What would you have done?

[chicago_RN]

I was doing an admission this morning in a home. She was discharged from hospital yesterday after only being there for 24 hours for a syncope episode. They did a big work up and never determined the cause. At the start of my admission she started saying she was dizzy while sitting at the table with me. She asked me to hand her the trash because she was a little nauseous. I took her blood pressure and it was 95/48. I get her a thermus of water and tell her to drink. We continued along and probably 20 min later she complained she was really dizzy and was having a hard time keeping her head up. I took her BP again and this time it was 59/32. So im like yikes a 40 point drop almost and shes symptomatic. So I tell her and her son who is present that she needs medical attention. I take it again a minute later and this time it is 55/28. Shes 85 and weighs 100 lbs and has a wheel chair and lives 5 min from hospital. What would you have done... Let her large son and grown granddaughter drive her to ER, or call for an ambulance and remain with the patient?

[Marshall1]

Called an ambulance & stayed w/the patient until EMS arrived. Too much could've gone wrong w/her family trying to take her to the ER (even 5 min away) plus there is all the down time to get her inside, registered etc. EMS can load, go and get her at least assessed stat.

[Marshall1]

Often time patients will refuse EMS because they are worried about a bill, neighbors "seeing" etc. In this case she was continuing to be compromised & at least EMS would've had the means to act if she coded on the way & would've been able to get IV access & fluids started. Yes, the patient has the right to refuse but the nurse has the right to cover herself & go w/her gut instinct. I still would've called - if the patient refused to go w/EMS then I would've at least been able to cover myself that all bases were covered should anything ever come of this situation.

[bonesrn]

911 for sure! Her children can't do anything if she completely passes out, codes in the car, etc. seconds count.

[Libby1987]

I'm interested in the outcome of this readmission, please update us.

You tried to call for an ambulance. She refused. She wasn't SOB, C/o CP, seizing, having new onset of neuro changes..I would document and when I called the ER I would have told them upfront that she refused an ambulance and her family carried her to the car despite your protests.

[RNKPCE]

I'd have called the ambulance and while waiting educated the fsmily/ patient why transporting that way is safest. Lay people may not understand how serious the situation is. When EMS arrived if they still refuse I'd document it all. What is your agency's take or policy in regards to this situation?

[Libby1987]

I didn't address documentation. I would document notification of the MD and all of the teaching and precautions I gave to patient and family.

[kellyjs]

I would just called 911, an ambulance can easily start her IV access and get her to the hospital for a rapid and much needed attention.

[Tampa121]

I would most definitely called 911, because she could arrest in family car if they drove her. This way here, she has paramedics to provide CPR if needed. Yes, we cannot force pts to go by ambulance-but you can call 911 for them to evaluate her and they will tell her she needs to go by ambulance. If she says no-they have her sign refused against medical advice and you have a witness for your decision to send her and her refusal. Same thing happened to me a month ago, I called 911 and did not ask pt. permission to do so, paramedics arrived. Pt. refused to go to ER, he signed doc stating he was refusing to go to ER and I was covered. He was dizzy, too, low BP, hx of CA, etc. I documented what happened-called my agency and left pt. at home. I called his MD, told him what happened (documented that call). I told him to call 911 if dizziness continued and documented that, too.Patient ended up OK.

[GrumpyRN63, ADN, RN]

Definitely would've called 911. No hesitation, and I don't jump the gun, but really unsafe to have someone drive her.

[toomuchbaloney]

If our nursing judgement indicates that EMS is the safest conveyence to the ED then we should activate that system. The family ALWAYS has the option to refuse the ambulance and to pursue a less safe method of transport, that's on them. It should go without saying that one should attempt to educate the patient and family as to WHY EMS should be utilized. The documentation should simply reflect what you observed, said, and did.

Be sure to notify the MD and the home care office of the incident.