What would you do. Not really medical.

[Sasha]

I was wondering that as well. In my area Hospice does not stay with patients 24 hours a day. They check on the patient frequently depending on what stage patient is in and will come to home when called.

The hospice nurse who met us at the hospital said there would be a hospice nurse at the house. That nurse was just a "runner" who visited hospitals and made arrangements. That nurse stated they had arranged for 24hr care.

 

[atropine]

This is an easy one since we don't take people home, however if one of the local bls companies found thier self in this situation, I would imagine they could contact their supervisor, who could then get the local PD, or FD clergy to come out.

 

[firecoins]

PD will not and should not come out for. They have no business being there. Same with the FD.

If you feel the patient is compitent to refuse going to the hospital, than she is compitent to stay home alone. If she isn't compitent to stay home alone, she needs to go to the ER until the hospice nurse is at home.

 

[bigbaldguy]

Law enforcement isn't going to be able to do anything. It's not a criminal matter and there are healthcare providers (EMS) currently with the patient. Law enforcement won't be able to do anything more than the EMS crew.

A scheduling issue isn't abuse. It's just a bad situation created by hospice not having someone at the home when they were supposed to.

I was thinking more as a stall tactic. If it's anything like here calling for LE on a bs thing like this will get you a 2 to 3 hour response time.

 

[atropine]

PD will not and should not come out for. They have no business being there. Same with the FD.

Well why the hell do we have PD, and FD chaplins getting a public retirement, if your not going to use them for the public?

 

[bigbaldguy]

Clergy isn't a bad idea. Maybe ask the woman what church she goes to and try contacting them? Maybe they have a do gooder who can sit with her. After thinking about it ,calling LE as a stall tactic as I suggested is prob a bad idea as it could backfire if you get an officer who is too gung ho. Could ramp the whole situation up further and cause patients anxiety to sky rocket.

 

[Handsome Robb]

Right so she can't bel left alone. Got to wait or its abandonment. You can get a supervisor to sit with her.

This was my thought as well. I'd be a pain in the hospice company's butt as well along with attempting to contact the patient's family along with friends or neighbors if the patient is comfortable and close with the neighbors. I would also contact the sending facility and explain what I was told, who told me it and request that they get involved. They made a 'commitment' so to speak, although after the patient leaves their facility their responsibility in the problem is questionable unless it was put in writing along with signatures but I doubt it would be.

With that said I still think a situation like this implies intervention from a supervisor. I'm all for patient care, but in the system I work in I can't be tied up on a scene in this situation, we are too busy.

My thoughts are that if we did make the decision to leave the patient alone we are setting ourselves up for another 911 activation if things go downhill (hopefully). This isn't a bad thing but looking at the best interests of the patient it is questionable patient care. With the patient being AAO and ambulatory she meets our criteria for ability to sign an AMA.

This is a shiesty situation at best. Was this something you experienced Sasha?

Edit: seeing the posts about clergy this would be a viable option IMO. IF the patient was religious. I would be more comfortable if it would be someone that knew the patient rather than just a random pastor.

 

[Sasha]

This was my thought as well. I'd be a pain in the hospice company's butt as well along with attempting to contact the patient's family along with friends or neighbors if the patient is comfortable and close with the neighbors. I would also contact the sending facility and explain what I was told, who told me it and request that they get involved. They made a 'commitment' so to speak, although after the patient leaves their facility their responsibility in the problem is questionable unless it was put in writing along with signatures but I doubt it would be.

With that said I still think a situation like this implies intervention from a supervisor. I'm all for patient care, but in the system I work in I can't be tied up on a scene in this situation, we are too busy.

My thoughts are that if we did make the decision to leave the patient alone we are setting ourselves up for another 911 activation if things go downhill (hopefully). This isn't a bad thing but looking at the best interests of the patient it is questionable patient care. With the patient being AAO and ambulatory she meets our criteria for ability to sign an AMA.

This is a shiesty situation at best. Was this something you experienced Sasha?

Yeah it was a call we had on Saturday. My report on that one started out short, but ended up being super long because I documented the heck out of it, lots of quotes and names.

The hospice company told us they weren't even notified that she was being discharged and would require the care until 3:30. The EARLIEST they could get someone out there was 7. We got to her house at four. I don't know how that works when they have REAL actively dying patient requiring crisis care.

We were not comfortable with this at all. I didn't think anything would happen, but knew if it did it could be our butts on the line.

 

[Handsome Robb]

Yeah it was a call we had on Saturday. My report on that one started out short, but ended up being super long because I documented the heck out of it, lots of quotes and names.

The hospice company told us they weren't even notified that she was being discharged and would require the care until 3:30. The EARLIEST they could get someone out there was 7. We got to her house at four. I don't know how that works when they have REAL actively dying patient requiring crisis care.

We were not comfortable with this at all. I didn't think anything would happen, but knew if it did it could be our butts on the line.

That's a terrible situation I'm sorry. What ended up happening if you don't mind me asking?

 

[Sasha]

Read up a few posts

 

[Handsome Robb]

Read up a few posts

/lazziness

Well that's just backasswards 6 ways to Sunday... Idk what to say about that.

