# (Poorly) Skilled Nursing Facilities



## SafetyPro2

RANT ALERT!

OK, I just need to vent. Had a call about 3 AM at our SNF that was all to common. Toned out for a male PT age 94 with difficulty breathing. I had the ambulance, so respond, and walk in to find the patient with severe, rapid wheezing respirations. Ask the nurse what's been happening, and he tells me the PT has had an O2 sat in the 70s since that afternoon! So, they started him on oxygen...5 LPM via cannula.

So, preped our O2 kit for 15 LPM by mask. Took his O2 sat...was about 75%. Put the O2 on him, and surprise surprise, it came up to the 80s before we got him on the gurney (and we were hustling) and was in the 90s by the time we got him in the rig. Dropped back down again during transport because we had to suction him several times, but they had him back up in the ER. BTW, he had a HX of pulmonary edema.

I get so freakin' PO'd at this facility, because their response to any respiratory distress is 5 LPM (or less!) by cannula. I can't count the number of times we've come into that situation, and on every single one we've seen a marked improvement in the PT when we start them on 15 LPM by mask (shocking, I know).

I also love the fact that he'd been in distress for a little over 12 hours before they decided it was an emergency, and woke us up.

OK, got that off my chest. I'm just a little cranky this morning...calls at 11:30 PM, 3 AM and, oh yeah, our dispatch toning us out at 5 AM and saying "Sierra Madre Fire, disregard, accidental activation." just after I'd fallen back asleep.

Thanks for listening.


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## Chimpie

LOL Chris.  Maybe it's time that your medical director and their medical director have a little chat.  I'm sure their SOP's state to do 5 LPM-canula.  Maybe he can persuade them to go to a non-rebreather when it hit 70% or something.  I don't know... just throwing out suggestions here.


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## MMiz

Working BLS, I understand how this happens.  Being that our company sends ALS rigs for "Major incidents", the BLS rigs get called for the BLS Nursing Home transfers.

I've learned which nursing homes can and cannot be trusted.  At the worst ones, they'll ask for a BLS rig non-RLS, and the crew will arrive and start CPR.  The best NHs will be on top of the situation, have the vitals done, and the patient being attended to by RNs or LPNs.

Don't your calls go to a QI board?  100% of those type of calls would go to our QI board, and that person reports directly to our medical director.  

Another day in EMS  <_<


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## rescuecpt

Slip a note to the pt's family telling them to sue the nursing home for negligence if he ends up with dementia or brain damage.  That'll make the nursing home change their policies real quick (I wish we could do stuff like that!).

My gramps had CHF and the low O2 sats caused dementia that he never had until his edema started becoming worse.  The hospital actually had him on PPV to try to help bring his sats up (while conscious).


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## Luno

Yeah, the death camps, uh, I mean Skilled Nursing Facilities, hmmm, called for Resp. Distress, CNA had just placed a NC on the pt prior to the call, when BLS arrived, had to remove the NC from a pt with lividity, yeah, DRT, gotta love the death camps.


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## PArescueEMT

wow... 5lpm. I'm impressed. At least they know to use a cannula. I've walked in on 2 lpm via nrb
talk about CTD. Report from RN was Pt's sat was at 78 so they put him on a mask (coming from a concentrator.) One BVM, D cylender, and NPA later, the patient was back at 98%.

After that call is when I found that they were only allowed to give 2 lpm without orders from the Pt's PCP. that may be where your problem lies.

Good luck.

Zak


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## PArescueEMT

I got another "wonderful" facility.

70 y/o M CAOx0 responsive to painful. P:110, R:28, B/P:???/?? (to low to get) L/S: Rails throughout, Expiratory wheezing upper, SpO2:94% on 2 lpm via N/C, Cap Refill:<2 sec; PE: Generalized Edema, no extremity control. G-Tube with thick dark green puss aspirated (over 300cc in 1 day) with a recent cholycystostemy (is that spelled right?)


Who can guess what the dispatch was for.  MedicStudentJon is not allowed to guess.


