What was she thinking?!

[pharmanurse11]

Many of us are unaware that there are significant differences between post acute care/snf hospitals and acute care hospitals in terms of staffing, especially during the evening hours. SNFs do not have a receptionist after 6pm, which means the responsibility for buzzing visitors in and out falls on the nurse or CNA while they are still engaged in their primary duties. SNFs don't have a unit secretary in the evening so the phones may not be answered if the nurses and CNAs are tending to patients and not currently at the nurses' station.

I work the evening shift at a skilled nursing facility, and yesterday morning my patient was taken to the emergency room, and he was discharged last night. I noticed a PIV in the patient's left forearm while doing my assessment and told him that I would be removing it once med pass is completed.

Two police officers show up about an hour later at the facility to do a welfare check on my patient at the request of someone from the ER.

When I try to obtain details from the officers, they are also confused, but they do believe it has something to do with the PIV, but they do not have specific information. They leave without ever seeing my patient. As a result, I contact the hospital's emergency department.

This is what the charge nurse said to me.

During shift change, the ER nurse assigned to my patient realized she had not removed his PIV. Several attempts were made by her to speak to someone at the facility for no other reason than to inform them that she forgot to remove the PIV. When she was unsuccessful in reaching someone, a colleague of hers suggested she contact the police and request a welfare check be done. She took their advice and the rest is history.

I'm still trying to wrap my heard around this one.

[Emergent, RN]

She was probably following some protocol. I remember I had a patient leave with her IV in place, she was a questionable character for sure. We had to call the police. She was the type that definitely wanted it for IV access.

Don't you have an answering machine at your facility? You might approach the administrators and suggest something to deal with this type of situation. The voicemail should give information regarding availability of staff to answer in the evening. Of course, a lot of time upper management wants to hide the fact that there is less staff than the public expects.

[Been there,done that, ASN, RN]

"I noticed a PIV in the patient's left forearm while doing my assessment and told him that I would be removing it once med pass is completed."  Yank it out while you are there.  Problem solved.

 

[Davey Do]

About 30 years ago, I worked at a SNF and was amazed at the lack of professional  communication between the facility and a local hospital.

On one occasion, a hospital nurse advised me to get a report from the family of a resident discharged from that hospital and I bluntly questioned that tact.

Sometimes, we need not to question what they were thinking. We need to question if they have the capacity for thought.

[Tweety, BSN, RN]

It does sound odd since you're a SNF.  But it's a CYA thing.  If a patient leaves with an intact IV (through nurse error, or them eloping) and all reasonable means to ask them to return for a removal are attempted, then the police are notified to go to the patient's residence.  

[MaxAttack, BSN, RN]

Been there,done that said:

"I noticed a PIV in the patient's left forearm while doing my assessment and told him that I would be removing it once med pass is completed."  Yank it out while you are there.  Problem solved.

It sounds like the issue was that the patient was discharged from the ER with a PIV, not how long it stayed in while at the SNF. 

OP, it sounds like you have your answer. The ER can't have a loose IV out there in there ether without some sort of follow up. Nothing crazy.

[klone, MSN, RN]

It's not odd at all. That SOP for an accidental intact IV if they can't reach the patient. 

[offlabel]

I'd say the bigger question is why a SNF can't answer the phone?

[toomuchbaloney]

offlabel said:

I'd say the bigger question is why a SNF can't answer the phone?

Because the owners don't pay someone to prioritize answering phones over patient care.  

[offlabel]

toomuchbaloney said:

Because the owners don't pay someone to prioritize answering phones over patient care.  

The person in charge carrying a cordless handset off of the facility land line is not a big deal. 

[toomuchbaloney]

offlabel said:

The person in charge carrying a cordless handset off of the facility land line is not a big deal. 

You are familiar with this facility or are you assuming?

[lifelearningrn, BSN, RN]

offlabel said:

The person in charge carrying a cordless handset off of the facility land line is not a big deal. 

Not if that person is in the middle of assessments or a med pass.