Best "Skilled" Nursing Home stories

[vc85]

I know we all have them. What are your best "skilled" nursing home stories.

Some of mine when I was working dispatch:


Wheelchair van driver called to report an aide was using a "green leafy substance with an odor consistent with marijuana" in the outside smoking area

SNF calls for patient with acute difficulty breathing. I dispatch ALS who reports that they will be delayed on scene because the facility has to get the patient bathed, dressed and fed before transport; oh and that they were expecting a wheelchair van

SNF who started the phone call with "I don't need no EMT's or nothin' but I got two patients who have to go out. One is AMS; the other has the worst headache of his life with a BP of 210/130. Me: You're right, you don't need EMT's you need Paramedics. Them: What, why?

SNF who reports a patient is having general weakness. I repeat back: So the patient is weak all over their body. SNF: Yes, weakness on the entire left side of the body. Me:

SNF who absolutely insisted a patient with a GCS of like 5 was okay for transport by wheelchair van and that it wasn't an acute change. Guess what, they were wrong, on both counts.

From working at a 911 center

SNFs who call 911 rather than the IFT service for low-acuity non emergencies because the fire department ambulance comes for "free" (taxpayer funded); IFT costs $600-$1000 a pop. What makes that even better is if the first due ambo is out, we have to send a suppression piece from the first due to keep quick response times. So some of these SNF's were getting a ladder truck and ambo for a general illness call.

Assisted "living" who called 911 back and tried to cancel the ambo. When asked why: "The patient expired, so we don't need you anymore"

 

[NJEMT95]

Another crew showed up at an SNF to find nurses bagging a pt by squeezing the part of the BVM that fills with O2.

 

[vc85]

That reminds me, we had one reporting diff. breathing Sp02 of 50%......on 2 LPM nasal

 

[Carlos Danger]

Another crew showed up at an SNF to find nurses bagging a pt by squeezing the part of the BVM that fills with O2.

That urban legend has been around for decades.

For some reason it's always "another crew" that saw it....

 

[unleashedfury]

That urban legend has been around for decades.

For some reason it's always "another crew" that saw it....

Exactly PICS or it never happened....

From my personal experience.

911 Dispatch for "chest pain" Arrived at the SNF. walked up to the nurses desk took us to a patient who was lying in bed. And she "started ACLS protocol"

My First response - Ok what part of the protocol. response was a blank stare.

I went in to greet the patient and see what her story was. I got from the nurse she doesn't talk, and she has dementia. Hmmmm :unsure:

I then asked well if she doesn't talk, she has dementia and shes as lost as you say she is. How do you know she has chest pain???

Nurse - I can tell by the look on her face..

My response - Are you sure that's not her CPR face?

Nurse - Dirty look, supervisor called and I received a write up when I got back.

Another one was a Code same facility, CPR in progress the whole shebang. Arrived on location, shes cold, pale and rigor solid.

Me - How long of a downtime?

Nurse - I swear we just checked on her 10 minutes ago she was fine, we came back around and she was like this..

Me - Did you talk to her?

Nurse - Yes my Aides said she was up and around, and she was fine, I walked into the room and then she was unresponsive pulseless and apneic..

I swear they all just talked to them 10 minutes ago. They also get a little upset when you call for a release on a code since they are dead.

My woman works in a rehab center and used to work in a SNF. She said no one is allowed to die in them places cause its just a lot of paperwork.. If they dump them off on the hospital its not their problem.

 

[cprted]

Crew from my station gets called for an 89 y/o female with chest pain and shortness of breath. On arrival, the care aid states that the patient began experiencing chest pain and sob about an hour ago, but in the last few minutes hasn't been responsive. "What do you mean, non-responsive," asks the crew? "Well she just won't speak or open her eyes anymore," states the care aid ... you guessed it, pt was in arrest. Crew asks if the 89 y/o in the care home has a DNR ... the care aid doesn't know and can't find one ... Pt gets laid on the floor, compressions start, pads go on, backup is called. I arrive a few minutes later, pt has ROSC, we load her on the cot and away we go. Arrive at the hospital, into the trauma room, give report and hand off. Now that care has been transferred we have time to flip through the pt's binder the care aid sent with us ... guess what we found? Yep, her DNR!

