SNF Patient

[Coleycole]

I received a 91 yo male as a patient Saturday morning. He was admitted for lumbar fx and stroke that occurred while in the ED. He's here for PT/OT/ST and skilled nursing. I had previously met this man on Wednesday. He is AOx3 with residual left sided weakenss. He's responsive and able to perform tasks. I'm off two days and I receive this man with normal VS, however when I check on him he is difficult to arouse. His family informs me he doesn't wake up this early and bc of his stoke his sleep/wake cycles are impaired. I agree to leave him sleeping and come back in a while to recheck. Long story short, I am unable to arouse him and he now feels clammy and his breathing is rapid and shallow. His SpO2 is 87% at this point and he's not responding to verbal or tactile stimuli. I call the doc and get the ok to send him to ED. I learned later that while I was off, 2 supervisors and several nurses had assessed him and didn't like the state he was in/condition, but did not feel he was bad enough to send. Friday afternoon docs ordered stat labs. I didn't have those Saturday morning and was calling the lab to get results to no avail. I sent him 911 and last I've heard is he is in ICU with a poor prognosis. I've talked to two nurses who saw him on Thursday and Friday and didn't like his state and asked supervisors to assess him. I have been struggling to accept that this is healthcare. What could I have done better (aside from calling for ED assessment earlier?) and what can we learn from this be it assessment skills or supervisor input?

[brownbook]

So sorry for your experience. My only concern is at age 91, even though he was normal and responsive for you. Did he want everything done when he was going to die? Did his family want everything done when he was going to die?

Hard facts to face but at age 91 death was definitely coming. You, a co-worker, or certainly the supervisor. should have started end of life care discussions the day he was admitted.

What was his code status. He could die peacefully in your skilled nursing facility with his family surrounding him.

I worked ICU five years, or as we called it, torture old people till they die unit. I have horrible images of him with tubes coming out of every orifice.

[neuron]

I received a 91 yo male as a patient Saturday morning. He was admitted for lumbar fx and stroke that occurred while in the ED. He's here for PT/OT/ST and skilled nursing. I had previously met this man on Wednesday. He is AOx3 with residual left sided weakenss. He's responsive and able to perform tasks. I'm off two days and I receive this man with normal VS, however when I check on him he is difficult to arouse. His family informs me he doesn't wake up this early and bc of his stoke his sleep/wake cycles are impaired. I agree to leave him sleeping and come back in a while to recheck. Long story short, I am unable to arouse him and he now feels clammy and his breathing is rapid and shallow. His SpO2 is 87% at this point and he's not responding to verbal or tactile stimuli. I call the doc and get the ok to send him to ED. I learned later that while I was off, 2 supervisors and several nurses had assessed him and didn't like the state he was in/condition, but did not feel he was bad enough to send. Friday afternoon docs ordered stat labs. I didn't have those Saturday morning and was calling the lab to get results to no avail. I sent him 911 and last I've heard is he is in ICU with a poor prognosis. I've talked to two nurses who saw him on Thursday and Friday and didn't like his state and asked supervisors to assess him. I have been struggling to accept that this is healthcare. What could I have done better (aside from calling for ED assessment earlier?) and what can we learn from this be it assessment skills or supervisor input?

Sounds like the pt declined on your shift. The sp02, breathing rate increased and lethargy. Are there the same vital signs, 02 in the previous documentation? Maybe the family told them the same thing if it wasn't.