Taking Vitals

[snoopy911]

First some backround:

I have recently started a new job, about a month ago. I will be working with the critical care transport team out of the local children's hospital. But since I haven't driven before, and I will be required to drive halfway, I am down at the company's corporate office getting some driving practice. Right now I am doing mostly interfacility transports, which I have not done before. I do have some 911 experience.

Now here is my problem:

I have worked with this same partner for 4 shifts now. After we load the patient, I usually shut the doors, he gets in, I get up front and start the truck. Put on my seat belt, and ask him if he is ready to go. I do this because I know some people prefer to get some of the paperwork and vitals out of the way before getting underway. From the beginning, he told me that I do not need to wait, that he is fine to do it while I am driving. Yesterday, After an extremely busy day of 7 back to back calls, we got a call to the NH that we were just leaving, to take a pt to the ER, emergency, no L&S, for hypotension. Upon arrival, the nurse stated that the patient had been having hypotension for about an hour, first BP being 90/50. Thirty Minutes later, it was 85/50. The patient stated she had been nauseas earlier in the day, and was feeling flushed now.

When we arrived at the hospital, The charge nurse asked what her BP was on the way. My partner stated it was 100/50. The nurse said, oh good it came up, and walked away. My partner asked for her signature, gave her the paperwork, and she walked away. After the call, as we were making up the stretcher, he made a comment about the call being BS anyway, and it began a conversation that really disgusted me. He hadn't taken the patient's BP, or any vitals, nor does he ever take any vitals. He makes them up on the state forms, and he had lied to the nurse about the pt's bp. I was really upset. I asked him to explain himself, and he said its just a transport its not really important to take vitals, and he can't hear with all the noise. When I pointed out that i always give him the opportunity to do them before taking off, he just shrugged his shoulders and walked away.

I feel that what he is doing is wrong. I am just not sure what to do. Do i report this to a supervisor? I am afraid to make a big stink of this, as I don't want to be seen as the new girl that comes in and causes a ruckus. But I also want to make sure that my partner isn't compromising patient care!

Some advice please!

[tcripp]

I have to ask. Are you sure he's not pulling your leg?

[HERBIE1]

First some backround:

I have recently started a new job, about a month ago. I will be working with the critical care transport team out of the local children's hospital. But since I haven't driven before, and I will be required to drive halfway, I am down at the company's corporate office getting some driving practice. Right now I am doing mostly interfacility transports, which I have not done before. I do have some 911 experience.

Now here is my problem:

I have worked with this same partner for 4 shifts now. After we load the patient, I usually shut the doors, he gets in, I get up front and start the truck. Put on my seat belt, and ask him if he is ready to go. I do this because I know some people prefer to get some of the paperwork and vitals out of the way before getting underway. From the beginning, he told me that I do not need to wait, that he is fine to do it while I am driving. Yesterday, After an extremely busy day of 7 back to back calls, we got a call to the NH that we were just leaving, to take a pt to the ER, emergency, no L&S, for hypotension. Upon arrival, the nurse stated that the patient had been having hypotension for about an hour, first BP being 90/50. Thirty Minutes later, it was 85/50. The patient stated she had been nauseas earlier in the day, and was feeling flushed now.

When we arrived at the hospital, The charge nurse asked what her BP was on the way. My partner stated it was 100/50. The nurse said, oh good it came up, and walked away. My partner asked for her signature, gave her the paperwork, and she walked away. After the call, as we were making up the stretcher, he made a comment about the call being BS anyway, and it began a conversation that really disgusted me. He hadn't taken the patient's BP, or any vitals, nor does he ever take any vitals. He makes them up on the state forms, and he had lied to the nurse about the pt's bp. I was really upset. I asked him to explain himself, and he said its just a transport its not really important to take vitals, and he can't hear with all the noise. When I pointed out that i always give him the opportunity to do them before taking off, he just shrugged his shoulders and walked away.

I feel that what he is doing is wrong. I am just not sure what to do. Do i report this to a supervisor? I am afraid to make a big stink of this, as I don't want to be seen as the new girl that comes in and causes a ruckus. But I also want to make sure that my partner isn't compromising patient care!

Some advice please!