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## MedicPrincess

Umm..."General" Sick Call?


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## ffemt8978

Non-code transport?


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## MariaCatEMT

*ummmmmmm.....SOB?*


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## rescuecpt

Cardiac arrest???  LOL - I've had "cardiac arrests" who RMA (Refuse medical assistance) when I get there...


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## Jon

> _Originally posted by rescuecpt_@Dec 27 2004, 08:08 AM
> * Cardiac arrest???  LOL - I've had "cardiac arrests" who RMA (Refuse medical assistance) when I get there... *


 I had a friend who got a signature for consent from a code. Well, he was P.C.L. on arrivial, and coded in the bus, they worked him, and he didn't make it. Anyway.....


Jon


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## PArescueEMT

Would you believe "Altered Mental Status"

Vitals given to our dispatch were all perfect.

On that run tho, I actually had a Train stop b4 the crossing and wave ne through.


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## Jon

> _Originally posted by PArescueEMT_@Dec 28 2004, 06:24 PM
> * Would you believe "Altered Mental Status"
> 
> Vitals given to our dispatch were all perfect.
> 
> On that run tho, I actually had a Train stop b4 the crossing and wave ne through. *


 Strange things happen with you. Also, you sure you didn't stop to see the new wheels SEPTA just put on that Silverliner II??????    :lol:  :lol:


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## SCEMT-B

I see this more times then I want to here in South Carolina. I work for a private company here and we're contracted with almost all the SNFs in three counties. First off I'm a basic out here. I can't count how many times I've been called to a nursing home for a non-emergent transport to the ER and its not. Two weeks ago I got a call for just that because someones sodium levels where high. Thats all the information my partner andI where given. We get there, the guys in the hallway in a wheel chair. The guys barely breathing and white as our gourney sheet. The guy had been puckin his guts out all day and apparently is walking up and down the hallways all the time. We loaded and went withit. After we got him into the ER the doc came out to us and asked us why we brought him in. When we told him he asked us to come in. The guy was flippin out and we all had to restrain him. I just don't get SNFs.   :angry:


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## emtchicky156

I've worked both ends of the spectrum as an emt and a cna in a snf. I've had many times where I know the pt NEEDS to be seen NOW, but the RN/LPN decide to just watch them over the next shift. I've come onto shifts where the nurses supposedly just checked the o2 bottle the pt's been on for the last two shifts and says it's full and wonders why the pt's o2  stats have dropped, so I switch the bottle and they come up again amazing I know. I had a  pt fall c/o neck and shoulder pain and the nurse walks in makes sure there are no obivious deformites to the hips and procedes to stand the pt up, two days later the pt is taken in for xray and had a slight neck fracture. I understand that these people are not trained in ems, but they should be able to do the basics (vitals correctly, know when the pt needs o2,correct assesments). I can only hope that one day things will get better.


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## Jon

> _Originally posted by emtchicky156_@Mar 2 2005, 10:30 AM
> * I've worked both ends of the spectrum as an emt and a cna in a snf. I've had many times where I know the pt NEEDS to be seen NOW, but the RN/LPN decide to just watch them over the next shift. I've come onto shifts where the nurses supposedly just checked the o2 bottle the pt's been on for the last two shifts and says it's full and wonders why the pt's o2  stats have dropped, so I switch the bottle and they come up again amazing I know. I had a  pt fall c/o neck and shoulder pain and the nurse walks in makes sure there are no obivious deformites to the hips and procedes to stand the pt up, two days later the pt is taken in for xray and had a slight neck fracture. I understand that these people are not trained in ems, but they should be able to do the basics (vitals correctly, know when the pt needs o2,correct assesments). I can only hope that one day things will get better. *


 My most memorable nursing home call was in New Jersy (Which has an intresting prehosital EMS system, but at least the state recognizes that a transport truck isn't any different than a 911 truck, and treates them as such) I was on a 3 person crew (funky staffing - my partner didn't show, so I was thrown in as Lift assist)

I was a EMT, not im Medic school yet
My two partners were female, one a PA student, and one a Paramedic Student, both mostly finished their training.

