What prompted this, you ask? Two trips to nursing homes this shift. On trip one I am absolutely sure that my displeasure was quite evident even though I kept my mouth SHUT. 93 year old woman with severe dementia who is usually quite active. She tried to pick-pocket both me and the doctor. I swear these people pull out a script when they see us coming:
"We just got on shift. We have no idea what happened. Usually she's up and walking around, but today she won't get out of bed. When you touch her, she screams."
I've been at this job as a volunteer since 1992 and as a "paid guy" since 2004. This script never changes. My all-time favorite is "He/She was just breathing a minute ago" when they're stiff and cold or severe respiratory distress and they have the patient on a cannula with 2 liters of oxygen. Anyway, this poor lady is bruised (and not recently so) all over, guarding the right side of her body and her right leg is drawn up and she won't move it. So you want me to believe she may have fallen and put herself back in bed? Somebody knows what happened. These people are criminal. And this poor woman cannot tell us herself. I hate these jerks.
But wait... There are worse places. We get a call around dinner time (of course) for hip pain. Doctor wants patient admitted. Cold response, blah, blah. Apparently these people don't understand the freaking concept of EMERGENCY. They want to call us and they tell us where to take a patient. Um, no. That's why you call a PRIVATE transport service. We get there, totally oblivious because it's a private residence. Turns out these people turned their house into a "assisted living" facility a month ago. Our patient, recovering from hip replacement, fell SATURDAY and has been lying in his own filth for three days in pain. We had to wait while a care provider who was more interested in telling me why she was not at fault changed his adult diaper. this man was lucid, and very talkative. Told me they'd been feeding him peanut butter and jelly sandwiches. Oh, hell no. I told him since he had a cell phone he should have called 9-1-1 himself. We would have broken the door down to get him out of there when he fell. He should have never lain there for three days. I checked up on him and found out his hip is broken. I called my supervisor and I know the nurse called Social Services on this place.
Vultures.
4 comments:
Your NHs use a cannula at 2 LPM?!? Ours insist on upgrading the pt to a NRB to "help" (still at 2 LPM). After all, everyone knows that masks deliver more concentrated oxygen and the doctor said to upgrade the pt to a mask... Ours use the same script that you do. I have happily informed them that their "severe respiratory distress" patient that they "just" checked on is not longer having any difficulty breathing. Of course, that is because they are not breathing and displaying rigor.
We have an ombudsman system here for NH complaints (Social Services have told us not to call them re: licensed facilities). It seems to consist of a political appointee's answering service guaranteeing that they will "look into it."
Calling these Angels of MRSA "vultures" is an insult to vultures. The vultures at least serve a useful function reducing the carrion along the roads. I'd love to see the family members of some of these victims place a nanny cam in the patient room to record the actual staff activities.
Well said sir, well said.
I have also seen 2L on a mask, and 10L on a cannula! As for the non-effective "we'll look into it" folks, we prefer to send our El-Tee who has roughly 2% body fat and owns his own gym in there instead.
Oh, and sorry vultures. You DO have a purpose.
I assume you all have the same knowledge as I....2 lpm via nasal canulae delivers around 23% O2, depending on tidal breaths and minute volume. 10 lpm via mask is harder to calculate, because of leakage, and the same parameters above.
It's degree of effectiveness depends on the condition, yes? What the patient is being treated for, the effect you wish to achieve.
I do hope you have some guidence in this.
? Should Fish More, why on earth do you think I need more guidance? I was pointing out that the nursing home staff routinely does not know how to use or how much oxygen to use with each oxygen delivery device. I, on the other hand, am not confused.
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