uncomfortable discharging a pt?

Sonjailana · May 29, 2009

Once I was supposed to discharge a pt--she was from what I could tell newly confused, and had a wound weeping large amounts of serous fluid. I called the physician assistant for the service and checked with the MD twice, because I thought it was inappropriate for her to go. I actually had a little pretend bet with a case manager about how long until she'd bounce back. It took her less than 24 hours to be re-admitted, and unfortunately, she died.

If I feel uncomfortable with a pt being discharged, I usually contact the physician twice about it, speak with case management, social work, and then let it go.

cardiacmadeline, RN · May 30, 2009

I once had a patient that was very unsafe to go home. His wife was going to care for him at home, but there is absolutely no way she would be able to safely. I did not feel comfortable at all sending him home to what I felt was an unsafe situation. I don't remember if I actually talked to the doc, but I did notify my unit manager of the situation and told her how I felt. She contacted the doc, and the patient ended up going home. I don't remember the specifics. I do remember the patient being extremely stubborn though. Anyways, we documented very well!

Pepper The Cat, BSN, RN · May 30, 2009

We had a pt that the nurses felt was not ready for d/c. The family said something wasn't right. However, MD said he was ready to go. Management said - send him home, we need the beds. He coded at the front entrance of the hospital, just as he was getting into the car. Luckily, he was revivied, readmitted and eventually did go home.

We still bring this up whenever Management is trying to "push" someone out to help with our on-going bed shortage.

Imafloat, BSN, RN · May 30, 2009

I worked in the ED one night. A little boy came in, he flipped his ATV and he wasn't wearing a helmet. He had some ortho issues, but he was going to the ortho clinic the next day to get them looked at. I wheeled him out to the car with his mom and dad. His dad went to pick him up to put him in the car and he puked all over the sidewalk. It looked bilious. I told the parents that I would have to take the boy back into the ED. I took him back in. The doctor came in and looked at the kid without touching him, just a quick glance. He said he looked fine and asked dad if he was comfortable watching the boy overnight. The dad said yes and the doctor said he could go, he then apologized that I brought the kid back in. I don't usually work in the ED, so maybe I was being overly cautious?

Tait, MSN, RN · May 30, 2009

I worked in the ED one night. A little boy came in, he flipped his ATV and he wasn't wearing a helmet. He had some ortho issues, but he was going to the ortho clinic the next day to get them looked at. I wheeled him out to the car with his mom and dad. His dad went to pick him up to put him in the car and he puked all over the sidewalk. It looked bilious. I told the parents that I would have to take the boy back into the ED. I took him back in. The doctor came in and looked at the kid without touching him, just a quick glance. He said he looked fine and asked dad if he was comfortable watching the boy overnight. The dad said yes and the doctor said he could go, he then apologized that I brought the kid back in. I don't usually work in the ED, so maybe I was being overly cautious?

So they never even bothered to CT his abdomen? I would have brought him in too, however I work floor and am not familiar with ED.

During my most recent orientation we discharged a patient after chest pain, and I remember him tell me he didn't think things were quite right as I walked him out. A few days later I ran into his son and his dad was back with a massive MI that happened behind the wheel.

Tait