A lot of my job as a EMT-B is basic transport. Today we transported an elderly male to an assisted living facility from a hospital. The pt. had come into the hospital for "generalized pain". The pt's pulse ox was 86% on room air, 94% on 2LPM via NC. The report I recieved from the nurse was cursory, the paperwork very vague. Per the RN, the pt has a "lung disease". We transported with the O2. Upon arrival at the assisted living we were told the facility had no O2 and that there was no RN or MD(as is the case with assisted living). Soooo, what do we do? The pt. was in no distress without oxygen, so we left, telling the aide that the pt. needed O2, which she promised would be told to the facility RN the next day, and I documented the heck out of the whole situation. I was just wondering if anyone had some thoughts on how that could have been handled. Any input would be appreciated.
Transport Question
- Thread starter klogerg
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What did the discharge instructions say?
I've had similar incidents working for a private transport company. Generally I get out my cell phone, contact the hospital, and talk to a nurse. I then document the nurse's name and position at the hospital. I've called hospitals in the burbs and the DMC in downtown Detroit, and I've found almost all to be helpful.
I've had similar incidents working for a private transport company. Generally I get out my cell phone, contact the hospital, and talk to a nurse. I then document the nurse's name and position at the hospital. I've called hospitals in the burbs and the DMC in downtown Detroit, and I've found almost all to be helpful.
Ridryder911
EMS Guru
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Was oxygen ordered for the patient? I believe I would had called my supervisor and or ER and see if oxygen was to be continued. If the patient was diagnosed with room air hypoxia, then formal therapy should had been carried out by a in-home oxygen service, or home health type service.
I am wondering if the nursing staff presumed that the patient already had oxygen at home, still crappy discharge planning and I would had called him/her up on that. They should had been sure that the patient had the needed medications ordered (oxygen) per either discharge planner or social services type.
Glad you documented it well, I would be concerned of it as well.
R/r 911
I am wondering if the nursing staff presumed that the patient already had oxygen at home, still crappy discharge planning and I would had called him/her up on that. They should had been sure that the patient had the needed medications ordered (oxygen) per either discharge planner or social services type.
Glad you documented it well, I would be concerned of it as well.
R/r 911
Airwaygoddess
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Per Matt and Rid, I also agree with their input and advice. I strongly feel that hospital discharge planners need a better report on the patient status on a daily basis, so when it does come time for the patient to be discharged, the patient still receives the care that is ordered by the M.D. and there is a continuity of care.
There was basically no paperwork to be taken back to the facility with the pt. No official orders, for o2 or anything else. I called my supervisor, who agreed with my plan of action. It can be very frustrating, but I guess thats why the company is constantly hammering us with the "proper documentation" speech. Thanks all for the input.
KEVD18
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i have found a simple and quite effective answer to this problem. i dont transfer the pt until i have a thorough report, appropriate paperwork and sig's and what not. now, for example, had i gotten to the receiving facility and found no oxygen for an 02dependent pt, we more than likely would have returned to the sending facility, after a case review by either or both my supv and olmc.
your is a tricky case as there was no o2 order. however, you initiated o2 therapy( i assume per your protocols) for the de satted pt. upon arrival, you(on you own authority if i understand correctly) discontinued a therapy that you had decided was necessary. had the pt's sat stabalized or was it still below normal on ra? did you run this through your supv or md?
im not saying you did something wrong, but there are a few questions there. if something would have happened and the right person got a hold of this info, theres the pottential for trouble...
your is a tricky case as there was no o2 order. however, you initiated o2 therapy( i assume per your protocols) for the de satted pt. upon arrival, you(on you own authority if i understand correctly) discontinued a therapy that you had decided was necessary. had the pt's sat stabalized or was it still below normal on ra? did you run this through your supv or md?
im not saying you did something wrong, but there are a few questions there. if something would have happened and the right person got a hold of this info, theres the pottential for trouble...
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If you work in Michigan, don't you have a PCS form or discharge instruction/prescription so that you can bill insurance? We require one on every that isn't emergent. When I worked in private EMS we also had a hospital dance:
EMT working with patient would:
- Get medical history/meds and fill out top part of our transport sheet
- Get discharge instructions signed by doctor/coordinator
- Verbally speak with the discharging nurse to ask about patients condition, what kind of care they required during the transport home, and anything else they thought we should know.
While the EMT/drive would:
- Get vitals
- Verbally interview patient and get a brief medical history
- Do the HIPAA dance and get the documents signed. The pt's copy was then given to the EMT working with the patient.
- Check the room/bed for pt. valuables bag that needed to be taken home
- Give the patient a quick rundown of what was going to happen during the transport.
It truly was like a scene that was repeated over and over throughout the day. Especially when you're working BLS stretcher-fetcher runs, it really helped to make sure everything was ready for the transport.
EMT working with patient would:
- Get medical history/meds and fill out top part of our transport sheet
- Get discharge instructions signed by doctor/coordinator
- Verbally speak with the discharging nurse to ask about patients condition, what kind of care they required during the transport home, and anything else they thought we should know.
While the EMT/drive would:
- Get vitals
- Verbally interview patient and get a brief medical history
- Do the HIPAA dance and get the documents signed. The pt's copy was then given to the EMT working with the patient.
- Check the room/bed for pt. valuables bag that needed to be taken home
- Give the patient a quick rundown of what was going to happen during the transport.