 

[coolidge]

discharge planning

Here is language from the CMS survey procecures which hospitals are inspected:
A-0468
(Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08)
[All records must document the following, as appropriate:]
§482.24(c)(2)(vii) - Discharge summary with outcome of hospitalization, disposition of case, and provisions for follow-up care.
Interpretive Guidelines §482.24(c)(2)(vii)
All patient medical records must contain a discharge summary. A discharge summary discusses the outcome of the hospitalization, the disposition of the patient, and provisions for follow-up care. Follow-up care provisions include any post hospital appointments, how post hospital patient care needs are to be met, and any plans for post-hospital care by providers such as home health, hospice, nursing homes, or assisted living.
The MD/DO or other qualified practitioner with admitting privileges in accordance with State law and hospital policy, who admitted the patient is responsible for the patient during the patient’s stay in the hospital. This responsibility would include developing and entering the discharge summary.
Other MD/DOs who work with the patient’s MD/DO and who are covering for the patient’s MD/DO and who are knowledgeable about the patient’s condition, the patient’s care during the hospitalization, and the patient’s discharge plans may write the discharge summary at the responsible MD/DO’s request.
In accordance with hospital policy, and 42 CFR Part 482.12(c)(1)(i) the MD/DO may delegate writing the discharge summary to other qualified health care personnel such as nurse practitioners and MD/DO assistants to the extent recognized under State law or a State’s regulatory mechanism.
Whether delegated or non-delegated, we would expect the person who writes the discharge summary to authenticate, date, and time their entry and additionally for
delegated discharge summaries we would expect the MD/DO responsible for the patient during his/her hospital stay to co-authenticate and date the discharge summary to verify its content.
The discharge summary requirement would include outpatient records. For example:
• The outcome of the treatment, procedures, or surgery;
• The disposition of the case;
• Provisions for follow-up care for an outpatient surgery patient or an emergency department patient who was not admitted or transferred to another hospital.
Survey Procedures §482.24(c)(2)(vii)
• Verify that a discharge summary is included to assure that proper continuity of care is required.
• For patient stays under 48 hours, the final progress notes may serve as the discharge summary and must contain the outcome of hospitalization, the case disposition, and any provisions for follow-up care.
• Verify that a final diagnosis is included in the discharge summary

 

[coolidge]

more on discharge planning CMS language

A-0799
(Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08)
§482.43 Condition of Participation: Discharge Planning
The hospital must have in effect a discharge planning process that applies to all patients. The hospital’s policies and procedures must be specified in writing.
Interpretive Guidelines §482.43
This CoP applies to all types of hospitals and requires all hospitals to conduct appropriate discharge planning activities for all inpatients. It applies to patients who are admitted to the hospital as inpatients. This CoP does not apply to patients who appear in a hospital emergency department but are not admitted as hospital inpatients.
The written discharge planning process must reveal a thorough, clear, comprehensive process that is understood by the hospital staff.
Adequate discharge planning is essential to the health and safety of all patients. Patients may suffer adverse health consequences upon discharge without benefit of appropriate planning. Such planning is vital to mapping a course of treatment aimed at minimizing the likelihood of having any patient rehospitalized for reasons that could have been prevented.
Survey Procedures §482.43
• Review hospital written policies and procedures to determine the existence of a discharge planning process.
• Review patient care plans for discharge planning interventions.
• Interview a sample of hospital staff that are involved in direct patient care. Ask the following questions:
o How is discharge planning conducted at this hospital?
o How are you kept apprised of the hospital’s policies and procedures for discharge planning?
o How is this communicated and integrated into a plan of care?
______________________________________________________

 

[rmabrey]

Just curious how taking her back to the ER would play out. If we put a hospice patient on our cot, they are immediately off hospice care. Also, could the nurse not being there be considered fraud.......kind of like a PCS saying patient needs O2, but there isn't O2 in the home when you get there?

Sent from my Desire HD using Tapatalk

 

[mycrofft]

Parse.

Ambulance crew was told care was arranged to be at the home and they were ordered to deliver the pt. They did but the care was not there. The order did not say "Unless the pt seems fine".

The issues are abandonment and failure to follow orders.

The actions I cited could be initiated by cell phone.

The hospital can say the pt was discharged on the guarantee the pt was covered by hospice; their hand are clean.
Hospice can say that their coverage was not set up due to a clerical error or failure of the employee to arrive. Since the failure is with hospice, and it would be illegal to abandon the pt, and it would be a breach of orders to leave the pt without the hospice hookup, I'd wait there eating her fig newtons and drinking her lemonade ,on the phone to your company and the hospice (or better yet, get your company to call the hospice company) until either someone came out, or a new order was received. (Can you accept phone orders except from your medical control?). The hospice can pay for your time, so there is no lost income.

Your company may have ordered you to leave, and if the pt assessed fine, have her sign an AMA if she would, record the time date and name of the person issuing you that order, leave the hospice and ambulance company numbers with the pt, and drive away; file your contact report with all the pertinent info; maybe submit a "memo for record" to your boss.