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 Provided by Clinician 1
Sometimes, I feel like I am swimming in a fishbowl. Throw me a pinch of food for sustenance, and I will maintain the status quo. Push me to the limits and test my mettle, and we’ll just see how far I can swim before sinking into the deluge of the never-ending litmus pool of sewage, ever-creeping in on my tidy little bowl.
So in the quest to get graphic and give you details, I will share my latest saga with a local assisted living facility. I have blogged before about the perils of their communication. Several weeks ago, I received a fax from one place, asking for a Rx for eye drops, for the patient’s red, crusty eyes. Oh, and by-the-way, the fax mentioned that he was “grabbing at invisible things in the air and more agitated than usual.” I ordered the eye drops, but also requested labs, including a UA C/S, to rule-out infection. I also mentioned that if he was having mental status changes, perhaps he needed to go to the ER for evaluation for this possible infection.
Fast forward 24 hours... I received a phone call on a Saturday from his son, questioning the eye-drop order, as he gets his meds from the local Veterans Administration. In our 20-minute conversation, he related his dissatisfaction with his father’s care at the home, but also that he had not been notified about his mental status changes, nor had the staff collected the UA C/S (not that we’d been notified). I then got a second call 30 minutes later – his father was sent to the hospital for more severe mental status changes. The ER diagnosed a UTI. He was treated for this and sent home the same day.
This past week, our office got a call from a staff member at the facility... the patient had not eaten, drank, nor voided... he was UNRESPONSIVE and COLD TO TOUCH. She was calling to get orders... per her SUPERVISOR’S request. I got on the phone, verified that my staff’s information was valid, then asked this person, “Why in the world are you calling ME? Call 9-1-1, as he is a full-code!” Afterward, the thought occurred to me, I should have asked, “Does he have a PULSE?” Admittedly, I was rather abrupt, and I stated if her supervisor had a problem with my order to call 9-1-1, I was more than happy to speak with her. Hmmm... she didn’t call me. Guess I made the point to the aide...or whatever her title was.
The patient was admitted with a temperature of 93.4, sepsis, and was unresponsive except to noxious stimuli. Obviously, NOT a good sign. Would it have made a big difference to call 9-1-1 earlier? Well, the reality is... we’ll never know. He had (+) blood cultures, but negative urine cultures. He was treated for infection, stabilized... all the things that “acute care” is known for.
Fast forward one week... he went back to his personal care home, now with hospice care orders. He was responsive, but not doing well, as expected. Hospice will take good care of him, I am sure.
So what am I left with?
Feelings of inadequacy. Would it have made a difference had he been evaluated by someone at the home who knew what she/he was doing? How in the world did his temperature get to 93.4 degrees in the first place? I wish that an NP or PA was on-site to look at these people and diagnose minute changes before they became BIG ones.
I know that we did the best that we could, under the circumstances. I just wish that there was a better solution for long-term care patients. And I pray I am not lying in a bed in the same situation some day.
Kim Spering is a family nurse practitioner who currently works at Brndjar Medical Associates, P.C., a family practice in Emmaus, PA. Her past experience includes the fields of medical/surgical ICU, open heart/trauma ICU, labor and delivery, nursing education, nursing supervision, and as a nurse practitioner in both family practice and OB/GYN settings. She currently serves as a NP preceptor for her graduate school alma mater, DeSales University, as well as for local baccalaureate programs. She is passionate about patient education and helping patients understand that they are ultimately responsible for their own health. She also firmly believes that the public needs to be educated on the value of NPs and PAs in meeting the health care needs of the next decade and beyond. In her free time, Kim enjoys family vacations with her optometrist husband, Mark, and her two sons, Matthew and Connor.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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