It truly was like a scene that was repeated over and over throughout the day. Especially when you're working BLS stretcher-fetcher runs, it really helped to make sure everything was ready for the transport.
Welll, we operate in that exact fashion. To answer the other posts questions, upon arrival at the patients bedside the NC was off, as he was eating, that was when the initial sat was obtained, mid 80's. Part of the problem with assisted living facilities is there is usually no RN or other "qualified" medical personnel to hand pt. care over to. There was almost no discharge paperwork. And the ambulance neccessity form was actually not even filled out, I had to ask the RN to do it. I admit it was the end of the day, i was tired, and I probably didnt out my best firt forward on the whole run. In the end, the pt. was in no distress without o2, and I documented the heck out of it. I could have transported back to the hospital, but I'm not sure the hospital would have accepted the pt. There was no distress. I know I could have done better, especially getting a more thorough report from the hospital staff. One of the problems with private transport companies is it gets dull and I find myself getting lazy.
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We all make errors and we learn from them... I'm not saying you really made an error... but you've got some things to think about for the NEXT TIME this happens.
Anyway... I probably would have called my supervisor and perhaps the sending facility. I might also have had the Assisted Living staff call whoever was on-call for medical problems (usually one of the RN's/LPN's is on call to make decisions regarding pt's being transported to the hospital) I think that you or the staff member explaining the situation to this staff member might have gotten exactly what was needed... because they don't want to have to deal with it if it becomes an emergency overnight... it wouldn't be good for anyone.
Anyway... I probably would have called my supervisor and perhaps the sending facility. I might also have had the Assisted Living staff call whoever was on-call for medical problems (usually one of the RN's/LPN's is on call to make decisions regarding pt's being transported to the hospital) I think that you or the staff member explaining the situation to this staff member might have gotten exactly what was needed... because they don't want to have to deal with it if it becomes an emergency overnight... it wouldn't be good for anyone.
Raf
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That sounds like patient abandonment where I come from. If a patient shows 86% oximetry on room air and you essentially take oxygen away from him, there must have been a mistake somewhere along the line.
Although he didn't show any signs of distress, at 86% pulse oximetry you have the chances of abdominal organs or distal skeletal muscles becoming ischemic after a matter of hours, right?
If there was no RN or MD at the facility, I assume you are transporting a patient to someone of lower training than you. Thus, patient abandonment.
Although he didn't show any signs of distress, at 86% pulse oximetry you have the chances of abdominal organs or distal skeletal muscles becoming ischemic after a matter of hours, right?
If there was no RN or MD at the facility, I assume you are transporting a patient to someone of lower training than you. Thus, patient abandonment.
Ridryder911
EMS Guru
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Abandonment is only when person is turned from care or given to a lesser trained individual, resulting in injuries or death. As well, 86% can actually be normal for some COPD with hypoxic drive albeit I would not prefer for them to be, but the worry is the hypoxia to the brain and heart.
R/r911
oldschoolmedic
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It's just my two cents worth...
The patient is in no signs of distress, amiable, eating without a problem, I can assume speaking without a problem, but you are stressing over a reading from a machine powered by batteries? Change your batteries and recheck the pulse ox. I had a physician's office call one day with an abnormally low pulse ox reading and wanted an emergent transport to the ICU. I put my pulse ox on the patient and came up with a 98% room air reading (they didn't put the patient on O2, simply called 911). They were so concerned with the numbers they forgot to look at the patient. Like I tell all of the students I work with, treat the patient, NOT your monitors. The initial 86% may have been this patient's normal saturation level. While it is good to err on the side of caution and be a patient advocate, the most trouble I ever see ems personnel get into is when they second-guess doctors. Their knowledge of the human body and their specific patients is encyclopedic while ours wouldn't fill much more than the sidebar of a People magazine.
My advice, let it go, learn from it, and move on.
The patient is in no signs of distress, amiable, eating without a problem, I can assume speaking without a problem, but you are stressing over a reading from a machine powered by batteries? Change your batteries and recheck the pulse ox. I had a physician's office call one day with an abnormally low pulse ox reading and wanted an emergent transport to the ICU. I put my pulse ox on the patient and came up with a 98% room air reading (they didn't put the patient on O2, simply called 911). They were so concerned with the numbers they forgot to look at the patient. Like I tell all of the students I work with, treat the patient, NOT your monitors. The initial 86% may have been this patient's normal saturation level. While it is good to err on the side of caution and be a patient advocate, the most trouble I ever see ems personnel get into is when they second-guess doctors. Their knowledge of the human body and their specific patients is encyclopedic while ours wouldn't fill much more than the sidebar of a People magazine.
My advice, let it go, learn from it, and move on.
I'd like to say thank you to everyone who responded, this is why i joined this forum. As for abandonment, since its an assisted living, and not a skilled nursing facility, the pt. is, theoretically, capable of caring for him/herself, albeit with some difficulty, neccesitating an assisted living facility. I agree with ridryder, and since the pt. was AOx3, and seemed to have no difficulty with breathing, I was inclined(obviuosly) to leave him at the facility with no 02. The real mistake I made was not makign sure I had a thorough understanding of this particular patients problem/history. I have no idea is the pt. was copd, or some other "lung disease", as the hospital RN so professionally put it. And yes, I asked the pt. if he had copd, and he said he didnt know, which is actually fairly common, that is a pt. not even knowing what he/her has.