Nursing Homes

[housert]

Does anybody else have an issue with nursing homes moving a pt. that has fallen? Our communities nursing home is notorious for taking a patient that has fallen with obvious injury and moving them back into bed. I guess they have never heard of C-spine! We always make sure that we document it on the report so it doesn't come back to us! I know it seems cruel to leave a patient on the ground but it is the best interest of the pt.! AUGH!

 

[Ridryder911]

It is not unusual for them to move the patient. Yet again, I do not place C-collars on every patient with a fall either. Unless the MOI or indication is needed, I attempt to avoid it.

R/r 911

 

[housert]

I understand if the move them for a minor fall but they are moving them when the pt. has obvious hip deformity or obvious head trauma.

 

[Ridryder911]

Even for a hip fracture, unless they are complaining of cervical pain or again there is a potential; I personally refrain. True, one has to be cautious due to osteoporosis/ osteopenia; you can never be too cautious but many patients have kyphosis and cannot tolerate a cervical collar. I personally just use a blanket in a horseshoe configuration and secure. It works just as well and is tolerated as well.

R/r 911

 

[RESQ_5_1]

Our LTC facilities don't move pts that have fallen. They are actually restricted from this practice by their facilities. Due to the possibility of back injury to the employee. So, we are called for every fall. More often than not, we transport due to the condition that caused the fall and not the fall itself. We rarely c-spine since it is very rare that the MOI requires it. Approx 98% of the calls we get to the lodge involving a fall are falls from standing where the pt went to their knees first and haven't impacted their head on any surface.

 

[VentMedic]

You document whatever information you need to do your job such as where the fall occured and how the patient got from point A to B. Sometimes, patients are moved by other residents, family and may walk even with a hip fx.

Sometimes, as Rid mentioned the various conditions, it may be in the patient's best interest to be comfortable within reason to prevent further injury. Not all NH calls will be through a 911 system and often in some parts of the country the patient may wait several hours for a BLS truck to be available for a "routine" transport.

The hospital is also documenting everything about the patient as they receive them. Some of the documentation can be used for studies like those mentioned by Dr. Bledsoe concerning spinal immobilization. If you followed your protocol and provided good documentation, then it may show the protocols work or at least you have done what you can within your limits. Hospitals also photograph pressure sores for tracking and treatment. The skin of an elderly person will start to break down very quickly.

 

[emt_angel25]

there are 2 particular nursing homes in my area that have a habit of NOT calling 911 until the next day or a few hours later or when the family arrives. so yes our pt has been moved and no spinal precautions have been taken. however most of our nursing home calls dont get fully immobilized unless MOI indicates that we need to.

 

[emt19723]

dont even get me started on nursing homes. the ones in my area have about the most incompetent dumb a$$e$ to ever grace the medical field.

 

[Ridryder911]

dont even get me started on nursing homes. the ones in my area have about the most incompetent dumb a$$e$ to ever grace the medical field.

Ironically, I hear the same thing from nursing home nurses about EMT's too!...

R/r 911

 

[JPINFV]

Ironically, I hear the same thing from nursing home nurses about EMT's too!...

R/r 911

 

[Bosco578]

I board everyone. Abd pain = C-spine and board,Chest pain - Collar/Board, General Malaise,yup you gussed it. Every single pt., every time.....

 

[BossyCow]

Our biggest problem is with the in-home caregivers. They are generally paid around $10 per hour and hired with hiring bonuses by companies who bill their time out at $20 + to the family of the pt or their insurer. If anything goes wrong with the pt. including a minor ground level fall, the caregiver is instructed to call 911 and not to attempt to give any care at all to the pt.

Most of the caregivers we see got the job as part of a re-training program for their chemical dependency rehab, DSHS jobline, etc. They tend to be 'on disability' or otherwise physically incapable of even assisting us with lifting the pt. Most of the time this is a 'pick up and dust off'.

But what irritates me is the family is given the impression that their loved one is getting care from 'trained home healthcare providers' while they are actually getting a babysitter whose sole skill is the ability to dial a telephone. The local medics are the ones giving the care to the pt. This means the care facility is pocketing a cool $10 ph x 24 x 7 on the backs of the city's 911 system. There is private ambulance available, but the agencies know that if they ask for the city medics, there won't be a bill, so who would you call?

