the 100% directionless thread

MrJones said:
Unless the rules have changed in the last few years, an individual cannot receive the Global War on Terrorism Medal and the Iraqi Campaign Medal for the same tour in Iraq. And the National Defense Service Medal is earned simply by graduating Basic Training
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so what is it received for? the next tour...
 
Ran the absolute worst hospice call I've ever had last night. Go out at 330 for an unknown medical to find a terminal pancreatic cancer patient who is highly altered, emaciated, and vomiting blood. Hospice RN cannot get there for at least 45 minutes, and the patient only has PO morphine and Phenergan suppositories for comfort. Family is there and are wrecked by how poorly patient is doing. Can't get an IV on the patient to provide pain control, so we were hoping to go IM with some morphine and haldol per hospice request. Hospice then changes their minds and says to take the patient directly to local hospital so they can access his port to give medication (we cannot access ports unless the patient is in "extremis," and cannot provide anything but "life-saving" medications through them). For whatever reason they were adamant that the port be used and not IM. So we have to stairchair this poor guy out of this massive splitlevel house as he screams in fright and pain. Family is losing it, which is making my partner, me, and the fire crew start to lose as well. We got him loaded up, loaded the family in back and then headed for the local hospital.

Get there and one of the ED nurses looks at me and asks without a hint of compassion and in earshot of the family, "so you just brought him to die, huh? That's not what we are for." They then yelled at me for getting warm blankets for the patient "without permission." Meanwhile the patient's son has absolutely lost it and no one will even get the poor guy a chair to sit next to his dad. I went back in to explain to the son that if the hospital could get his pain under control that we would come back right away to bring the patient back home. And then I just broke down, which has never happened to me on a call. Didn't feel very professional, but the son was just so sad and it got to me.

Nothing else comes to mind besides F that.
 
I feel for you Tigger. I had a call very similar to that a few months ago. We got to the hospital the nurse just glared at me and said what the hell. But the family was very happy with us. Even when the pt. died an hour later. They were just taken back how sudden the pt.'s condition declined.
 
That is a ****ty call. On the plus side, it is a good reminder that you haven't lost your sense of compassion which is a very good thing; bad as it was, it is a good reminder of that, so take it for what it's worth. And keep in mind that what you did was in the best interests of your patient, and appropriate for all concerned.

**** the **** at the ER. Which brings me to the next part.

What comes next will be less fun, but needs to be done. Take a day to think about what actually happened when you arrived at the ER. If what happened really is what you said here (not to imply that you are embellishing anything, it's just that in the heat of the moment perceptions can be skewed) you need to file a complaint about the reception you recieved, and specifically about the nurse you mentioned. That goes far beyond what is acceptable, and the people involved need to be held accountable. This goes back to you being a good patient advocate; rough as it may be, that can't be allowed to pass. So file a complaint with your department, and directly with the hospital. And then keep calling them every week until the matter has been resolved; DO NOT allow it be be ignored.

And to anyone who says "oh but you have to work with those people" or "don't rock the boat" or "they aren't like that all the time"...nutz. If you really believe that your job is to be a patient advocate and aren't just paying lip service to it, this is one of those times to prove it.

Do what's right. It'll suck, but you need to do it.
 
triemal04 said:
That is a ****ty call. On the plus side, it is a good reminder that you haven't lost your sense of compassion which is a very good thing; bad as it was, it is a good reminder of that, so take it for what it's worth. And keep in mind that what you did was in the best interests of your patient, and appropriate for all concerned.

**** the **** at the ER. Which brings me to the next part.

What comes next will be less fun, but needs to be done. Take a day to think about what actually happened when you arrived at the ER. If what happened really is what you said here (not to imply that you are embellishing anything, it's just that in the heat of the moment perceptions can be skewed) you need to file a complaint about the reception you recieved, and specifically about the nurse you mentioned. That goes far beyond what is acceptable, and the people involved need to be held accountable. This goes back to you being a good patient advocate; rough as it may be, that can't be allowed to pass. So file a complaint with your department, and directly with the hospital. And then keep calling them every week until the matter has been resolved; DO NOT allow it be be ignored.

And to anyone who says "oh but you have to work with those people" or "don't rock the boat" or "they aren't like that all the time"...nutz. If you really believe that your job is to be a patient advocate and aren't just paying lip service to it, this is one of those times to prove it.

