Sent patient to ER during admission

[Holisticlifern]

There's a first time for everything. I'm a little traumatized. I admitted a 80yr old who was d/c from SNF the day before. Originally the patient had a fall that resulted in a brain bleed. I arrived to find her with a very wet cough, typical of end or life or bad aspiration pneumonia. Per her very optimistic children they told me she was the same way to at SNF. She had recently had pneumonia but a follow up chest X-Ray showed it resolved( per family) The whole time I was in the home I kept thinking to myself she could not have been discharged this way. As I complete my assessment she seemed to become more and more lethargic and was very tachypneic with sats ranging 88-92.I finally said to the family that I think she needs to go to the ER. The family wanted to take her themselves but I insisted we needed 911, theyalso asked if they could just take her to a minute clinic, again I said no. I felt so bad sending her in an ambulance because she just got home and her family so so happy to have her there. The minute I walked into the home and seen her I knew something wasn't right, but since I'm a little new to homecare I assumed she was well enough to be at home since she was discharged.

Long story short I found out today this pt passed away, I believe it was the same day

the the nurses at my agency assured me that this kind of thing happens. Sometimes often. I feel so bad, like maybe I should have called 911 as soon as I walked in I know it's not my fault but I just feel so bad and like I did a bad

[LadyFree28, BSN, LPN, RN]

What you did was appropriate. You didn't back down and your assessment skills were correct; such is life; there is nothing to feel bad about.

[ChristineN, BSN, RN]

It was not your fault and I really doubt getting her to the ER any sooner that day would have made a difference. Instead, good for you on your assessment skills and picking up that something just wasn't right

[emtb2rn, BSN, RN, EMT-B]

Good assessment.

[AmyRN303, BSN, RN]

It's understandable that you feel badly. I'm sure you didn't expect that outcome walking into that house. That being said, it sounds as though you did everything you could do for this lady, and you should be confident that you made the right choices based on your assessment.

[LindseyRN86]

Just know you made the right call, you did everything you could. Thanks for being a fantastic nurse!

[trishmsn]

This was NOT your fault, you just got caught up in our mismanaged health care system. Getting EMS in sooner would not have mattered a BIT!

Almost the exact same thing happened to me on my first solo admission in HH 20 years ago. To add insult to injury, it was the mother of the local town's fire chief, who came out with his first response team. It was VERY hard not to tell him what I thought of him leaving a dying woman home alone. This patient died within hours of my attemped admission, and it really rattled me for a long time!!

[Holisticlifern]

Thanks everyone, I feel a little better. After reading all of the replies I realize I would have felt much worst had I not sent her to the ER. I honestly thought about her and her family for hours after I left them, I had a feeling she wouldn't get " better" but I wasn't expecting her to pass that day .

[silverbat]

This even happens with SNF admits. We got a Pt from a hospital who coded and died 15 minutes into the admission with the admitting office in the SNF. Hummm hospital didn't tell us he was unstable at all...... You did good!

[Mom2boysRN]

As others have said, calling EMS a little sooner wouldn't have done anything. I'm sometimes amazed at the condition people are d/c from the hospital or SNF in. You did what you needed to and made the right call.

[toomuchbaloney]

Those deaths now do NOT count in their facility M&M Reports, that is why they were discharged when clearly NOT in a condition to be moved around like a bag of beans.

The referral should have been to hospice, not home care for pity sake.

sigh

[ackbar]

Sounds like you did a great job!