 

[VentMedic]

But what irritates me is the family is given the impression that their loved one is getting care from 'trained home healthcare providers' while they are actually getting a babysitter whose sole skill is the ability to dial a telephone.

Do you know what their training actually is? There are different levels in that profession just like the many "certs" of the EMT. Some do carry certifications from the state and some do not.

Yes they are instructed to dial 911 if there is an emergency. That is why there are EMTs and Paramedics. In the home care environment they have very limited devices to provide any type of emergency care.

Babysitting and just the daily care needs is a big responsibility. One that very few EMTs or Paramedics is trained to do.

Considering there are some prison systems that have trained inmates as EMTs and/FFs for volunteers to the outlying communites, I don't think EMS has room to talk. Also, as with recent headlines and topics on forums, there is little to keep a person from getting their cert or license.

Originally Posted by emt19723

dont even get me started on nursing homes. the ones in my area have about the most incompetent dumb a$$e$ to ever grace the medical field.

As I mentioned before, in the hospital, we document everything about everyone that comes in by ambulance. My favorite is the patient with agonal respirations BUT has an SpO2 of 100% per the EMTs, so they are "fine". Or the dialysis patient that goes apneic unnoticed while the EMTs are waiting to deliver the patient to their chair. Or, the EMTs who leave their sleeping patient unattended on their stretcher and it topples over when the patient wakes up and doesn't know where they are because there is no one there to orient them. Or, those that take the time to C-collar and then have the pt walk to the ambulance and step inside to lay on the stretcher. Or, CPAP on a pt with a mouth full of vomit. AND then, we get to hear all about the "rales" they heard.

Yeah, nobody's perfect so you need to realize your own deficiencies before insulting another group of healthcare providers that you may have little or no idea about their training or working conditions.

 

[marineman]

Interesting point to note is that R/r and Vent medic posted that full immobilization isn't always indicated, and I didn't pay too much attention but I believe the OP that felt C-spine was a big deal was an EMT-B. Not trying to knock the OP but seems like that cookbook medicine deal at work again.

 

[mycrofft]

I think that we all see different instances so cannot espouse generalities.

Wonder what longboarding an Alzheimer's pt who suddenly wakes up is like?
(O....M.......G).:sad:

 

[VentMedic]

Interesting point to note is that R/r and Vent medic posted that full immobilization isn't always indicated, and I didn't pay too much attention but I believe the OP that felt C-spine was a big deal was an EMT-B. Not trying to knock the OP but seems like that cookbook medicine deal at work again.

Dr. Bledsoe's article covered some of this.

a policy was in place to allow EMS personnel to determine who should be immobilized and who should not. The premise is that all patients should be immobilized unless they meet the criteria to bypass immobilization. The protocol requires that EMS personnel complete a structured, standardized exam (e.g. altered LOC, spinal pain or tenderness, neuro deficit, distracting injury). If the patient meets any of the established criteria, they must be immobilized.

http://www.ems1.com/Columnists/bryan-bledsoe/articles/426350-Danger-at-the-Door

While full immobilization may not be warranted, an adequate and accurate assessment protocol must be in place to make that decision. The EMT or Paramedic must understand mechanism and be fully knowledgable as to what a neuro/spinal assessment consists of.

 

[Flight-LP]

Ironically, I hear the same thing from nursing home nurses about EMT's too!...

R/r 911

Touche..............

 

[RESQ_5_1]

Our LTC here is actually the top floor of the hospital. Staffed by nurses and PCA's (the equivelant of CNA in most states). We only get called there for routine transfers. Our most common caller is the Lodge. This is an assisted living facility. No nurses on staff. The only staff aren't even PCA's or CNA's. They have some first aid but that's about. Except of course the Med Techs (they disperse the resident's medications). And, there is another level. The Garrison Manor. These are our most independant elderly. However, they are not quite independant enough to maintain their own domicile. The Lodge is where we do most of our calls. I actually worked in LTC for 3 years. It has been a great help on many calls to elderly patients I have had.