Lying for what? (venting a little...)

[mshow00]

I don't want to stand here and slam SNF (skilled nursing facility) nurses; I do have the utmost respect for those nurses who go to that job day in and day out and honestly try to make a difference, but what is the point of lying to the responding to EMS crews when they call for them? We had a pt today that we were called for that was increasingly lethargic. We arrived on scene to have 8 various levels of staff in the room, my partner (the medic) asked why we were called to which all 8 said the nurse is out there (pointing to the desk in the hall way). I went to talk to her, and she told me that he was usually up walking around without assistance, but was in bed all day just laying there; were unable to obtain a BP due to the pts tremors, and his SpO2 was reading 58% with a pulse of 60. When we got him out to the truck and placed him on the moniter he showed PSVT @ 170+ bpm with no radial pulse, and extremities so cold (a long with the SVT) that the pulse ox would not read. I just don't understand why she would make up those V/S and call us non-urgent for such a serious pt. Is it lack of caring? knowledge? policy of the SNF? I am just at a loss here.

[brentoli]

Usually they make up worse vitals to get you there faster.

Anycase, how long of a time between the nurses vitals and yours? What kind of history did she have? Was there anything to suggest this could have been a rapid onset?

Remember, in America you investigate to prove innocence. Not guilt.

[mshow00]

Remember, in America you investigate to prove innocence. Not guilt.

LOL very true! As for the time between her V/S and ours I can not say, however we saw her leaving the pts room with a pulse ox. She did say his hands were "smurf blue" prior to our arrival and that they put him on 3 LPM via simple mask, "just" prior to us (the crew) walking in. When I saw his hand they were pale and cold. The pt only had psych hx nothing cardiac, nothing resp. I doubt very much that this was new immeditate onset, it just did not fit.

[VentMedic]

were unable to obtain a BP due to the pts tremors, and his SpO2 was reading 58% with a pulse of 60. When we got him out to the truck and placed him on the moniter he showed PSVT @ 170+ bpm with no radial pulse, and extremities so cold (a long with the SVT) that the pulse ox would not read. I just don't understand why she would make up those V/S and call us non-urgent for such a serious pt. Is it lack of caring? knowledge? policy of the SNF? I am just at a loss here.

They probably did not make up the numbers but took a machine's word for the values especially the HR. A pulse ox will have difficulty analyzing a rapid poor perfusioning rhythm and will give you a value of 1/2 to 1/3 of what the actual HR is. The same with the HR reading on the BP machine.

Unfortunately they are not the only "professionals" that rely on a machine to do their assessing these days.

It is probably more a matter of very poor assessment skills than lying.

As far as the non-urgent call, the nurses may be caught between an EMS system and/or doctors that want them to arrange for transport rather than using the 911 system and what they know they should do.

If it is sepsis, it may give some symptoms earlier but can progress very rapidly. We have had patients BLS'd in by crews who thought their patient from the SNF just had some BS fever but was being intubated by the ED staff before they got back out to their trucks.

The same with a new onset A-Fib. It depends on what may have triggered it.

[jsadin]

I love the 3ltrs by simple face mask! 2 by NC is more the norm around here. "Gee, we don't know why his SOB didn't improve...we've go the concentrator up as far as it will go!".

[VentMedic]

I love the 3ltrs by simple face mask! 2 by NC is more the norm around here. "Gee, we don't know why his SOB didn't improve...we've go the concentrator up as far as it will go!".

It is hard for NHs to rely on concentrators but many are not capable of switching to a bank or liquid tank system.

We have noticed the 2 - 3 liters by mask increasing over the past 3 years and some hospitals may be part of the problem. We use a mask that can go from 1 - 15 L and often the transfer orders are not converted to NC. That has been put to task with our risk management and education department in attempt to get a handle of this serious order problem.

[Chief1C]

Could it be that the patients vital signs changed between the time they took them, and you took them? I'm well aware of substandard care on the part of nursing facilities. However, on top of that, you have the nurses, who aren't all that bad at all, they're just following a physicians order. Which is why I think we see low oxygen administration with masks, rather than NC. They may hope that the patient will get more out of it, perhaps, thats what I think of, before saying something unprofessional.. Which I wouldn't do unless their care was causing harm, or worsening the condition.. Like calling us for labored resps, w/ the patient literally blowing bubbles, and not suctioning as best they can.. or moving a fall victim with obvious fractures.

[JPINFV]

I love the 3ltrs by simple face mask! 2 by NC is more the norm around here. "Gee, we don't know why his SOB didn't improve...we've go the concentrator up as far as it will go!".

No, no, no. It's 15 liters per minute by nasal cannula and 2 liters per minute by non-rebreather.

/sarcasm

[VentMedic]

No, no, no. It's 15 liters per minute by nasal cannula and 2 liters per minute by non-rebreather.

/sarcasm

Unfortunately the 2 liters per minute by non-rebreather happened too frequently and that is why we changed to the OxyMask in the hospital. It usually originated from a couple of ED doctors that regularly ordered 4 L/M by NRBM for "hyperventilation". The patient would then go to med-surg by transporters with the NRBM and that order in place. After a couple of serious incidents, we switched masks much to the dismay of the two ED doctors. But, nobody has bought a ventilator from a NRBM order since we did that.

I think nursing homes would be a little safer if they also went just to NCs and the OxyMasks to get rid of the mistakes made by Simple and NRB Masks.

[Arizonaffcep]

There was a case in Tucson not to long ago where a SNF (in reality, one of the NSNF--Non-skilled nursing facility), left an elderly lady in a wheel chair, on a non-rebreather mask at 2 lpm...and they left her for so long...she died.