Looking for advice (Patient Scenario)

[Sublime]

I currently work a tech in the county hospital. The unit I work in is a med/surg - Telemetry mixed unit. We also do outpatient procedures such as blood/plasma infusions. Today we had an infusion patient who came in to get an iron infusion. I was asked by the nurse to take the patient to the urgent care clinic down stairs due to a BP of 220 systolic (not sure of diastolic, but if was around 80-90 if I remember correctly). The patient had already recieved her infusion. Apparently this was per request of one of the hosptial physicians, that the patient be taken down to the ER/Urgent care clinic (these people are classified as outpatient, so in a situation like this we can't treat them like a normal patient who is admitted to our unit, they have to start from the beginning and get admitted first, its stupid but thats how it is)

Our urgent care clinic does not deal with BP's that high, and would of sent them to the ER, so I went ahead took the patient straight to our ER. When I get to the triage area, a nurse asks me where I am from so I tell her and explain the situation.

The nurse instructs the tech (who is a paramedic) to take a BP. She does it with a machine and it reads 188/78. She then looks at the nurse who is right next to me and says "It's normal". The nurse see's the BP also, and starts to get an attitude with me. She says "Did you get a manual BP of 220? I thought you said it was higher, whats the number to where your from?". I give her number to the nurse upstairs where the pt. came from and told her I did not witness the BP being taken upstairs.

The ER triage nurse (who I believe is the ER Charge nurse), tells my nurse that the pt. is not hypertensive. She then calls the doctor that requested the patient be sent to the ER/Urgent care and told him "Yeah well we have the patient down here for an apparent hypertensive crisis, but the thing is she's not hypertensive at all." That was her exact words. At this point I was pretty pissed but I bit my tongue and didn't say anything because it would of resulted in a argument in front of the patient. I was told by the ER nurse I could leave while she waited on the doctor to call her back.

I feel like I should have said something to the ER Nurse / Tech. I just keep thinking what if the doc sends her home under the impression she didn't have a high BP and something happens. I will probably never know anyway but its bugging me. Wish I would of atleast spoken up for her. We do have an incredibly busy ER. It is not uncommon to have patients all over the walls, and really long wait times to get a bed, but I don't believe its an excuse.

Instead I told my charge nurse when she got back, and talked to the patients nurse about it. Both of them disagreed with the ER nurse about this, but nothing will be done about it.

What do you think I should do? Let it go? Should I go to my manager and talk to him about it? What would you have done in my situation?

Thanks for the advice!

Edited April 12, 2012 by Sublime

[Arctickat]

Disagreements between co-workers in two different chains of command are best resolved through your manager.

My Thoughts:

• Treat the patient, not the machine, did they do any other sort of assesments? Lung sounds, Sp02?
  
• 188/78 isn't hypertensive? WTF?
  
• If the nurse upstairs used ears instead of a machine to get the BP, I would have at least done the courtesy of following up my machine with the same, just to check.
  
• And this brings us around to the old debate of ears vs. machine...sorry.
  

[craig]

as Sean Connery said in the Indana jones and the Last Crusade.......

"let it go Indy....just let it go...."

what good will it do now to make a deal of it?

* Firstly you didnt take the original BP, you were told it was 220 sys

* You were doing what was requested of you by a RN and Doctor

* You are not responsible for the percieved inadequacies of other staff and the wat they treat the patient in thier job.

* if you do make a deal out of this, what will the working relationship between you and your unit and the ER staff ad the ER end up being?

with all this in mind, what do you hope to be the correct outcome if you make a complaint? will it make the way either you or your unit work different? Do you hope that the ER will then have to do what ever you guys tell them?

If it is after the fact (I assume it has been a little time since the incident) it would be better to let sleeping dogs lie, but document it to you manager, for reference if something like this happens again

[mobey]

Are you new there?

[Kiwiology]

Most importantly, does the patient have a history of hypertension?

[ERDoc]

Yeah, I would call this pt hypertensive. My next question is, was she symptomatic? If she was not symptomatic, what is the ER treatment for asymptomatic hypertension?

As for what you should do, I would say you have done it all already. No offense but you are the low man on the totem pole. You informed your superior of the situation and it is up to them to decide what to do with it.

Edited April 12, 2012 by ERDoc

[Kiwiology]

Yeah, I would call this pt hypertensive. My next question is, was she symptomatic? If she was not symptomatic, what is the ER treatment for asymptomatic hypertension?

$10,000 bill and the door

[ERDoc]

$10,000 bill and the door

Of which, we will see less than 10%. The door probably costs more than we will collect.

[Kiwiology]

That is if the patient even pays

Poor Emergentologist, should have been an anaesthetist, you could be in private practice now doing simple elective procedures for a thousand bucks a pop somewhere nice like California or Las Vegas where winter is a foreign term

[ERDoc]

I almost ended up in Vegas. I will admit that it was funny to hear you call May freezing in one of the other threads.