We were all EMT-B

We were sitting ACROSS THE STREET from our most often called nursing home, all sleeping at 3am, when our dispatcher calls on the radio and wants an ETA for that facility with a patient in Resp. Distress with a SPO2 of 76%.

I say we are 1 minute away, and we pull the truck across the street.

I am Paperwork boy - I stay at Nurses station doing my paperwork while my partners assess the patient.

The Patient was on 2lpm O2 via N/C, only in the Left nostril (right prong was aimed at eyes - cold eyball syndrome). pt supine in bed, rales and wheezing throughout on auscultation. SaO2 mid 70's.

Pt. moved to strecher, in high fowlers and placed on NRBM. 2 minutes later, as we are walking off the unit we use their pulse ox again - 89-91% range - the nurse looked and said "how did you do that." My PA student partner pulled her aside and said, "well, we SAT HER UP, and PUT HER ON MORE O2"

I understand that most nursing homes around here cannot change O2 delivery method or rate without Dr's order, but I think it should be part of the protocol for sending someone out with a low sat or S.O.B. (which the doc approves anyway)is that the doc orders high flow / higher flow after the decision is made untill EMS arrivial.

Anyway.

Jon


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## CodeSurfer

> _Originally posted by PArescueEMT_@Dec 26 2004, 02:06 PM
> * I got another "wonderful" facility.
> 
> 70 y/o M CAOx0 responsive to painful. P:110, R:28, B/P:???/?? (to low to get) L/S: Rails throughout, Expiratory wheezing upper, SpO2:94% on 2 lpm via N/C, Cap Refill:<2 sec; PE: Generalized Edema, no extremity control. G-Tube with thick dark green puss aspirated (over 300cc in 1 day) with a recent cholycystostemy (is that spelled right?)
> 
> 
> Who can guess what the dispatch was for.  MedicStudentJon is not allowed to guess. *


 PCL?


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## SCEMT-B

This being a common one here I'm taking a shot at low o2 sats  :blink:


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## TTLWHKR

I could go on for hours about the poorly skilled workers in Nursing Homes. Especially the night shift. You know they don't check on the patients regularly. Most* cardiac arrests are right at meal times, or medication time (I feel this is the only time most are checked on), very rare to get a call late at night unless they were watching the patient close.

The Golden Hour, this doesn't exist there. Just this week I ran a class 1 respiratory at a N/H. I asked when it began "about noon" (meal time-who knows how long before then), it was now 4AM. Why didn't you call then? "He has a DNR". Yeah, that means we don't do anything when there is nothing to do. We can reverse this condition, you need to call when it starts. "Well, we were hoping he would pass on". HOPING? WTF is wrong with you...?

 :angry: 


I strongly dislike, to the verge of hating nursing homes. There are some really good ones, but the bulk are bad! I've seen things that have made me want to beat the staff out of their utter stupidity.


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## Jon

> _Originally posted by Blueeighty8_@Mar 3 2005, 10:27 PM
> * I've seen things that have made me want to beat the staff out of their utter stupidity. *


 MODIFIED O2 Therapy?


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## Jon

Had it last night on what the Nursing home had called in to the ED quote charge nurse "they said this was a BS change in mental status."

Myself and PA Rescue took to the hospital Facility had requested (8 min. travel) instead of the closest (5 min travel) because of similar times. Then the Facility said to go to the sam hospital system as their first choice, but the one that was 25 min away. We said No, you smoking something?

Called in with 2nd pressure being 76/50, 1st was 78/44. Said 4 minutes out with Change in mental status that is SEVERLY HYPOTENSIVE. Ran Class 1 in BLS bus.

What scared me and PA Rescue was no palpable radial, regular but VERY weak carotid, and muffled lung sounds, Pt. responsive to pain (this on demented Pt. who normally walksaround and talks somewhat coherently).



