(Poorly) Skilled Nursing Facilities

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.
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MODIFIED O2 Therapy?
 
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
 
Originally posted by MariaCatEMT@Dec 27 2004, 07:55 AM
ummmmmmm.....SOB?
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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.
 
WTF?!?!?! :angry:

That facility needs to be visited by some state inspectors and lose their license.
 
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.
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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.
 
Too true.
 
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.
 
9 year old topic. How do you people even find these things?
 
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
 
I walked into a snf rn trying to "bag" a patient with a nrb.... Spoiler alert it didnt work very well
 
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.
  1. 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.
  2. 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?!
  3. (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).
 
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.
 
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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