Published Nov 2, 2005
Haunted
522 Posts
Got an admit from ER day 2 who had fractured his pelvis from a motorcycle accident. Young, helathy guy. 2 young kids, lovely supportive wife. Day 2 MD says send him home! I had to beg and nag to at least get him evaluated by PT and then hounded that department to order him a wheelchair and a front wheel walker. They did evaluate him for transfers and ordered a wc only!
I had to again call the MD and request some continuing rehab and the best they could get him was a home health aid once a week! THEN... the discharge med was vicodin for pain. No lovenox! Soo... I again call the MD and suggest lovenox, which I got a 10 day supply of but there is no one, including the wife who was competent to give an sq injection, they were all squeemish. I spent about 20 minutes on discharge teaching and suggested that they return to the ER for ANY problems. I asked the case manager if he could at least have a few days of in patient rehab but she said NO!!!
I don't know what else I could have done, I can see the outcome for this guy will be bleak and this facility is CHEAP!!!! What would you do?
SmilingBluEyes
20,964 Posts
DAY 2??? WOW. I wonder what the Risk Management dept would have to say......I can see why you are troubled about this.
Tweety, BSN, RN
35,715 Posts
Day 2 is not surprising. What is surprising is that he wasn't evaluated by PT prior to the MD writing d/c orders and that you had to ask for it. Too weird. Our MD's say "d/c home when independent with PT and with durable medical equipment (wheelchairs, etc.)". A young healthy guy may indeed be independent enough on day 2 to go home. But this should have been demonstrated. Someone in his shape probably is not a rehab candidate, because independence could be demonstrated probably rather easily. If he's young and healthy, his future isn't as bleak as you fear. He should be o.k.
I get in situations like that too. We're about to discharge the patient "I'm not sure I can climb the three flights up". Back to bed he goes. Just because an MD orders discharge. If the patients isn't safe, I don't discharge him. That's negligence.
Good for you for being his advocate.
IMustBeCrazy
439 Posts
A thought...
In this dire circumstance maybe the MD would at least be willing to write for something like 81 mg aspirin q day?
And yeah, that rush to discharge really stinks. I really hope your guy is ok.
:hug:
~IMBC
If I told you the name of this hospital group, starts with a "K" you would understand that they probably have no Risk Management Department. I am lucky to get a CNA with 5 patients primary. I believe their motto is "rack em, stack em, treat em, street em" . I am really concerned overall with this place.
They take IV pumps directly out of a patients room and use it on a new patient without cleaning it, they have crummy isolation supplies, use the ear thermometer on every patient without cleaning it, use a regular steth on patients in iso rooms, I would think that disposables and temadots would reduce the spread of infection. God help these patients if that super flu really does make it here. Speaking of Infectious Disease, they have 1 guy for the entire facility and he is a microbiologist. YIKES!!!!!
May I go on? Thanks. When they place an NGT they not only PLASTIC TAPE it to the patients nose ( ) they NEVER get placement confirmed by portable xray. I can't tell you how many times I have come on shift and upon making rounds, find a patient with NGT feeds laying flat, unrestrained with half the tube pulled out and that crummy pump is just PUMPING away.
How do they get away with this? Well, they are probably the cheapest healthcare provider for employers and that's their bottom line.
GET OUT!!!!
:chuckle :chuckle :chuckle
sjt9721, BSN, RN
706 Posts
"They take IV pumps directly out of a patients room and use it on a new patient without cleaning it...use the ear thermometer on every patient without cleaning it... I can't tell you how many times I have come on shift and upon making rounds, find a patient with NGT feeds laying flat, unrestrained with half the tube pulled out and that crummy pump is just PUMPING away." The above problems are directly related to nursing care. I don't see the correlation between the above problems & the guy dc'd early without proper eval/follow-up.
I just go there thru registry and believe you me, I document and chart very carefully and thoroughly in the traditional C.Y.A. module. It is CRAZY there and they have very little turn over. They are pretty top heavy when it comes to administration but overall this place cares very little for the patient as an individual.
Day 2 for a broken pelvis? WOW women having babies stay longer than that. You are saying you get ALL the required tx, pt, and discharge teaching for patient and family done in 24 hours????!
Color me SHOCKED.
erroridiot
266 Posts
Did you consider a home health care referral? Under Medicare and private insurance, he would have qualified for a home health R.N. assessment of needs for Lovenox or any new Rx med teaching for the patient or a caregiver and following up to make sure that the injection is done correctly. He would also receive comprehensive teaching for signs and symptoms of complications and PT, OT, MSW, Home Health Aide as needed.
LoriAlabamaRN
955 Posts
I was thinking the same thing... home health referral. As far as the infection control problems, you owe it to yourself and your patients to have a meeting with your higher-ups to address these problems. Go up the chain of command until you get some results.
Lori