It gets worse ... hospital staff pulled her chart and this is now the second time we have successfully resuscitated this pt because the care facility staff can't find or don't know the patient's code status ...

 

[MagicTyler]

I had a full code at a skilled nursing facility and my dispatch info on the computer was:
Full code, CPR in progress. Unkn pt info, unkn caller name. Caller states "I don't have time to give you my name and all that crap. I'm a nurse, and I've got to get back to beating on the chest"

Upon our arrival, CPR was in progress at a rate of about 30 a minute on a mattress (pt bounced with every compression). Pt was rigor and hadn't been seen alive for 3 hours.

 

[NomadicMedic]

I had a full code at a skilled nursing facility...

... As opposed to a half code, or those rare but deadly quarter codes?

 

[yowzer]

So some of these SNF's were getting a ladder truck and ambo for a general illness call.

That's normal for those of us who live or work in places where the fire department doesn't/won't transport but does do primary EMS response.

 

[mycrofft]

That urban legend has been around for decades.

For some reason it's always "another crew" that saw it....

I have seen it in students and once with a deputy. Most everyone quits after the first squeeze, it's just so insubstantial.

I had a co-worker declare the BVM was busted as to why no resps given. (Pt survived, didn't need it). When she stood up, the mask was under where she was crouched. Also didn't know you can use a pocket mask as a BVM mask. (NOT one of my students).

 

[mycrofft]

That reminds me, we had one reporting diff. breathing Sp02 of 50%......on 2 LPM nasal

Before pulse-ox, we responded to call to SNF, resident needed to go to hospital, losing consciousness, hx cardiac. On 2 LPM by mask with elastic headband nice and snug…

Amazing how she pinked up when we turned it up to 10 lpm for a bit.

 

[mycrofft]

Called to SNF (working private ambulance company).told pt needed to be admitted. Got there, they said she's not ready, so we walked around the lobby and dropped some complimentary advertising ashtrays and cards and pocket calendars around. Went back fifteen minutes later.

"So, is she ready yet?".

Desk aide's eye get real big and she looks scared. "No-o-o..".

"Well, when will she?".

"She's gone".

"GONE? Who took her? Where…".

"No….she's GONE…." looks like she's about to cry.

"Oh she DIED? Ah, ok, sorry about that…". (Aide took off back into the medical records room).

 

[Kevinf]

Went to pickup a patient to take them to their routine dialysis to find said patient had been dressed by the CNAs that morning while profoundly and obviously unresponsive. The patient was in severe septic shock, we transported her to the ED and she died later that day.

******

Another one (same facility as above) was after we had dropped off a patient, secured him in his bed with his controls and informed the nurses desk about his return. Our management gets a call a day later saying the patient is dead and they wanted to see the PCR of the trip. There is a bunch of back and forth and they keep calling our management wanting more info about this or that. Nobody will say what exactly happened, they just want to ask questions. So next time I was in that facility and free from a run I hunted down the administrator. Turns out the patient had gotten up 3-4 hours after we had left in an attempt to use the restroom, fell and fractured his femur (pt hx of prior femur fx in same leg) and bled out. Our trip sheet showed us having the facility staff RN sign the patient into the facility's care and the call bell and controls were provided to the patient hours before the fall occurred. Document everything and get those signatures! Our best guess is the patient either didn't ring his call bell, or did and they didn't respond fast enough for him so he decided to try to make it to the restroom alone.

******

Another one (SAME FACILITY) was where I had a return dialysis trip with a patient. His vitals were NOT within normal limits and he had a week+ long productive cough with bilateral crackles and a falling SpO2 while on 2LPM NC. So I crank up the O2 to 6LPM and got him to a stable 94% (hx of COPD, good sats for him) and I inform patient that I believe he has pneumonia and he should be taken to the hospital given his current status. Patient refuses, and we are back at the facility (transport time of < 3 minutes from dialysis) so we take him in on the stretcher and speak with the facility staff about convincing him to go. The have a CNA come in and take his vitals, then an LPN come take his vitals, then an RN come take his vitals (why all of them, I haven't the foggiest). They are talking to him and he is still refusing, so they call the attending physician. They give him my report, and their report, and the physician tells them to inform the patient he is recommending he be taken to the hospital (this takes about 1.5 hours to accomplish). Patient finally agrees. We take him in, give report, go home for the night.