Just venting.


Jon


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## TTLWHKR

> _Originally posted by MariaCatEMT_@Dec 27 2004, 07:55 AM
> * ummmmmmm.....SOB? *


 Went to a nursing home on 5th-Due EMS (4 companies scratched b/c the facility thinks EMS is free for them), Asked what the problem was...

Nurse said "SOB on the 4th floor again". Went to four... Nursing staff had to look up a room b/c nobody was with the patient  :huh: 

I asked when the problem started, "Last shift the SOB started complaining of chest pain". Did you get orders for oxygen or albuterol? They asked why? For his Shortness of Breath.. "He doesn't have shortness of breath" Then why did you call for an SOB patient? "Oh my gosh, that was a joke, we meant Son Of a B*tch; the CNA that called it in must have thought we were serious". Walked into the patients room, finally after they found out who the patient was. The bed was empty, cleaned, and all his effects were gone. I said "Do you people even know what the hell your doing?" They said "That's not our job..." Obviously you don't know what your job is anyway. 

The patient charge sheet said "Patient began having severe SOB and chest pain, TOD 21:30. Morning shift should make necessary contacts." The patient had died the night before, and was already taken away by the funeral home. They were supposed to call the family, but called 911 instead. So we know that they did all of this with out ever checking on the patient.


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## ffemt8978

WTF?!?!?!  :angry: 

That facility needs to be visited by some state inspectors and lose their license.


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## TTLWHKR

> _Originally posted by ffemt8978_@Mar 11 2005, 11:56 PM
> * WTF?!?!?!  :angry:
> 
> That facility needs to be visited by some state inspectors and lose their license. *


 They get fined all the time, don't know why they're still in business. I've made several calls to various state agencies myself, from pay phones -in a deep voice; so I couldn't get slapped for possible HIPAA violations. 

Personally, sometimes I want to get out the roll of spare O2 tubing and either whip the staff. How they got to be in the business of caring for those who need "24 Hour Continuing Care", I'll never know. But I bet that they only check on people at shift changes. 

Walk into a room, patient is blowing bubbles b/c the staff didn't know if they were allowed to suction or not. Just makes me so angry, but what can we do, other than pass along word at the ER? Anything else we'll get slapped with a go**amn privacy act violation.


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## Jon

Too true.


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## SCEMT-B

I could have used that spare tubing today  ^_^


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## johnrsemt

On dutyat FD Had a Rehab hospital call for a cardiac arrest about 0400;   got there, worked him, called MD, called code.     approx 0730 get dispatched for same facility, get there, realize it is thesame room.  Walk in, same patient,  still has ET Tube, and IV's in that I put in 3.5 hours ago.  Night shift didn't call anyone or tell dayshift.    CNA commented as we walked in how easy it was to bag the pt.


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## Chewy20

9 year old topic. How do you people even find these things?


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## redundantbassist

Chewy20 said:


> 9 year old topic. How do you people even find these things?


The search bar...


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## Twitch559

Chewy20 said:


> 9 year old topic. How do you people even find these things?


Never underestimate the power of boredom


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## johnrsemt

If we start a new topic that has been done before someone comments that we need to search.  If we search and add to an old topic someone asks why

can't win


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## redundantbassist

johnrsemt said:


> If we start a new topic that has been done before someone comments that we need to search.  If we search and add to an old topic someone asks why
> 
> can't win


Or, you can just read the answers already provided...


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## bddd

I walked into a snf rn trying to "bag" a patient with a nrb.... Spoiler alert it didnt work very well


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## NomadicMedic

Did you actually see that, or just hear about it?


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## bddd

Saw it sadly.


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## bddd

It made my brain hurt just to see it


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## GirevikMedic

This is when I was still an EMT but doin' my medic learnin'. Chest pain, at least an hour or so before they call 911... "I checked his blood pressure, it was 70/40 so I gave him nitro."  

