Helpful Hints for SKILLED Nursing Facilities

[AnthonyM83]

Though they'll probably never see these, I thought I'd start a thread on useful little tips for nursing homes based on our experiences on 911 to these places. We usually never get to tell them, because we're out the door so fast (they usually wait for patients to become critical before calling).

1) NRBs should flow @ 8LPM minimum. If your O2 regulator doesn't go that high, use a nasal cannula.

2) CPR actually requires you to touch your patient

3) Have the person who meets us at the door have a clue what's wrong with the patient. It's not helpful when the most we can get out of them is "she's over there" with a fingerpoint.

4) Since you don't know your patients well enough to know their history, have someone reviewing their facesheet the moment you call 911. We need someone to tell us their chief complaint, normal mental/physical state, last time someone saw patient normal, medical history, allergies, medications, DNR, etc.

Someone merely pointing to the patient and giving me a BP from a Walmart digital cuff and telling me their O2 sat is 30% on 2LPM via NRB doesn't help THAT much...

5) Clear a path as we go in and out...as much as I like playing race car with the gurney and your residents lounging in their wheelchairs, now is not the time.

6) In case it wasn't clear in #4, medical history includes communicable diseases like MRSA!!! Tell us any isolation precautions as we step out of the ambulance...better yet, include them in the 911 call.

7) Speaking of 911 calls, don't just call in a cardiac arrest as an unconscious. While one person dials, someone else can confirm whether she has a pulse or not. Use your little O2 sat machine if you can't figure it out.

Others feel free to add

[Scaramedic]

[align=center:ecaa36af79]Take Cover!!!![/align:ecaa36af79]

[align=center:ecaa36af79][/align:ecaa36af79]

[align=center:ecaa36af79]Terri Incoming!!!![/align:ecaa36af79]

[MeekoBB]

:shock: :shock: :shock: oh snap! :shock: :shock: :shock:

[captainstandup]

Please if you know of even one of these piss palaces that actually has one single skilled staff member not including maintenance tell me where it is and I will travel there to see it for myself.

[JPINFV]

Please if you know of even one of these piss palaces that actually has one single skilled staff member not including maintenance tell me where it is and I will travel there to see it for myself.

The Covington in Aliso Viejo and Walnut Manor in Anaheim. There are a handful of others, but the bad ones much more numerous then the good ones.

[AnthonyM83]

You can buy your tickets here: http://travelocity.com/

[Just Plain Ruff]

Captain don't make a blanket statement like that.

I've been in EMS for 15 years(semi retired now) and I've seen some really really good ones and some really really really really really badddddddddddddddddddddd ones.

For every good one there may be 100 bad ones.

For instance, the nursing home that my grandmother is in is pretty good.

One other thing that I do take exception to, if the facility has 100 employees, I can bet your next paycheck(I won't bet mine, because it would put you into the next higher tax bracket) that there are several good employees who really care about the residents.

[mrmeaner]

From what I've seen, the system is pretty much set up to fail. Nursing home runs, although sometimes pointless, do tend to make me appreciate my job a little more. At least I get to leave the NH.

[njmedic1485]

I would like to add the following helpful hints to the list ;

8 ) The "M" in BVM stands for Mask, and it is an integral part of the device. It does no good to stick the 15 mm port in the dead guys mouth and squeeze the bag, even with the nasal cannula set to three liters per minute.

9) Don't get your panties in a wad when you present me with a DNR order 10 minutes after I asked for the residents chart and I stop the resuscitation in the middle of the hallway (we did put him back in his bed).

10) I fully appriceate the importance of skin care in the bed bound patient, but the time to slather on the skin cream is not when I'm trying to apply defibrillation pads .

[str8upparamedic]

I used to work in skilled nursing facilities, several years back, as a cna. I always felt like I was the only one that had any sense among the staff or compassion for the residents. I was overworked as they were always under staffed. I worked night shift and there were times there were only 2 of us for the whole building. There were 168 patients and 4 wings. Trying to get the nurses to get off their butts and help was unthinkable. It was all we could do to keep the residents dry, answer call lights and shower and dress those that wanted up, much less get vital for the nurses who would sit at the desk all night cracking jokes. They wouldnt even take their own vitals. They barely got up to do rounds to pass out meds. Trying to get one up to give a tylenol was a major chore.

One night I answered a call light This wasnt my patient or even on my wing, but I got tired of hearing the bell ringing, so I went to check. First I went to find the cna and found her outside smoking with some of the nurses. Noone showed up so I answered the call. This man was having chest pains and asked for his nitro. So...I went to tell his nurse. This started at 12 am. She said ok...be there in a minute. So I told the man that his nurse was on her way and went about taking care of mine. His light comes on again around 1...I answer....no nurse as of yet. I got really angry and went to her again. Around 3 am, she refuses to give his nitro. This man is begging me not to let him die. I told the nurse that if she didnt do something that I was gonna call the medics myself and get him to a hospital where he would be taken care of. Around 4 am she makes the call. She said that she didnt want to do the paperwork on him if he died. So the medics arrive. I am the only 1 in the room with this man. they start questioning me and I start giving them report. They asked why they werent called sooner. As soon as I started answering , the head nurse comes in and physically throws me out of the room. She told me to keep my mouth shut. The man was taken to the hospital but died from a massive heart attack. I called the state, found the medics that answered the call and told them what had happened. I couldnt take it anymore, so I got out of that mess. I will Never send one of mine to a nursing facility. And I hope I never wind up in one. There might be a few decent facilities where the staff actually care, but they are rare. Trust me. This isnt a crack on nurses. I have worked with very committed, caring and compassionate nurses. But I have also worked with undesirable ones too. The horror stories I could tell you would blow your mind. I worked with two that would pop the patients pills right in front of me. One was fired and the other got busted in a routine traffic stop. She had pill cards in her pocket. Stole them right off the med cart. I feel for those who continue to work in facilities, the ones who actually do care. And I feel for the residents who have to live in them. God bless them all. As for me....my heart and my nerves couldnt take it. I couldn't fight them anymore. And I couldnt stand by and watch this kind of stuff go on.