Best "Skilled" Nursing Home stories

Called to a SNF, pt lost consciusness. Got there (two EMT-Basics), found pt warm but without either auscable or palpable pulse, nor resps. Slammed him on the litter, flew down the hall, got him into the ambulance. Went to start CPR, and he raised his eyelids. Weak rapid regular pulse and low BP, was doing even better once we got him to the ER.

We called that "gurney resuscitation", and a few co-workers had seen that also.
 
Rehab hospital, called 911 for unresponsive at about 0430; we got there and the staff was doing a great job with CPR, everything right, We worked him for 20 minutes called the ED, got permission to call him. Hospital staff said they would handle everything. Police showed up, we left.

About 0730 same morning got dispatched back to the same hospital for unresponsive person. Just as we arrived I managed to look up last run, and found out we were going to the same room and same bed (I didn't have time to tell my partner). When we walked in I took one look at the patient and got on the radio and disregarded everyone. Told the staff they could stop doing CPR. When my partner asked what I was doing I told her I refused to work the same guy twice in 3 hours. (He still had my IV in his EJ, clamped off). The night shift left him, didn't tell dayshift he was dead. When they walked in to check on him, they found him dead. I don't know what they thought about the ET tube (that wasn't hooked up to anything) or EJ, but they were bagging the tube.


SNF: called for difficulty breathing, working at a private service I took the call. Got to the desk and was told which room and which bed. Went to the room turned on the light, and the lady that we were there for was sitting up in her bed, stating that her room mate wasn't breathing well. First lady was fine, second one was breathing about 3 times a minute. We bagged her a couple of times, moved her to the cot, bagged her out to the nurses station to get the paper work. Her roommate was standing in the doorway telling us to take good care of her friend.
THe nurse told us that we had the wrong patient it was her roommate that needed to go to the hospital for respiratory distress. I told her we would come back for the other one, and this one's paperwork. Took patient across the street to the ED gave report with no info except a name. Went back to SNF to get paperwork.
Met a deputy out front that was dispatched because an ambulance crew had kidnapped one of the residents. Told him our side as we went up the elevator.
The nurse had the paperwork for the first patient that we took, even though she was mad at us. 2nd patient was in chair at desk, and the nurse insisted that we take her too. The 2nd lady said she wanted to go and check on her roommate; and was ok going with us. Deputy just stood shaking his head the entire time, I asked him if he wanted to go and talk to the first lady we took. He almost jumped for joy over that thought to get away from the nurse.
1st lady was admitted, 2nd one was in the ED long enough to talk to the doctor for 3 minutes on the way to the 1st lady's room to check on her, and to tell the doctor to take good care of her. and we took her back within 5 minutes.
The next week we took the 2nd lady (that wasn't sick) to a new SNF and a week after that we took her roommate from the hospital to the new SNF. and they were roommates again
 
Kevinf said:
Went to pickup a patient to take them to their routine dialysis to find said patient had been dressed by the CNAs that morning while profoundly and obviously unresponsive. The patient was in severe septic shock, we transported her to the ED and she died later that day.

******

Another one (same facility as above) was after we had dropped off a patient, secured him in his bed with his controls and informed the nurses desk about his return. Our management gets a call a day later saying the patient is dead and they wanted to see the PCR of the trip. There is a bunch of back and forth and they keep calling our management wanting more info about this or that. Nobody will say what exactly happened, they just want to ask questions. So next time I was in that facility and free from a run I hunted down the administrator. Turns out the patient had gotten up 3-4 hours after we had left in an attempt to use the restroom, fell and fractured his femur (pt hx of prior femur fx in same leg) and bled out. Our trip sheet showed us having the facility staff RN sign the patient into the facility's care and the call bell and controls were provided to the patient hours before the fall occurred. Document everything and get those signatures! Our best guess is the patient either didn't ring his call bell, or did and they didn't respond fast enough for him so he decided to try to make it to the restroom alone.