My medic partner and I didn't even look at each other, just both kinda stopped in our tracks for a millisecond, wide-eyed in puzzlement... grabbed the paperwork, the patient (who was still alive and even conscious and alert), our gear and just got outta Dodge like WTF?! 

The last couple weeks, though, 3 different patients from 2 facilities; you'd think they were trying to off 'em or something.

Several days with increased weakness, fatigue, SOB and recorded BP trending downwards. Labs showed the blood volume was a couple quarts low. The labs were dated 4 days prior, read by MD and reported 3 days prior. Apparently transfusion was "discussed" the day before but... eh.
ALOC > normal at least 3 hours (apparently they literally thought just putting him back in bed from his wheelchair would fix him). Newly admitted the day before after ER discharge post ground level fall. Back at ER where the same staff happens to be there again... no, he's not normally altered at all and he wasn't then. Long story short... popular opinions (haven't been back to find out the final verdict) were UTI with sudden heavy onset and possible sepsis or opiod OD by "mistake".  He wasn't on any pain meds normally and none were listed on file but pupils were the definition of pinpoint. For the record, his eyes remained closed and he clinched them down hard when I tried to get a look. Oh, but at the ER no resistance. Seriously?!  
(Same SNF, same day, very next call) "Abnormal labs" that indicated kidney failure... that was worsening... over the course of 3 drawings in the previous week. Also with noticeable lower extremity edema, borderline hypotension literally holding right about 90 systolic - give or take a couple points with each read - with some mild confusion (not sure how long that had been going on).


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## GirevikMedic

A few months ago...

Night shift so we have to be let in. Once inside the hallway splits, either continuing straight or to the right. 
"Where are we going?"
"Oh, to the left"
"So... right?" No answer, keeps walking straight as we go right.

In the room, 2 nurses. Female patient, one keeps saying him - repeatedly. I politely correct the nurse, "You mean 'her'?". Apparently, that didn't go over well as she left the room soon after to the med cart just outside the room. The pissy look she had on her face before just got worse. 

Here's the rundown from the nurse giving report:

Patient with uncontrollable coughing.
Started at 17:00. It's currently 21:00.
Dinner time was at 18:00. Patient requires physical assistance feeding. Yup... they still "fed" as usual.
Sometime between dinner and now it was med time. Yup... more "feeding".
Food contents are visible in her mouth (applesauce).
Lungs sound junky... like rhonchi... like aspiration.
With continuous coughing, applesauce keeps coming. The whole time. It doesn't stop. Luckily, ER is only about a mile away. 
_Did I forget to mention why the nurse said it couldn't be aspiration? _
Because the uncontrollable coughing occurred two days prior. The patient was sent to ER for eval then. The x-ray was negative. Two days prior. A two day old x-ray was proof that it couldn't have been aspiration now. Supposedly, the same x-ray even negated the aspiration risk before "feeding". 

"Applesauce" became our code word for calls that just left us otherwise speechless due to stupidity/absurdity.


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## NomadicMedic

While I was still just a BLS guy, but in medic school. Dispatched with Medics to a difficulty breathing at a SNF. PT is in extremis, not moving any air. I attempt to ventilate with a BVM, nothing. Medics show up about a minute later and immediately get ready to tube her. Get versed and sux on board, pass the blade and WTF! They fish out an ENTIRE HALF SANDWICH, WRAPPED IN PLASTIC. 

oops. 

Patient died in ICU later.


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## read2go

I can not tell you how many times I have seen a patient in respiratory distress at an SNF on a nasal cannula on 2 to 6 LPM. I have seen it at other types of facilities too. I often write the name on the nametag of the nurse who made this mistake in the run report so it can be investigated later. I hate to bad mouth SNF's since I have seen some good ones with very competent and caring staff, but I think some of them should be shut down this second.


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## ERDoc

read2go said:


> I can not tell you how many times I have seen a patient in respiratory distress at an SNF on a nasal cannula on 2 to 6 LPM. I have seen it at other types of facilities too. I often write the name on the nametag of the nurse who made this mistake in the run report so it can be investigated later. I hate to bad mouth SNF's since I have seen some good ones with very competent and caring staff, but I think some of them should be shut down this second.


