Weekend Admission Dangers
Posted by Kim on April 10th, 2007 / Print This Post
We’ve all seen this happen: A resident is admitted on a Friday afternoon when doctors are no where to be found; family tells us the patient is “doing well” and the discharge summary from the hospital tells us the patient is stable. THEN, we find out the truth over the weekend. The resident is NOT stable and needs attention nursing homes are not able to provide. This case is interesting. The death of a resident is at issue. Specifically the nursing home and some staff are being charged with negligence because they allowed the resident’s 02 to run dry; the nursing home defense is claiming the resident should not have been admitted on a
Saturday in an unstable condition.
BIG RAPIDS – Attorneys representing six former nursing home employees charged in the death of a 50-year-old patient pointed the finger of blame elsewhere during a court hearing Monday, saying Sarah Comer died because Spectrum Health transferred her to the home before she was stable.That is in contrast to the state attorney general’s claim that Comer died because the home’s employees allowed her oxygen tank to run empty.
The long-running preliminary hearing, which began last August and has resumed sporadically ever since, is to determine whether there is enough evidence for the former employees to stand trial.
Defense attorneys began laying the groundwork Monday to prove Comer died not from lack of oxygen, but because she had an irregular heartbeat when transferred from Spectrum’s Meijer Heart Center to Metron of Big Rapids.
“This woman should never have been released from Spectrum,” David Nickola, one of seven defense attorneys, said during a break in the hearing. “It’s a matter of making a buck and someone dying.”
Comer was found dead the morning of Jan. 16, 2005, 16 hours after she was transferred from Spectrum’s Butterworth Campus.
The state attorney general contends she died because a nurse aide and two nurses at Metron of Big Rapids allowed her oxygen tank to run empty.
Another nurse, former administrator Robert Koch and former medical director Rudy Ochs are charged with falsifying records to cover-up Comer’s cause of death.
Earlier in the long-running hearing, Dr. Gregory Sandman, former head of the hospital’s intensive care unit, testified Comer was stable when she was transferred to Metron of Big Rapids.
On Monday, Gary Jeromin, a former respiratory therapist for Metron, said he tried in vain to convince his bosses at the Cascade Township-based company not to accept patients with respiratory problems on Fridays, Saturdays or Sundays, since no respiratory therapist was on duty weekends.
Comer was admitted on a Saturday.
“This is really crazy,” testified Jeromin, who is not a defendant in the case. “We get these patients with no notice at all showing up at our door.”
Much is at stake here. Depending upon the outcome of this case, nursing homes will look at the policy regarding accepting admissions on weekends and off hours. Also, this proves a point in sending a nurse or the DON to the actual hospital and making an assessment BEFORE accepting a resident…we do this at my work. No matter what the discharge summary tells us, we send in our own people to check things out.
April 10th, 2007 at 9:44 pm
Oh yes this has happened to us. Usually its a resisent we sent out earlier in the week though…and come Friday afternoon they call and want to discharge the person. A couple times we’ve let them back; one we had to ship right back out that night due to high fever and reaction to antibiotics. Another resident died three hours after coming back. So now we don’t take them after Thursdays. The DON says legally we have no choice, but ehtically we do.
I don’t recall ever getting a resident back on a weekend though.
April 19th, 2007 at 2:31 pm
on behalf of the hospitals, i can say this…weather ” we” (the aids/nurses) think the patient is well enough to go home or back to the nursing home is not our call…the doctors make that decison!..we cant override the doctor if he discharges the patient…being a cna…we are the last to be heard and the first to be blamed…we are the first to be told what to do and the last to get help with our ” to do list”…dont get me wrong..some nurses will help, with out being asked…but we do have our few that wont “degrade” themselves.
April 20th, 2007 at 6:55 am
Nurses, so many think they are too good for the hands on work. Many of them used to be aides and became nurses to get away from this work…which is admirable so long as it’s not forgotten.
I believe a nursing home can refuse admissions on weekends though. I am not 100 % sure, but if they have a policy in place they can turn away residents until THEIR own doctor is able to see the resident. Which isn’t usually until Monday.
April 20th, 2007 at 10:42 pm
cheryl….here in louisiana were i work..when we discharge a resident/ patient from the hospital back to the nursing home, weather its a friday or a saturday…the nursing home has to except them back. if the patient/ resident is able to ride in a van, the nursing home driver comes to get them…if they cant ride sitting up or are on 02 then the ambulance will transport them back to the nursing home.
April 23rd, 2007 at 7:41 am
What I see happening, a lot, is a patient in the hospital is deemed well enough to be discharged, and there is a push to GET them out ASAP with insurance issues and the like. So, a doctor from the hospital calls the Medical Director of a nursing home and asks for either admission or re-admisson permit without even seeing the patient. I think this is a very dangerous practice.
Very common though.
Nursing homes CAN make it their policy to not accept admissions or re-admissions on weekends, holidays and other times. Many do just that too and they stick to their guns with it.
April 23rd, 2007 at 10:44 am
at our hospital the doc writes dc orders and the nurses call report to the nursing home…never have i see a nurse or anyone from the nursing home come evaluate the pt/resident to return to the nusing home after a hospital stay…the only time one has come is to evaluate a new pt/resident that has never been in the nuring home….i guess it works this way b/c we’re a small town and everyone knows evryone…i dont know really ….could be that the doctors own the nursing home here…one of them…and the other one , the doctor is on the main commitee of the nursing home. we have a bunch of doc’s for a small town!!
April 23rd, 2007 at 5:42 pm
It wouldn’t be so bad if they had a nurse manager type person on duty every weekend…this person could assess the resident and write a care plan and do all those things, instead of expecting the charge nurses to do this. Add to this the family thing, too…sometimes the resident comes with a bag of upset or overly tired and demanding spouses, adult children and the like.
April 23rd, 2007 at 7:43 pm
sometimes patients family are much more difficult that the patient….i mean its bad…every 5 sec there at the nursing station complaining or demanding somethng…they dont relize there loved ones not the only paient in our hospital and we staff only one cna on the floor per shift…so you do the best that you can….some familys think there at the hilton or something..they compain about everything even when everything is good…some times i want to ask them if the want a mint on there pillow…lol
May 2nd, 2007 at 7:23 pm
Recommend consulting:
Trust in a Medical Setting.
Experience dealing with a host of difficult to impossible situations may help others in their encounters with these difficult and distrusting patients. These individuals may make up a small per cent of patients and family members, probably less than 2 per cent, but take up 90 per cent of energy in coping with day-to-day conflicts that arise from their behavior. Difficulties managing distrustful patients and family members must be dealt with on the spot, and they don’t go away.
Examples come from office experiences or wards, including situations that keep doctors and nurses and therapists awake at night, aggravate waking hours and poison leisure, that is, empirical, based upon experience and observation alone without science or theory. To survive an outrageous patient or relative requires resourcefulness, patience and imagination. Street wisdom learned the hard way is what I present, and without a guide or mentor to soften the bewilderment and sense of failure and frustration that accompanies these individuals. We seldom talk about these difficult, distrustful and sometimes threatening individuals amongst ourselves; rather we suffer and endure them silently, by ourselves. The problem is timeless as recorded in the world’s literature.
Out of the wreckage of human behavior comes valued experience leading to maneuvers and tactics of survival that are appropriate to almost all aspects and settings of human interaction including day-to-day medical care.
Links:
Trust in a Medical Setting. Hauppauge, NY: Novinka Books, Nova Science Publishers, 2006.
http://www.novapublishers.com
richardsmithmd.com
May 3rd, 2007 at 5:52 pm
Thank you, Dr. Smith for the comment and commentary.