Leslie, Suesquatch, anyone else who might know the answer to this:
Background: I receive an elderly patient in the ED coming via EMS from an LTC facility for "failure to thrive". One look at him, and I already know he is in end stage Alzheimer's. Medic gives me report, hx Alzheimer's dementia and a couple of other pretty benign conditions, has a DNR-comfort measures only. Medic cannot tell me exactly why EMS was called, as he could not get straight answers from the staff at the facility. We don't even know if family has been called. I do my assessment and it's clear to me that this person's symptoms are r/t their disease process; impaired swallowing, nonverbal, etc.; even if it is a stroke, exactly what are we going to do about it?
So, I am wondering if there is something I am missing here. Is there a good reason to send a person with a DNR who is in the end stages of Alzheimer's Disease to the ED? Exactly what are we going to do for them that can't be done for them at home in the facility that they know? They will spend at least two hours if not more sitting on one of our notoriously hard and uncomfortable gurneys, under bright, glaring lights, with lots of strangers in and out of the room, and who knows what kinds of sights and sounds right outside their doorway? If this were me, I would be absolutely furious that my wishes were ignored. Fortunately, and I can only hope, it didn't seem that this person understood what was going on at all, as their facial expression was completely vacant.
So, my question is, WHY? Why did someone make the decision that the right thing to do was to call an ambulance and send this person to the ED? What am I missing?
We never send someone out to get rid of him. Doesn't work. Nor do we send out someone for being dangerous. That's 911. Or every staff member approaching him and recommending that they calm the blank down. Works.
We never send someone out to get rid of him. Doesn't work. Nor do we send out someone for being dangerous. That's 911. Or every staff member approaching him and recommending that they calm the blank down. Works.
Really? That is our DONs favorite method of removal, send out, don't accept them back lol. We just call the ambulance transport to pick them up and send them to the nearest ED lol.
It probably has a lot to do with census. Our census tends to be high so we can pick and choose our pts a little better then most facilities. My wife's old facility took anyone and everyone no matter what....yuck.
No restraints at our facility and we also take any warm body to fill a bed. I can only recall two situations where the facility absolutley refused to have a resident back. Currently we have a resident that has slapped, kicked, choked etc at least 11 staff members since he was admitted only a year ago. 911 has been called on him a bunch of times and everytime they show up he acts helpless and confused. As soon as they leave he is back to his normal self. He is someone that the facility has NOT gotten rid of so you can only imagine just how bad the two they did refuse must have been.
Census was low last month so we've had four admits from the homeless shelter and psych ward of our local hospital to fill the beds on my floor.
Really? That is our DONs favorite method of removal, send out, don't accept them back lol. We just call the ambulance transport to pick them up and send them to the nearest ED lol.
It probably has a lot to do with census. Our census tends to be high so we can pick and choose our pts a little better then most facilities. My wife's old facility took anyone and everyone no matter what....yuck.
Census was low last month so we've had four admits from the homeless shelter and psych ward of our local hospital to fill the beds on my floor.
I can't imagine. They're almost all demented anyway, let alone with other diagnosed psych conditions and the psychosocial issues that lead to homelessness.
you don't know how many times i've wanted to use the 'blank' word.
leslie
You've never cursed at a pt before?
I like to call it "therapeutic communication."
I never curse until the pt curses first though, once that door is open I use the "familar language and vocabulary that my pt understands to communicate effectively and concisely." :smiley_ab
you don't know how many times i've wanted to use the 'blank' word.
weren't you the poster who was talking about all the family relations that were in mgmt (at a facility you worked)?
i'm especially appreciating the reality of that, after reading this post.
leslie
We phrase it more therapeutically. "Jack, you must calm down. Now. We are here to help you control yourself until you can do it yourself." Once in a great while, "Hey! Enough! Stop that immediately!"
Yeah, I was talking about all the family. This facility, too.
Schmoo1022
520 Posts
Since you didn't get much info on why they sent him to you, agency or new nurse to the facility comes to mind. Also, maybe a covering MD.
Be the way the facility I used to work for would flip if we sent out a patient for being a pain. We had to notify the DNS before sending anyone out.