Do what's right. It'll suck, but you need to do it.
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Well said. That is what was said, though I don't know is if the family was actually in earshot. It's a six bed ED, so I tend to think everything is within earshot when it likely is not. I'm going to talk to my partner about her perception of it tomorrow too, I was already a mess when we showed up at the ED so I want to make sure I am fair to the staff. But I have filed written complaints about this particular RN in the past with some result, and will do it again if I have to. Just tough to know if I'm overeacting because I had lost control of the call already, or if they are in fact just terrible people. You'd think working in a six bed critical access ED wouldn't lead you to the level of jadedness often found with crispy inner-city trauma center staff, but I guess not.
 
Cool. At the time that something happens it can be hard to tell if you're overreacting sometimes, so taking a little bit and then going over it with your partner is best; just don't take to long to move forward if it becomes neccasary. It sounds like you're more than aware of what needs to be done, and willing to do so, so I won't belabor that point.

Honestly, job well done, on all accounts.
 
Can you not IM opiates on standing orders?
 
We can't give IM opiates.
 
RocketMedic said:
Can you not IM opiates on standing orders?
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We can, however both the hospice nurse and patient's family (one who was also a nurse) were pretty adamant that we not do that. I am not sure why that was the case and things were too hectic to try and get them to understand. The son had MPOA and was taking all advice from his nurse wife who was not budging.
 
Yikes...I'm sorry Tigger :/

Sounds like bad news overall. Did you get a chance to talk to this RN at all, or would you want to?
 
RocketMedic said:
Lame.
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Very much so.

There's rumor that some things may be changing soon. Like a new MD, tiered paramedic levels with pay differences to go with the added scope and responsibility. Basically would have "basic" medics that are what the county requires then with experience, education and demonstrating clinical competence you'd be able to move up "levels" and have a larger scope of practice.

Reasoning behind no IM is we have IN and our clinical department is all about intranasal medication administration. With that said I don't see any particular reason that we couldn't administer IM opiates with OLMD. Never tried it though, always been able to get access. I'm not too proud to start a 22g or 24g to use for medication administration. The hospital might *need* bigger access but ultimately if I can get a small bore line to make patient more comfortable to get them to the ER that is capable of starting lines under ultrasound then I'll gladly do it.
 
irishboxer384 said:
so what is it received for? the next tour...
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It depends - if we're talking about the Global War on Terrorism Expeditionary Medal (which was my original assumption) then yes, if someone is authorized both it's due to multiple tours. If, on the other hand, we're talking about the Global War on Terrorism Service Medal, the criteria for presentation is similar to the NDSM, except that the former requires 30 days of service in the military during the designated period while the latter is essentially automatic upon enlistment during the designated period.
 
Tigger said:
Ran the absolute worst hospice call I've ever had last night. Go out at 330 for an unknown medical to find a terminal pancreatic cancer patient who is highly altered, emaciated, and vomiting blood. Hospice RN cannot get there for at least 45 minutes, and the patient only has PO morphine and Phenergan suppositories for comfort. Family is there and are wrecked by how poorly patient is doing. Can't get an IV on the patient to provide pain control, so we were hoping to go IM with some morphine and haldol per hospice request. Hospice then changes their minds and says to take the patient directly to local hospital so they can access his port to give medication (we cannot access ports unless the patient is in "extremis," and cannot provide anything but "life-saving" medications through them). For whatever reason they were adamant that the port be used and not IM. So we have to stairchair this poor guy out of this massive splitlevel house as he screams in fright and pain. Family is losing it, which is making my partner, me, and the fire crew start to lose as well. We got him loaded up, loaded the family in back and then headed for the local hospital.

Get there and one of the ED nurses looks at me and asks without a hint of compassion and in earshot of the family, "so you just brought him to die, huh? That's not what we are for." They then yelled at me for getting warm blankets for the patient "without permission." Meanwhile the patient's son has absolutely lost it and no one will even get the poor guy a chair to sit next to his dad. I went back in to explain to the son that if the hospital could get his pain under control that we would come back right away to bring the patient back home. And then I just broke down, which has never happened to me on a call. Didn't feel very professional, but the son was just so sad and it got to me.

Nothing else comes to mind besides F that.
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That sucks you had to go through that man. Said nurse and I would of have a "come to Jesus" talk after I got the patient off my cot. If that didn't work I would be happy to stick around until the Charge Nurse can put me in touch with the Unit Director/Manager..... After that conversation I would urge the family to also follow up and lodge a complaint against said nurse, especially if you have had issues with her in the past. I don't tolerate being disrespected, let alone in front of a patient and family, in that situation. Have some compassion, or find another career. I will go out of my way to be a torn in someone's side if they exhibit continuing behavior like that......
 
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