******

Another one (SAME FACILITY) was where I had a return dialysis trip with a patient. His vitals were NOT within normal limits and he had a week+ long productive cough with bilateral crackles and a falling SpO2 while on 2LPM NC. So I crank up the O2 to 6LPM and got him to a stable 94% (hx of COPD, good sats for him) and I inform patient that I believe he has pneumonia and he should be taken to the hospital given his current status. Patient refuses, and we are back at the facility (transport time of < 3 minutes from dialysis) so we take him in on the stretcher and speak with the facility staff about convincing him to go. The have a CNA come in and take his vitals, then an LPN come take his vitals, then an RN come take his vitals (why all of them, I haven't the foggiest). They are talking to him and he is still refusing, so they call the attending physician. They give him my report, and their report, and the physician tells them to inform the patient he is recommending he be taken to the hospital (this takes about 1.5 hours to accomplish). Patient finally agrees. We take him in, give report, go home for the night.

So we come back in for a different patient two days later and I ask about him and one of the women at the nurses desk says he's back and starts telling me all about the EMTs that didn't have him on O2 and that's why his sats were bad and the EMT's didn't know what they were doing and he didn't need to go to the hospital in the first place because he doesn't have pneumonia. Good stuff. I informed her politely that I was the EMT in charge of that call and mentioned that he was in fact on O2 the entire time and that the on-call physician and floor RN had agreed with the assessment to transport to the hospital. She backpedals fast enough to power a small city and starts stammering about how that was just second hand information and she wasn't sure what actually happened. Ok then.

The patient was taken back to the hospital by 911 the next day and treated for severe pneumonia. This was after the facility had called our management to complain that the EMT's didn't have him on oxygen (6LPM O2 via NC was documented in my PCR) and that they shouldn't have had to pay for transport because he didn't really need to go.

*******

(we no longer provide services to that facility)
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Like that last line. But who will save the pts from them now?
 
johnrsemt said:
Rehab hospital, called 911 for unresponsive at about 0430; we got there and the staff was doing a great job with CPR, everything right, We worked him for 20 minutes called the ED, got permission to call him. Hospital staff said they would handle everything. Police showed up, we left.

About 0730 same morning got dispatched back to the same hospital for unresponsive person. Just as we arrived I managed to look up last run, and found out we were going to the same room and same bed (I didn't have time to tell my partner). When we walked in I took one look at the patient and got on the radio and disregarded everyone. Told the staff they could stop doing CPR. When my partner asked what I was doing I told her I refused to work the same guy twice in 3 hours. (He still had my IV in his EJ, clamped off). The night shift left him, didn't tell dayshift he was dead. When they walked in to check on him, they found him dead. I don't know what they thought about the ET tube (that wasn't hooked up to anything) or EJ, but they were bagging the tube.


SNF: called for difficulty breathing, working at a private service I took the call. Got to the desk and was told which room and which bed. Went to the room turned on the light, and the lady that we were there for was sitting up in her bed, stating that her room mate wasn't breathing well. First lady was fine, second one was breathing about 3 times a minute. We bagged her a couple of times, moved her to the cot, bagged her out to the nurses station to get the paper work. Her roommate was standing in the doorway telling us to take good care of her friend.
THe nurse told us that we had the wrong patient it was her roommate that needed to go to the hospital for respiratory distress. I told her we would come back for the other one, and this one's paperwork. Took patient across the street to the ED gave report with no info except a name. Went back to SNF to get paperwork.
Met a deputy out front that was dispatched because an ambulance crew had kidnapped one of the residents. Told him our side as we went up the elevator.
The nurse had the paperwork for the first patient that we took, even though she was mad at us. 2nd patient was in chair at desk, and the nurse insisted that we take her too. The 2nd lady said she wanted to go and check on her roommate; and was ok going with us. Deputy just stood shaking his head the entire time, I asked him if he wanted to go and talk to the first lady we took. He almost jumped for joy over that thought to get away from the nurse.
1st lady was admitted, 2nd one was in the ED long enough to talk to the doctor for 3 minutes on the way to the 1st lady's room to check on her, and to tell the doctor to take good care of her. and we took her back within 5 minutes.
The next week we took the 2nd lady (that wasn't sick) to a new SNF and a week after that we took her roommate from the hospital to the new SNF. and they were roommates again
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oh my dear Jehosaphat!
 
1. Nursing home calls 9-1-1 for respiratory emergency. Patient is found on NRB in significant respiratory distress and pulse ox 50-60. Staff report they suctioned, a clear airway because they thought that might be the problem. Our suggestion for the future, change out the O2 bottle when it is empty and turning it on helps too.

