Residents leaving for outside appointments...

Fiona59 · Nov 25, 2004

Its up to the family to get their relative to the appointment. They arrange transport and companion. They can hire someone from an agency need be.

However having said that for those with no family or "next to no family" volunteers would go if there was no transferring involved. I mean the staff at the other end can do the transfer.

Mind you I once escorted a woman to xray in the hospital next door. The woman's incontinence product leaked (ok down her leg onto the floor) never saw a damp patch on her. She was capable of independent transfers but a wander risk. The x-ray tech stood in front of the door and said "what about that? while pointing to the puddle "you don't leave until its clean." Being a good LPN I towelled the floor and asked if she could arrange for housekeeping to come on down and clean it properly. Then I escorted my woman who still didn't have a damp patch on her back to our facility. I still wonder if the puddle was there before we got there.

**canoehead, BSN, RN** · Nov 25, 2004

It was the Xray tech's problem in my opinion. Would she make a family member clean it?

lovingtheunloved, ASN, RN · Nov 26, 2004

I DESPIES doctor's appointments. I would sell my kidneys on the black market not to have to go on one. I accompanied one lady (who yells help all day long, just a behavior,) to the dentist, where she yelled HELP! the entire time we were in the waiting room, and the other patients just looked at me like "Well, aren't you going to help her?" And then she spit bloody gauze at a three year old. And, it throws staffing off. When we barely have enough staff in the first place...OH! Check this crap out...

A resident's husband (who is out of his mind himself) wanted his wife to get a perm at a local salon. The DON not only said that the facility would provide transportation, but that an aide would go with. Mind you, this resident is in a geri chair, so the sinks at the salon wouldn't accomodate the chair, she is VERY easily agitated, has chronic pain, and is a two person transfer to the toilet, which would have to happen since the appointment was projected to take about FIVE hours. And to top it off, the day of the appointment we were short already. My charge nurse and I threw a fit. My suggestion was that he go on the appointment since as an RN, he would be able to give the Ativan that she was sure to need, and since he's a very large man, would have no trouble transferring this lady. The administrator put a stop to that nonsense. The hairdresser came to the facility. Bless her.

Larry77, RN · Nov 26, 2004

Mostly we use services that do this sort of thing. They have vans and will drop off and pick up pt's from appt's...they do not wait with them however. If someone needs someone to stay with them, a family member must be present. We do not allow staff to go with them for the same reason that you are having problems, there's just not enough of them to go around. Luckily I live in a small community where family members seem to be very involved with their loved one's so I haven't had a problem with finding someone to accompany when needed. Also we have a social-worker that takes care of all the appt. transportation needs. As nurses we just leave her a note and place the appt. on the calender.

Don't know if something like this would be possible in your area but it works well for us.

Good luck,

Larry

donmomofnine · Nov 27, 2004

I have sent the unit clerk. We also have unit assistants who have gone in the past. It IS a pain! :rolleyes: If worse comes to worse, we send the aid who has that resident on their assignment. As far as help on the other end (at the MD office) YOU HAAVE GOT TO BE KIDDING!:rotfl:

Antikigirl, ASN, RN · Nov 28, 2004

I am in assisted living...all private pay patient must have family to arrange and transport their family to appointments, unless it is arranged far in advanced and our transportation staff has the time to take them to the office lobby, and pick them up when they are done.

We also have residents in a care program where we take care of all their medical needs (IE the reason we have transportation), and it is still...take to doctor, bring back...and they have a doctors order sheet and appointment summary sheet they must fill out so we know what happens. Once in a blue moon, if say a person is going in for some bad news, our DON goes with them (we have had some Dx of cancer we knew were comming and we don't want them to take that news alone...too heartbreaking). But those are rare!

This allows staff to stay on the floor, and has worked very well for us! We have a wonderful transportation system, including wheelchair transport to and from appointments at a VERY discounted rate for seniors (like 10 cents a mile, and most places they go are only a few miles! We try to have family arrange close by appointments!). We also can use our ambulance company for non-emergency transport if someone is bedridden also at a very seriously discounted price for seniors..that is VERY handy!(we have private owned ambulance company's). So it is very easy for folks to get to appointments, and that sheet the doc fills out is GREAT and easy for MD's to just fill in! :)

Maybe those ideas will help you!

MQ Edna · Nov 28, 2004

Well again,, I work in substance abuse so we just call a cab & give them instructions the pt goes directly there & straight back with no pit stops in between, then they drop a urine upon return..but when I was in a extended care facilty we had a transportation service that we used to transport & a family member had to attend to the pt, no way we were going to give up our precious staff! -that just doesn't make sense for a multitude of reasons!

-sara

BowlerRN · Nov 28, 2004

I work in a nursing home where we do not have any kind of clinics available in the facility, so almost all appointments are outside, except homevisits made by docs. We never send one of our CNA's from off the floor. The facility has a van and the resident if not taken by family is taken by the social services director or the activity director, both which are also CNA's. I also work in another facility where there is a transportation system that is ran by the maintenance staff.

donmomofnine · Dec 1, 2004

Well again,, I work in substance abuse so we just call a cab & give them instructions the pt goes directly there & straight back with no pit stops in between, then they drop a urine upon return..but when I was in a extended care facilty we had a transportation service that we used to transport & a family member had to attend to the pt, no way we were going to give up our precious staff! -that just doesn't make sense for a multitude of reasons!
-sara

At our facility, it DOES make sense, because they pay a good deal of money to live there and are entitled to those services.:)

flashpoint · Dec 1, 2004

Well...as someone who has worked in a clinic, I don't have a problem at all with simply assisting a patient from a W/C to the exam table, etc. I do, however have a problem with being the one to take the patient to the bathroom or take care of their other ADLs. When we are seeing 4-6 patients (or more) in an hour, we don't have the time to take the patient to the bathroom, stand them up, get them to the toilet, wait for them to go, provide pericare, and get them situated back in their W/C. It also makes it really tough on us if they are incontinent and don't bring their own supplies. Most clinics simply don't have a bunch of Depends or similar pads lying around. I think that a lot of people think that taking their loved one or a resident from an LTC to a clinic should provide them an opportunity to take a break...well, it doesn't. You are the ones who know how this loved one or resident transfers best, you are the ones who know their habits, you are the ones who know how to cajole them into doing what needs to be done when they are acting out or belligerent...not the clinic employees. You also need to remember that clinics often don't have the staff to do two or three person transfers...they also don't have mechanical lifts. I know it takes away a valuable employee from the facility for a few hours, but it is in the patient's best interest to have someone who is familiar with them at the appointment.

ComicRN · Dec 5, 2004

Thanks to everyone who has replied. This has been a big issue in our facility. Last month we had 10 outside appointments which left us short staffed 10 days. Granted, it wasn't for the whole day, but it does put a burden on the staff left behind. Our policy says that a staff member (usually a CNA; NEVER have I seen a social worker or therapeutic rec person go!!) has to go with the resident.

Anyway - thanks again all of you for your replies.

Jan