Friday, March 15, 2019

A rehab/nursing home sent a demented patient for a fall.  History of many falls, a hip fracture, and of course, on Coumadin.  He hit his head.  Automatic head CT.

His family member arrived 20 minutes after the ambulance, in a mad tizzy, having been left to cool her heels in the waiting room until he could be triaged and assessed for serious injury.  We almost never (aside from parents of minor children) let ambulance-follower family members into the treatment area right away.  Visitors are strictly limited, and are told by the front desk people that it will be about 10 minutes AT LEAST  before they are escorted back.  We largely get the most pertinent information from the EMT's and paramedics that bring in the patient anyway, and you will shortly see why. 

Me: "So what happened today?"

"I told them to put on his hat because it's very cold out, and dress him warmly!  Look at the shirt he has on, that is not the one I wanted to have him wear!"

The patient was talking a merry blue streak about absolutely nothing.  I inquired as to whether this was the normal level of mentation for him, but the wife kept up with the nonsense about the inappropriate seasonal wardrobe choices that had been made on his behalf.

"He had flannel pajamas on earlier, and a turtleneck, but for some reason they took that off!"

Me:  "Can I confirm his medications and allergies with you?":

"I have no idea if he even had breakfast today!  And those are not the socks I put out for him!"

I resignedly moved on to inquire as to the patient's normal level of activity:

"What if he has to go to the bathroom? I don't know if he has had his bowel movement today!"

I gave up.

She followed me out to my work area, asking about when he would have his scan, when he would get lunch, if her doctor had been notified, if he could have a blanket, urinal, glass of water, TV on channel 8, the heat turned up, the lights turned down, a bag for his belongings, does he need to have an IV.

Here is a small public service announcement.

A rehab is not an acute care facility.  The assistants are taking the vital signs, performing toileting runs, and bringing meals.  They do all of the necessary personal care.  The nurses bring meds and do assessments.  The nurses generally don't see the patients all that much on a shift.  That is a good thing.

And I know this how?

I recently had a family member in rehab.  As a nurse, I am pretty hip as to what is needed in terms of day to day medical stuff.  I have a good handle on the care she received as an inpatient in a acute care facility.  Again: rehab (clap)is not (clap)  an acute (clap) care (clap) facility.  After a couple of minor tussles regarding medication on the first day, (thus likely earning me a reputation as bitchy  pushy) I was quite pleased the care.  The aides are polite, pleasant, and do all the things we as RN's signed up to do but don't have time for anymore, such as making people comfortable.

Beating them up because there weren't exactly 16 blueberries on the oatmeal is just being a douche.

My hat is off to these hard workng ladies and gentlemen for making sure my family member got food she could eat, was kept safe, clean, warm, and comfortable.