Saturday, January 30, 2010

The nursing home dump.

99 year old male, agonal breathing, heart rate we are watching drop from 150 to asystole. Why are we not doing anything, because he is a full DNR. No Chest compressions, No airway management, No medications, No cardioversion, and No antibiotics. Are hands are tied and their is not a dang thing we can do. So, why do we have him in the ED?

Ah, it is a nursing home dump! Nursing home sent him over because of his agonal breathing and did not tell the EMS what his DNR until until after he was loaded in the rig. He arrived at the ED and we watched him die with in 5 minutes. Not coding him was the right thing to do, but still I am a fixer and that is why I work in the ED, standing there not being able to do a thing is hard for me.

Now,Back to the nursing homes... I figured I would make a short list of reason why a patient should not be sent to ED.

1. They have died (sorry, once dead there is not a dang thing we can do)

2. They are about to die and have a full DNR (Still we can not do anything)

3. If patient is normally confused; such as, dementia, don't send to ED for confusion. (I will send them right back)

4. patient has cloudy urine and fever, but just started treatment for UTI less than 24 hours ago (Can't do a thing on that but discharge back with instructions to continue home meds)

My favorite

5. Transfer to the ED due to short staffing is not a way to make friends with ED staff

As a side note, just because a person is in a nursing home, it does not mean that they are not human. I will call you and question why a person is in the condition they are when a simple bath and turning could have prevented their pain.


  1. Ah, the nursing home dump. It seems that #3 and 4 can be related. Confusion worse than normal because UTI and febrile. Have nursing homes not heard of a magical drug called Tylenol?

  2. It seems that it was a confusing topic for some of the nurses that I have dealt with. Unfortunately, a few bad nurses make the entire nursing home system seem bad. However, there are many good nurses that work in the nursing home that care.

  3. Welcome to my world. My (latest) favourite was the nsg home which sent in a UTI on po antibiotics for "uncontrolled fever" --- then when questioned why (like NurseMe) they didn't give Tylenol, the RN told me (very haughty-like, as if I just fell off the nursing turnip truck)there was a "high risk of aspiration."

    Ahem, I said. Pt is already getting po meds, and there is such a thing as per rectum.

    "Oh," she said. "I'd have to get an order to change the route.."

    You just gotta shake your head and move on. . .

  4. These are horrible stories. I will continue to fight and advocate. Thank you for telling these stories. I have provided a hot link. We need more like you ladies and gentlemen. I am a Hospice Volunteer and have had to fight bitterly for my clients. You give me the understanding and the power to do so.