Thanks for nothing doc

[PMHNP10]

Last night I had a pt fall. He is a 82 y/o male in for depression, but in reality we are spinning our wheels on this poor guy because he just wants to die. In fact, he was placed on a DNR just that day or perhaps the day before. He was a hiker and author until recently he was hit by an automobile. Since his accident, he has decompensated quite significantly.

First thing I notice is that he is bleeding from his head. There is a nice 1-1.5 inch gash on the back of his head which is bleeding, although certainly not profusely. I also notice that he is able to tolerate some movement of extremities and noted no external rotation of the legs.

So after I get the vitals and assess his wound I call the MD on call and he says to send him to the ER for eval. and treatment. Unfortunately this guy was not the pt's MD, so he said for any further questions, call the pt's personal MD. I then called the sup. because we are going to need some help getting this guy off the floor. She informs me that the MD has to call the ER MD and give orders and a brief overview of the pt. So now I have to call the pt's regular doc; this doc is not on call so I have to page the on call doc. Shortly after I leave the message he calls back and I explain the situation. His orders are to cover the wound with gauze and a MD will evaluate him in the AM. At this point I'm pretty uncomfortably annoyed, so with an uncomfortable giggle I strongly suggest that he send the pt. up to the ER. He say "well that's fine, I'm just not going to call the ER". A bit after the incident I notice that the pt's SBP is down about 40 from 140s to 105. Coincidentally, the ER MD calls, trying to get some information on the pt, because it's hard to understand what he's saying if anything. During the course of our conversation she mentions his EKG is showing bigeminy, which was a change from NSR recorded on an EKG just a day or so prior to this incident. Needless to say this guy was transferred to a medical floor some time during the day. Of course I wrote up the incident as well as charted the interactions with the second MD; I only hope he's held accountable--yeah right :angryfire. If the MD had his way, perhaps he could have come in to evaluate a corpse. Fortunately I didn't mention the pt. was on a DNR or perhaps the order would have been to leave him to die where he lies. So unfortunate.

[z's playa]

You represented your patient and looked out for what you felt was best, which is more than I can say for the doctor. Way to nurse!

[Blackcat99]

Sounds like you had a hellish night! Yes Don't you just love playing these "telephone games" during the night? :angryfire

[PMHNP10]

Well after this patient had been on a medical floor for a couple weeks the psychiatrist decided to put him on a hold for danger to self (which is a joke in and of itself) and bring him right back in to us. So anyone wanna guess what happened?

If you said "He fell again." pat yourself on the back. So the next day we manage to get him a sitter and then guess what happened... The manager got rid of the sitter. But the conversation which took place is the kicker:

manager: so why does Mr. X have a sitter?

nurse: he fell again.

manager: SO. He's fallen 3, 4, or 5 times already.

I have to admit that a part of me hopes when he's elderly he receives the same treatment. I know that if I were a family member I'd be livid. I'm not stupid, I understand the bottom line is money, but this is a situation of penny wise dollar foolish. He's falling, will continue to get up and continue to fall. The MD will continue to order him medications which make him stiff and only exacerbate the situation. Eventually he will do more than bust his head open--he'll break something--and then the money saved on the sitter is spent in triplicate to repair his broken body part and any complications which will surely follow. That's high quality management right there.

Oh pardon me, I have to end this post...he just fell again. Ladies and gentlemen, we are working real hard to kill this guy. :angryfire

[VivaLasViejas, ASN, RN]

I think that maybe these falls could be passive suicide attempts......this poor man needs more help than he's getting right now. Please keep trying........sounds like you're the only one who's advocating for him. :stone

[Blackcat99]

I think that maybe these falls could be passive suicide attempts......this poor man needs more help than he's getting right now. Please keep trying........sounds like you're the only one who's advocating for him. :stone

I agree. At the LTC we had a guy who was the "perfect resident" until his wife died at the LTC. After she died he kept jumping out of bed and his wheelchair. They hired a 24 hour sitter for awhile to stop the falls. Of course, it cost money for a sitter so they stopped having a sitter for him. He continued to jump out and had constant falls until he died.

[happthearts]

We had a women falling all the time like this and the hospital refused to get a sitter .So on 11/7 we pulled her out into the seclusion room door left open to watch her , put her back in the morining It was either this or let her hurt herself. This was before they had bed alarms.

Can't they put an alarm on the bed? pad the rails .Put a jingle bell on the chair.Get an order for a posy since he is en-dangering himself?

[apaisRN, RN, CRNA]

Sounds like reportable elder abuse/neglect to me. These reports can be anonymous, I believe.