to the disposable briefs. So they absolutely do not get sent considering certain medications and supplies are extremely expensive.

[Here.I.Stand, BSN, RN]

I guess I don't get the whole issue because if we didn't end up needing the replacement or parts then they'd go back with the patient when they went back to the ECF/SNF/LTAC. [/Quote]

Unless they don't. On my unit (ICU) they don't even want to send monitoring cables if the pt goes to the OR -- we're all human and can forget to return them.