Friday, May 1, 2009

Nursing Home Fail

"Um, she fell" said the CNA.
Sigh.  I already knew that.  That's why you called me.  At 2am.  But CNA's are borderline retarded on a good day, so maybe another try will help get me a little information.
"Okay, and..."
"Um, lemme get the nurse."
Fail.  Double fail.  There's an 80 y/o lady moaning and writhing in pain in a wheelchair, its 2am.  Of course she fell.  I knew that before I left the station to come here.  When did it happen?  Wheres she hurt?  Why is she in a wheelchair?  Why is she moaning in pain?  Mental status, medical history?  But no, you don't know anything.  And worse than that, Sandy (not her real name) looks like she's actually injured, seriously injured.  And she is definitely in pain.
"Sandy, what happened to you tonight?  Where are you hurting?" I ask, kneeling down in front of the wheelchair.
"oh sweet Jesus, oh my leg hurts.  My leg hurts really bad.  Oh, please help me." Sandy yells.
Airway check, breathing check, good skin color so we'll give circulation a tentative check.  Quick impression: elderly black lady, in distress, holding her left thigh, left foot/leg rotated outwards 90 degrees, left leg possibly shortened.  Clearly in severe pain and major distress.  No other obvious injuries.  Her right foot is hooked around the left ankle providing the only stabilization she has in the wheelchair.  The "nurse" shows up.  I'll let Cute Medic Partner start a more detailed assessment, I want answers from the nurse.
"What happened and whats she doing in a wheel chair?" I ask, not really bothering to hide my anger.

"Oh, well she fell and we pick her up.  Bed alarm went off at 12:30" says the vacant eyed LPN who's English is barely understandable.

90 minutes.  90 minutes since the alarm saying she fell til now.  90 minutes where she has been screaming in genuine pain either on the floor, or worse in your wheelchair.  90 minutes of not calling, and then requesting we come non-emergent.  This goes above and beyond usual nursing home failures.  WAY beyond.  

"How did she fall, and where is the paperwork?"

She hands me the paperwork and I start running through it looking for important stuff, meds, allergies, code status, etc.  But as always with shitty homes, the paperwork has a face sheet, the blurry photocopy of a photocopy of a photocopied med list from last month, and medicare paperwork promising Sandy can have her room back.  The very last thing I could possibly care about is insurance and medicare paperwork.  Its not relevant to me and even if it was relevant, I'd want some actual medical information about Sandy first.  

I turn back to my partner and look at Sandy and try to decided how to get her out of the wheel chair.  If she had been lying on the floor, I could have used about 4 different techniques to get her up with only moderate amounts of pain.  Now, we have to lift her up by hers shoulders and thighs.  Its the only way and its really gonna hurt.

"Sandy, we're gonna have to lift you out of this chair they put you in.  I'm not gonna lie, its gonna hurt alot.  But we'll be as quick as we can."

So we lift and she screams and its horrible.  My partner looks like she about to kill someone, but we stabilize the hip was best we can with heavy blankets and cot straps.  Then the Russian "supervisor" shows up with more useless paperwork.  I do see buried at the very bottom is important info like her last History and Physical and code status (Full Code, of course).

Best part is once we get her lying down flat and no longer putting pressure on the broken hip, we see her left leg is 1-2 inches shorter than her right leg.  and the whole thing is very obviously rotated 90 degrees outwards.  So, Sandy is in for some heavy duty orthopaedic work.

On the way out we've already decided that she needs pain relief in the field.  So the medic partner starts hooking up chest leads for an EKG while I prep the IV supplies and get the blood pressure and pulse ox hooked up.  

"Wait, whats she allergic too?  They didn't mention any allergies and its listed as No Known Drug Allergies in the paperwork."  I ask noticing an allergy alert band on her right arm.

We both search for the paper work.  Its either listed as blank or NKDA everywhere.  So why the alert band?  In the very back of the paperwork is a form saying she is having her routine annual TB skin test and it was started yesterday.  Further exam reveals a circled area of skin on the inside of her right arm.

"You've got to be kidding.  They used an allergy alert band to mark the TB skin test??" my partner asks.  "Tell me even these people aren't that stupid"

"Well, best I can figure, yeah that's exactly what they did.  They are that stupid"

So she starts an IV while I get printouts of the EKG and other vitals signs.  And like a helpful EMT-B, I have the narcotics box pulled out, still sealed, and sitting on the bench next to her before she is finished taping the IV down.

"Alright, lets go, I'll give her this while we get going"

So I start the drive, going 20 mph at the most, weaving back and forth to try to avoid the biggest potholes.  We finally make it to the ER all the way across town and get her inside.  4 mgs of Morphine have definitely helped, but she's still obviously in major pain.

While we give the report to the ER nurses they look at us like we're pulling a joke when we point out the allergy band and the 90 minutes sitting on the deformed, probably broken hip in a wheelchair before we arrived.

"No, I couldn't make up that sort of abuse if I tried" says my partner.

We wish Sandy good luck, and I go start cleaning up the back of the rig and the cot while Medic Partner finishes paperwork.  Then we get a nurse to watch her waste the extra Morphine into a bio container and its time to clear.  We still need to fuel and we might have a chance to get 2 hours sleep if we're lucky.  We weren't that lucky but we did get to talk to Awesome Dispatcher about the nursing homes massive screw up when we went to get more narcotics.

Just another day in paradise....


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