So we come back in for a different patient two days later and I ask about him and one of the women at the nurses desk says he's back and starts telling me all about the EMTs that didn't have him on O2 and that's why his sats were bad and the EMT's didn't know what they were doing and he didn't need to go to the hospital in the first place because he doesn't have pneumonia. Good stuff. I informed her politely that I was the EMT in charge of that call and mentioned that he was in fact on O2 the entire time and that the on-call physician and floor RN had agreed with the assessment to transport to the hospital. She backpedals fast enough to power a small city and starts stammering about how that was just second hand information and she wasn't sure what actually happened. Ok then.

The patient was taken back to the hospital by 911 the next day and treated for severe pneumonia. This was after the facility had called our management to complain that the EMT's didn't have him on oxygen (6LPM O2 via NC was documented in my PCR) and that they shouldn't have had to pay for transport because he didn't really need to go.

*******

(we no longer provide services to that facility)

 

[unleashedfury]

... As opposed to a half code, or those rare but deadly quarter codes?

I spit coffee everywhere reading that.. <_<

 

[vc85]

Two more stories:

One SNF couldn't tell me whether a patient was actually bleeding through tubes or if they just found a drop of fresh blood in a tube. Every time I would ask "is he actively bleeding through the tube" they would tell me "Yes, I see a drop of blood in there"

 

[Akulahawk]

Over the course of several years of doing SNF to ED runs, I probably have too many "interesting" stories... but I've forgotten many of them simply because they blurred together. I've had too many instances of complaints of "weakness and lethargy" where the patient was clearly septic, if not in septic shock.

One call that I wasn't involved in (thankfully) was when a patient at a SNF (weakness & lethargy complaint again) had the patient being altered. Yes, the patient's pulse rate was an astoundingly fast 25/min. Who knows how long that was going on for... Much of the rest of the story was a serious cluster, but the patient ended up doing OK.

Any time I hear of that complaint, I've learned to take it with a huge bag of salt and be ready for darned near anything... including codes because I've seen it happen.

 

[rsd2nla]

Too many to count, but here are a couple.

Dispatched to a SNF for a fall pt c/o back pain. My partner went to assess the pt while I talked to the nurse. I asked the nurse when the pt fell and what happened, she said she wasn't sure, so I had her find someone who did know (pt didn't speak english and no one was able to translate). After talking to 3 different nurses (with 3 different explanations), the fall was from his bed and apparently either "the night before" "this morning" or "4 weeks ago.":glare: Since we weren't getting anywhere we just transported the pt to the hospital with the info we had. At the ER the nurse asked when the pt fell, and I explained to her what happened. Her face = :blink:

Had a nurse at a SNF tell me they didn't practice isolation precautions because "everybody has one thing or another." Noped out of there as soon as I could.

 

[phideux]

Had one come through the ER last week, the called for evaluation for a possible syncopal episode after they put the patient to bed.
She was sleeping.:blink:

 

[TechMedic]

Heard a story from my department that one nursing home somehow got a bp on a dead pt. They said they got it not long before we got there and when my paramedic showed up, he rolled her over and said "lividity, ladies and gentlemen"

 

[vcuemt]

Crew from my station gets called for an 89 y/o female with chest pain and shortness of breath. On arrival, the care aid states that the patient began experiencing chest pain and sob about an hour ago, but in the last few minutes hasn't been responsive. "What do you mean, non-responsive," asks the crew? "Well she just won't speak or open her eyes anymore," states the care aid ... you guessed it, pt was in arrest. Crew asks if the 89 y/o in the care home has a DNR ... the care aid doesn't know and can't find one ... Pt gets laid on the floor, compressions start, pads go on, backup is called. I arrive a few minutes later, pt has ROSC, we load her on the cot and away we go. Arrive at the hospital, into the trauma room, give report and hand off. Now that care has been transferred we have time to flip through the pt's binder the care aid sent with us ... guess what we found? Yep, her DNR!

It gets worse ... hospital staff pulled her chart and this is now the second time we have successfully resuscitated this pt because the care facility staff can't find or don't know the patient's code status ...

So who got sued?