Tell him that unless you know he has taken vitals, you will not sign the run sheet.

Do them yourself. After you load the PT, grab the BP cuff and ears and obtain the V/S. The guy will either be guilted into it while working with you or you simply do them yourself. Do NOT trust someone who is this blatant about poor patient care.

Years ago when I was on the privates, we were supposed to take a patient out of an ICU to go to another hospital. No special meds or drips, but it was someone with a very sick heart. We asked the nurse what the vitals were and she said- stable, normotensive. We looked at the guy and he LOOKED like he was ready to code. I told my partner to manually check his BP and it was 60 systolic. I told the nurse this guy was NOT stable and asked if they were going to do anything about the BP. She checked with the resident and he blew it off- "Just transport him". I said I was not comfortable with that BP and called our medical control. We were instructed NOT to take the patient. Of course the doc and nurse had a hissy fit, we put them on the phone with our doc, and the resident looked really sheepish. He hung up the phone and directed a tirade at us. We ignored the guy and walked away, expecting to catch hell from our bosses because we pissed off one of our big accounts. I told the boss the story and surprisingly, he backed us up.

It's your license to lose. Protect it and your livelyhood.

Edited May 29, 2010 by HERBIE1

[CBEMT]

Tell him that unless you know he has taken vitals, you will not sign the run sheet.

I don't get it. Why would she need to sign the runsheet? She's not doing the paperwork.

[Kiwiology]

I know more than one Officer who make up some vital signs (not all and its generally only respiration rate) or they rely on the NIBP, SPO2 for RR and ECG for HR OR they slap on an NIBP and that is the only vital sign they take.

I will admit to just writing down "15 - 4/5/6" to a GCS on a patient who is conscious and alert sitting up talking to me without scoring each component individually.

You should report him to your Clinical Standards Officer or local equivalent.

Honestly this does not suprise me and once again I blame education, professional development and recognition, or the lack thereof.

[snoopy911]

No he is definitely not pulling my leg. This is not the first incompetent behavior i have seen from him. He is literally dumber then a bag of hammers. The next patient, I made him take a BP, he whined and complained about it the whole ride home, said he didn't have a stethescope, didn't feel like getting all the stuff out for a 5 minute ride, every excuse in the book. He can't lift a stretcher properly either, and almost caused me to drop a patient, and i did throw my back out a bit.

I don't have to sign any paperwork. I have nothing to do with any patient paperwork as long as I am "just the driver".

[Kiwiology]

Why not have him drive, or is that an even worse proposition

[snoopy911]

Are you crazy? I wouldn't let this kid babysit my cat, let alone drive me in an ambulance.

Plus he doesn't have a license. Afraid to ask why not.

[Kiwiology]

Can I suggest seeking an alternate crew partner?

[HERBIE1]

I don't get it. Why would she need to sign the runsheet? She's not doing the paperwork.

I don't know about your location, but here each provider has a license and the same level of training, which means you are equally responsible for the info contained in that report. Thus, each of you is supposed to sign each report.

As providers, you are both responsible for patient care. Now in the case of long time partners, you KNOW the other person and trust their skills. As an officer, in my agency, I am responsible for writing the report. I sign my name but print my partner's. I was told by our system folks this is acceptable. If there is an unusual call or want to clarify important details, I have my partner look over the report to add anything he feels is appropriate before I finish it. My partner is an excellent medic, has excellent skills and I trust his judgment 100%. If he says something, I believe it. I've known him for years, and he's been in this business almost as long as I have.

When I work with someone new, one of the first things I ask is if they want to see the report before they sign it or are they OK with me printing their name. Some do, although I have a reputation of being a stickler for details and my patient reports are very thorough.

As far as court cases go, I've never been a defendant, but have testified and done depositions dozens of times as a witness. The lawyers always want to know who wrote the report, and usually are the ones who need to testify, although sometimes, one partner recalls or sees something different at the scene than the other, so both testimonies are needed. Obviously, if you are being accused of something and patient care and/or treatment is in question, both providers need to testify.

Are you crazy? I wouldn't let this kid babysit my cat, let alone drive me in an ambulance.

Plus he doesn't have a license. Afraid to ask why not.

Huh? How can you work on an ambulance without a license/certification?