DwayneEMTP Posted October 15, 2012 Author Posted October 15, 2012 Actually, not a red herring at all. That is the story that I was given by the patient AND staff, but at that point their stories disagree greatly. I see no reason not to believe the patient, as I find nothing wrong with her... Neg h/a, BGL as above, pupils equal/reactive at 3mm. Pt answers all of your questions correctly, without hesitation with a voice that's clear and concise. She says that she just fell down, barely, no big deal and as she was getting up that the staff told her to stay sitting on the bed that they were going to call an ambulance. When she said that she was fine and just wanted to go back to sleep the nurse told her that she had to go to the hospital because she fell down, company policy, no choice in the matter... The nurse is wickedly pissed off now, has the doctor on the phone, and you get the distinct impression that it's possible that the symptoms were created by the nurse to lighten her patient load on this floor...
mobey Posted October 15, 2012 Posted October 15, 2012 (edited) If there is no history of alzheimers/dimentia, I would inform the patient that she may have had- exactly what that means- then explain the risks and the probability of haveing a CVA, combined with the risks from a fall Then let her make the call. At 96 years old, who the f am I to tell her what is right for her? Forgot too add: ECG also has to be clear, with no history of palpitations or chestpain. Edited October 15, 2012 by mobey
DwayneEMTP Posted October 15, 2012 Author Posted October 15, 2012 (Edit, posting at the same time Mobes. ECG was unremarkable, and she had no history of cardiac issues, stroke, diabetes, CVA/TIA, etc..) That was pretty much what I did, though as I began to ask if she wanted to go in, and she refused, the nurse flipped and handed me the phone with the doc on it. I explained to the doc why I'd chosen not to transport, he said, "Yeah, go ahead and take, she should be checked out..." I said, "So do I understand you to say that you are stating that your patient is incompetent to refuse, in your professional opinion, and that you are instructing me to take her against her will?" He hung up on me... The nurse is red faced, pulls a number out of her pocket, dials it, begins yelling into the phone, explains that mom is having a stroke and the medic refuses to transport, and says, "Her daughter has POA and she says (this is true) that you had better get her to the God damned hospital right now!!!" I say that I can't transport her against her will, and refuse, to which she says that the daughter and her husband are on their way down! I tell her that the POA is useless with a patient that is competent to make their own decisions. They arrive, both are super, duper pissed off after the nurses report. I explain that it's looking after her mom that has caused this issue, not trying to avoid caring for her. I've now been on scene for over an hour, the hospital is approx. 200 yards across the parking lot. Transporting would have been much easier. She talks to her mom, her mom verifies what I've said, and the decision is made not to transport. And, miracle of miracles, the family is truly grateful that we treated her mother like an adult instead of a damaged child. 0600, called back to the nursing home where the doc has made an appt to have her transfered to the ER for evaluation. I begin to explain to him what went on, he responds, "Whatever, just take her..." We do, and that......is the rest of the story... Maybe not terribly interesting, but I truly find patient advocacy and moral and ethical issues some of the most interesting and challenging calls of all... Of course the nursing home called my boss and I got called on the carpet for refusing to transport a stroke patient...but bottom line is that she tripped, fell lightly on her ass, the nurse saw a chance to send grandma out into the sub zero weather to get her out of her hair, and no one was happy that I didn't allow it to happen.... Anyway, that's the deal...got the idea from the "would you transport" though this is a really accurate description of what took place... 1
mobey Posted October 15, 2012 Posted October 15, 2012 I'd be calling OLMC. I personally would make a big stink, but that is my style.... I'm a stinker! I also do whatever it takes to do what is right for the patient, therefore I would do the following. 1) Tuck in the patient, tell her to have a good night, and leave the room 2) Ask nurse for papers stating POA. * If she can't produce them, tell her goodnight & leave. If she does hen go on to the next step: 3) Get the daughter on the phone and tell her my side, being sure to use phrases like "I am not sure dragging your mom out of bed at 1am for something that may or may not have happened is best for her, and she really does not want to go" and "we don't kidnap people" 4) Get my OLMC on the phone and have him consult on speakerphone (after I speak privately with him of course) 5) By this time, the nurse should be alsmost in tears and hating her life, and that is a great time to ask "How long do you want to drag this out?" Thereby dumping all the blame for this dramafest on her and putting her in defence mode, which will hopefully result in her asking us to leave and threatening to call supervisors tomorrow. 6) Find the closest Tim Hortons, and get a large double-double in celebration of my small victory and knowing that patient is tucked in warm and cozy safe from her nurses politics. Stinker 1
island emt Posted October 15, 2012 Posted October 15, 2012 Are you sure nurse nail polish nancy even has the correct room? A pissed off night nurse has revenge in mind for you. How dare you go against her wishes. Don't you know who your superiors are you lowly ambulance driver! 1
DwayneEMTP Posted October 15, 2012 Author Posted October 15, 2012 Oh my God!! I think you were joking, but that never really occured to me!! We've seen many strange things happen in nursing homes, how bad would it suck to be making a stand and refusing the wrong patient in another room!! I'm going to verify that next time...Stupid, I know, but I'm going to....
Curiosity Posted October 15, 2012 Posted October 15, 2012 WOW...that is insane. I've been to NH to pick up patients who had fallen (as per the NH policy as you stated) but never for a patient who is capable of making his/her own decisions. They are patients with dementia who are incapable of telling you if and where it hurts. Has anything come up about the NH probably lying about the patients symptoms?
DwayneEMTP Posted October 15, 2012 Author Posted October 15, 2012 This call was from a couple of years ago, a little more maybe, but to the best of my knowledge nothing came of it....plus, how is one going to prove that it's bullshit, and not a resolved TIA? Plus, obviously her doc was onboard with dumping patients at the ER...Podunk town, Smallville...life as usual....
island emt Posted October 15, 2012 Posted October 15, 2012 nothing at a nursing home surprises me. We once walked in and found the lunch aid and the med aid taking care of a pt that had "collapsed" so they were doing CPR. Well the intent was really good anyway. the med aid was pushing on her abdomen and the lunch lady was blowing air into her like a car wash dryer. You get the idea. fill the stomach up with air and then push the contents back out. Would have been comical except the lady was alert and screaming bloody murder for them to stop which we heard as we were wheeling our gurney down the long hall We were expecting a major trauma from all the noise. The nurses you ask :::::::: why they were all down the other wing in the cafeteria chatting and having their break We did transport the pt out of that place just to give her a break. This was years ago in another state that shall remain nameless to protect the guilty
Bieber Posted October 15, 2012 Posted October 15, 2012 Good on you for standing up for your patient's rights, brother. Honestly, I'd have done the same thing. I don't think I'd've been able to be as nice as you when it comes to that nurse, though... My tolerance for being disrespected by other medical providers is pretty low, especially nursing home staff. "Her daughter has POA and she says (this is true) that you had better get her to the God damned hospital right now!!!" "Sorry, ma'am, but I don't take my orders from you or your doctors, and if you don't calm down and please go away, I'm going to have to call the police on you for interfering with an emergency responder." Cheeky grin. 1
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