2. Same nursing home calls 9-1-1 for unconscious/unresponsive. Upon requesting paperwork, staff fetch paperwork and are told by crew, not the right paperwork. Staff insist it is. Crew continued to insist it wast. Crew had to point out that the paperwork had a patient of the opposite sex, picture present on facesheet.
 
SNF calls 911 for patient with altered mental status and difficulty breathing.
We get on scene, and the patient was just walking on her own to go to the restroom. We talk to the staff and they report that her SpO2 was in the 70s and her heart rate was in the high 90s. We tried explaining to them that with that SpO2, she shouldn't be conscious, let alone walking on her own. Patient comes out of the bathroom and wonders why we're there. She's 100% alert and talking fine. She says she feels fine, but staff insists she goes to the hospital because they called the doctor and he insisted (because of the extremely low SpO2). So we get her on our monitor and her SpO2 is 98% on room air and her pulse is 70. They mixed up the numbers on their monitor.
 
Went to a "skilled" nursing for a reported fall…. Turns out none of the staff spoke much English, and I can't speak Tagalog. They kept saying what sounded like "he fall" over and over again, and guided us back behind the nursing station and pointing at the desk. Turns out their computer system was down and they wanted someone to fix it. Still don't know what the whole "fall" thing was about…?

Had another call at a SNF for a fall and found a guy in full rigor in the bathroom. Staff kept insisting he had *just* fallen. No matter how many times I tried to explain that he was dead, and had been for hours, they didn't want to hear it. Finally gave up explaining and called the cops.
 
TheLocalMedic said:
Went to a "skilled" nursing for a reported fall…. Turns out none of the staff spoke much English, and I can't speak Tagalog. They kept saying what sounded like "he fall" over and over again, and guided us back behind the nursing station and pointing at the desk. Turns out their computer system was down and they wanted someone to fix it. Still don't know what the whole "fall" thing was about…?

Had another call at a SNF for a fall and found a guy in full rigor in the bathroom. Staff kept insisting he had *just* fallen. No matter how many times I tried to explain that he was dead, and had been for hours, they didn't want to hear it. Finally gave up explaining and called the cops.
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When the race was on to get CPR certified to allow you to keep working in home health care or elsewhere here in CA, I had classes where 30% did not speak English well enough to pass the written final without assistance. ANd we were told to assist.
 
-Had a call at a SNF once for trouble breathing. As we were walking to the room, we heard the sound of AED prompts. Walked inside to find the pt. coding. "Nurse" told someone to call but didn't mention why, so the caller just assumed trouble breathing because that is a common reason they send people out. Pt. was in the bed closest to the wall and the nursing home was also using the room as a wheelchair storage area. Literally had to move like 10 wheelchairs and this other patient who was on a broken bed to get our patient out. Extrication much?

-We have a SNF that will throw out pts. G tube if they pull it out. Important for them to hold onto it so EMS can transport it with the patient for the doctors to examine it and know what size to insert. Real smart to throw away medical devices that have been inserted into patients...
 
Got called to a cardiac arrest at a SNF. Arrive on scene, staff is doing CPR/BVM which is rare for this facility. The RN in charge is like: She has been down less than 10 minutes and we started CPR." At this point, I am thinking, "OK you are doing a good job so far" BUT.......

She them proceeds to tell me the patient is a hospice patient with a DNR. She hands me a pre-hospital DNR, a facility specific DNR, both properly filled out and signed by the proper parties. (Both of which are equally valid in my system.) She then tells me she just got off the phone with the patient's relative who has power of attorney who also stated he does not want CPR. She also states she called the mortuary while waiting for us to get there and they are on the way. So the conversation then goes somewhat like this:

Me: I don't want to be rude or anything, but why are you doing CPR if the patient has three valid forms of a DNR and is on hospice?

RN: Um I have no idea, it seems kinda stupid of us when you put it that way.

Me: Stop CPR.

CNA: We can't stop once we start.

Me: This is my "patient" now, please leave the room.

CNA gives me a dirty look and says "we could have saved her"

Ah, the joys of SNF codes.
 
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