Nursing Homes
Blue Ridge Medic makes some comments in his blog on why nursing homes are so limited in their treatment of patients with problems like respiratory distress. He poses the question:
Respiratory distress and the patient is on 2 liters with a mask, calls for confusion and the patient has diagnosed dementia and various other incidents. But I’ve given this nursing home thing a lot of thought. Why do the staff at these places do what they do? Are they really that stupid? Or are they just un-educated?
I guess it maybe the optimist in me, or maybe the lack of experience, but I just can’t believe they are all total idiots. I mean every now and again you get a good nurse or tech and they are actually on a first name basis with the patient and know their history and why they are going to the hospital when we arrive.
He has some good points here. One of the most important ones is to make sure you take them seriously when you get a vague report like “they’re just not acting like themselves” on a patient who has dementia or Alzeheimer’s. To you there may not be much to judge that by but most of the techs, nursing assistants, LPNs and RNs spend a great deal of time with these patients.
Often subtle changes in mental status can be an indicator of a decrease in cardiac output, an unseen change in respiratory status, or a stroke. In a patient with decreased mental status anyway — they nursing home staff will pick up on things that we’d never see.
- Find out who made the report — it’s not the RN you’re talking to.
- Ask the tech, assistant, or LPN who first noticed the change what exactly they noticed.
- Ask them to spell out the baseline and what is different now.
- This is your report to the hospital.
This all comes back to taking an accurate history — from the correct caregiver. In most cases, the RNs will give meds and assess things but its the techs and assistants who spend the day out among the residents.
Stay safe!
Jamie
Filed under EMS Tips by on Mar 22nd, 2007. Comment. 
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Comments on Nursing Homes
We have a real problem at one of our local ECF facilities when it comes o resp. calls. I have inquired as to their placing patients on 2-4 lpm via NRB’s before. Short answer, their in-house protocol in to do just that. Never mind that it is actually making conditions worse. It isn’t unusual to hear “He looks worse now than he did before I put him on the mask about 30 minutes ago.” I have to bite my tongue very often and just focus on my patient. It’s kind of like those 0300 calls when you are called to the same ECF and told that the patient can’t sleep. On the way to the ED you read in the patient’s chart that there is a standing order for a sleep aid such as Rozerem or Ativan. At the ED the patient never leaves your stretcher. That med is administered and you take them straight back to their bed at the ECF with Medicare billed for a pick-up, Ed charges, ED physician chargea, and take home charges. No wonder Medicare is in such sad shape. Personally I feel that in such cases the ECF should be responsible for all of those charges. When you concider that at my service alone we run 6-10 of those calls per week then imagine howmany are run nationwide it will stun you. Our transport bill starts at $300 for BLS with $7.50/mile then add at least $300(conservitavely) for the ED. $150 for the physician and another $300 plus mileage for the return trip. Multiply this 6-10 times per week and get a figure for my service alone. How many services are doing the same thing nationwide? Staggering, isn’t it? I’ll stop ranting now.
Why is it that nursing homes even have access to oxygen mask? A nasal cannula should be only seen on their oxygen dependant pts., and high flows given by ems. I am an R.T. who dreaded the poor soul being brought through E.R. doors made worse by the unskilled nurse prior to their arrival. I now work at an LTAC, and what a difference in types of nurses and knowledge of basic medical/emergency procedures.
Very scary….