Don't forget that those nurses have to operate within their protocols, just like you do.  Many don't have protocols that involve anything more than a nasal cannula.  The blame goes to the doc that writes the protocols, not the nurses.

PS-I cannot believe I just stuck up for nursing homes but I have seen some crap sent to the ER by the MD/DO/PA.


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## Akulahawk

ERDoc said:


> Don't forget that those nurses have to operate within their protocols, just like you do.  Many don't have protocols that involve anything more than a nasal cannula.  The blame goes to the doc that writes the protocols, not the nurses.
> 
> PS-I cannot believe I just stuck up for nursing homes but I have seen some crap sent to the ER by the MD/DO/PA.


It's not that you're necessarily sticking up for nursing homes, you're providing more insight as to where the problem of protocols lie. It's the Doc's fault or the Doc's glory as they're the ones that write the medical protocols.  I've seen patients that were "all the way up" to 2 LPM and still doing very poorly, as we all have... unfortunately, sometimes their protocols really are that poor to where the SOB patient gets at most 2 LPM and if still SOB, gets sent to the ED for further eval, almost no matter what the complaint is. That's what those nurses are stuck with and without an order to implement medical care (including meds), they can't do much without running risk of "practicing medicine." Sometimes they get a really good Doc that writes good, well-thought out protocols... so when they call for EMS, you're going to get a truly sick patient. 

We EMS folks are just as stuck and it's just that our protocols are usually more extensive and more aggressive than what's typically found at a nursing home for emergent care. If we dare to exceed those protocols, we run the same risk.


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## read2go

ERDoc said:


> Don't forget that those nurses have to operate within their protocols, just like you do.  Many don't have protocols that involve anything more than a nasal cannula.  The blame goes to the doc that writes the protocols, not the nurses.
> 
> PS-I cannot believe I just stuck up for nursing homes but I have seen some crap sent to the ER by the MD/DO/PA.



I agree that they may be following protocol, but I think they may fail to assess how severe the situation is and communicate that to the facility's doctor when they call them about transferring the patient to the hospital. I've also seen this mistake made in facilities that have a respiratory therapist in house 24/7. I think it's often not directly the nurses fault, but I think this mistake occurs with such frequency that it warrants discussion. 
Also I do think there are some very stuck-up EMS providers, but also some of the most caring and friendly people I've ever met.


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## Akulahawk

read2go said:


> I agree that they may be following protocol, but I think* they may fail to assess how severe the situation is and communicate that to the facility's doctor* when they call them about transferring the patient to the hospital. I've also seen this mistake made in facilities that have a respiratory therapist in house 24/7. I think it's often not directly the nurses fault, but I think this mistake occurs with such frequency that it warrants discussion.
> Also I do think there are some very stuck-up EMS providers, but also some of the most caring and friendly people I've ever met.


Sometimes they are able to do exactly that and the facility's doctor may not put much stock in anything told to him or her by the nurses and therefore may not actually appreciate the severity of the problem. If the nurses don't somehow properly assess the situation and the doctor doesn't trust the nurses and can't appreciate the severity of the problem (whatever it may be), then that's a double whammy to the not good side.


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## johnrsemt

Had a ECF get new Pulse Ox units;  the readouts were reversed;  so they were freaking out the 1st shift with them (no training on them, no break in period where they could check patient with the old units)  1st floor got them  2 days later 2nd floor got them).   Pt's with O2 sats in the 60's and HR at 94.   Or worse O2 sat in the 130's.    They called us to ship out 22 patients to the ED across the street, (entire floor).   We got there, started checking patients using our units on one hand theirs on the other.  We SHOWED them what was going on and they still insisted on shipping them (due to call to the doc with orders and paperwork done).   Fastest turnaround time at the ED ever  (1st patient took about 5 minutes, after that it was less than 1 minute each.  after the 5th patient the ED doc came back with us and evaluated them at the ECF.
We cancelled the other 3 trucks and my partner and I took the 5 patients,  finished the paperwork for the round trips (10 PCR's) in less than an hour too


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## phideux

johnrsemt said:


> Had a ECF get new Pulse Ox units;  the readouts were reversed;  so they were freaking out the 1st shift with them (no training on them, no break in period where they could check patient with the old units)  1st floor got them  2 days later 2nd floor got them).   Pt's with O2 sats in the 60's and HR at 94.   Or worse O2 sat in the 130's.    They called us to ship out 22 patients to the ED across the street, (entire floor).   We got there, started checking patients using our units on one hand theirs on the other.  We SHOWED them what was going on and they still insisted on shipping them (due to call to the doc with orders and paperwork done).   Fastest turnaround time at the ED ever  (1st patient took about 5 minutes, after that it was less than 1 minute each.  after the 5th patient the ED doc came back with us and evaluated them at the ECF.
> We cancelled the other 3 trucks and my partner and I took the 5 patients,  finished the paperwork for the round trips (10 PCR's) in less than an hour too




Wow, that approaches a whole new level of stupid there.


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## ERDoc

johnrsemt said:


> Had a ECF get new Pulse Ox units;  the readouts were reversed;  so they were freaking out the 1st shift with them (no training on them, no break in period where they could check patient with the old units)  1st floor got them  2 days later 2nd floor got them).   Pt's with O2 sats in the 60's and HR at 94.   Or worse O2 sat in the 130's.    They called us to ship out 22 patients to the ED across the street, (entire floor).   We got there, started checking patients using our units on one hand theirs on the other.  We SHOWED them what was going on and they still insisted on shipping them (due to call to the doc with orders and paperwork done).   Fastest turnaround time at the ED ever  (1st patient took about 5 minutes, after that it was less than 1 minute each.  after the 5th patient the ED doc came back with us and evaluated them at the ECF.
> We cancelled the other 3 trucks and my partner and I took the 5 patients,  finished the paperwork for the round trips (10 PCR's) in less than an hour too



Was contacting the receiving ER or medical control an option?  Sometimes the stupid just hurts too much.


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## johnrsemt

there the policy is You Call, We haul.  We can't tell them no;  and what do you do when they tell you to take them to the hospital.  If I called dispatch (I called our supervisor, he was down the hall with our patient) we would have been told to transport them:  If we told ECF nurse no, they would have called someone else.   Company actually got paid for every transport,  both ways.


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## phideux

Yeah,  22 round trip transports, 44 transports at a couple hundred bucks a piece, 22 ER evaluations at a couple hundred bucks a piece. Probably all medicaid and medicare, and people wonder why our healthcare system is so broken, and our taxes so high. Your med control doc couldn't call the ER doc, straighten it out without treating and transporting 22 people for no reason?


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## johnrsemt

It was only 7 round trips (there were 22 patients on the floor we only took 7):   before one of the ED docs came back with us to clear them at the ECF,  we requested them to call the ECF after the 1st one, they were slow responding.    ECF floor nurse called and complained about us refusing to take the rest even after the doctor cleared them at the ECF and she (the ED Doc) and I showed them what the problem was.
ED only charged the 1st 2.  We would roll in with them after that and roll right back out.

Was it perfect?  no;  If I had gotten permission from someone not to do what we did, and stopped transporting them; they would have called another service who would have been stuck with the same problem and either transported all of them or ended up doing the same thing.   (Indy at the time had 9 IFT services, so it was hard to try and stop abuse from ECF's because they would just call someone else.


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## Underoath87

read2go said:


> I can not tell you how many times I have seen a patient in respiratory distress at an SNF on a nasal cannula on 2 to 6 LPM.



I've seen patients on a NRB at 2-4 LPM who either just coded or were completely cyanotic. I guess their orders specify the oxygen flow setting, but not the delivery device (which is terrifyingly stupid).


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