Hospitals:

Hospitals:

Gail
Gail

April 15th, 2006, 6:01 am #1

hello everyone,i hope this does not affend any of you that work in the hospital,if it does im sorry as im not trying to affend anyone.But we have a resident that went out to the hospital last month over his toe,well they had to amputate the toe which looks awful.But he came back from the hospital tonight with a stage 3 decube on his right middle toe,open areas on his bottom,bruises all over his tummy and by his scrotum,his bottom and scrotum and sack looks like raw hamburger,now grant it he did not leave the nursing home like this,he is now a 3 person assist,is incotinent to BM,now has a catheder,they send no new orders for him,no pain meds,no antibiotics,his toe that was amputated,well they have dressings inside of it,the area is very red, and stinks.This has saddened us big time because the poor man use to walk,use to take himself to the restroom,all this before he went to the hospital.Why is itthat sometimes residents comes back from the hospital in worse shape then when they went.We are all very saddened by the sight of this poor man.He is a diabetic also.Sometimes i think we care so much that we think of the residents as our own family.
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Joined: February 13th, 2004, 5:08 pm

April 15th, 2006, 10:46 am #2

Well, that's one thing I can say about our hospital that IS good....

I posted something the other day about lack of time to properly feed those that need it. Our unit is bad about that.

But, we're known for general wound care. Of course, one cannot generalize about all hospitals, but I know ours is really good about decubitus. Techs (as myself) and nurses are really good about turning patients, checking them over thoroughly, and treating anything that even looks like the start of a pressure sore. We have several wound care nurses who float around the hospital and both take care of the patient and thoroughly instruct the nurses as to how to care for the patient --- actually, they will talk to me as a tech too. We use pillows prodigiously. I spend a fair amount of time with the patients that need it, positioning two pillows behind back and shoulders, and other pillows between knees or feet or whatever is needed and turning every 2-3 hours.

So, I can say we do send people back to LTC's in much better shape than they come in. Actually, I assume CNA's know that the greatest source of decubitous is not hospital or LTC(???), it's lack of good home care. A lot of people, with the best of intentions, allow the people for whom they are caring get pressure sores at home. That's one of the best arguments for bed-bound people to be institutionalized. It may sound bad, but LTC's generally do a better job of handling bed-bound people because they have more resources, not because they 'care' more.
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Anonymous
Anonymous

April 15th, 2006, 10:47 am #3

hello everyone,i hope this does not affend any of you that work in the hospital,if it does im sorry as im not trying to affend anyone.But we have a resident that went out to the hospital last month over his toe,well they had to amputate the toe which looks awful.But he came back from the hospital tonight with a stage 3 decube on his right middle toe,open areas on his bottom,bruises all over his tummy and by his scrotum,his bottom and scrotum and sack looks like raw hamburger,now grant it he did not leave the nursing home like this,he is now a 3 person assist,is incotinent to BM,now has a catheder,they send no new orders for him,no pain meds,no antibiotics,his toe that was amputated,well they have dressings inside of it,the area is very red, and stinks.This has saddened us big time because the poor man use to walk,use to take himself to the restroom,all this before he went to the hospital.Why is itthat sometimes residents comes back from the hospital in worse shape then when they went.We are all very saddened by the sight of this poor man.He is a diabetic also.Sometimes i think we care so much that we think of the residents as our own family.
I have noticed that too,when a resident goes to a hospital and then returns to nursing home they nearly alsways come back with "something".
They leave the NH with no open areas on their tush and when they come back it is always open and red..
I have heard that when they go to the hospital they are only going to treat what they went in for.
Most times they aren't repositioned and washed as well as they are in the Nurshing Home. Sad!!!!!!!!!!!!!!!
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Simone
Simone

April 16th, 2006, 12:47 am #4

Well, that's one thing I can say about our hospital that IS good....

I posted something the other day about lack of time to properly feed those that need it. Our unit is bad about that.

But, we're known for general wound care. Of course, one cannot generalize about all hospitals, but I know ours is really good about decubitus. Techs (as myself) and nurses are really good about turning patients, checking them over thoroughly, and treating anything that even looks like the start of a pressure sore. We have several wound care nurses who float around the hospital and both take care of the patient and thoroughly instruct the nurses as to how to care for the patient --- actually, they will talk to me as a tech too. We use pillows prodigiously. I spend a fair amount of time with the patients that need it, positioning two pillows behind back and shoulders, and other pillows between knees or feet or whatever is needed and turning every 2-3 hours.

So, I can say we do send people back to LTC's in much better shape than they come in. Actually, I assume CNA's know that the greatest source of decubitous is not hospital or LTC(???), it's lack of good home care. A lot of people, with the best of intentions, allow the people for whom they are caring get pressure sores at home. That's one of the best arguments for bed-bound people to be institutionalized. It may sound bad, but LTC's generally do a better job of handling bed-bound people because they have more resources, not because they 'care' more.
Your facility needs to have their liaison go over, with the hospital, exactly what your facility expects in the form of instructions and orders upon the patients discharge. What your facility needs to do is check for the paperwork before you accept your resident back (through a telephone report and ask about paperwork) and if the resident comes back without the proper paper work - don't let the ambulance company take them off their stretcher, but send them right back to the hospital. It may sound harsh (it is legal)but it will only happen once, the hospital doesn't have the bed avail. to keep letting it happen.

As for the wound issue, it is too bad this still happens. I would be curious of the CNA:patient ratio at the hospital. At my hospital, since the CNA:patient ratio improved about 7 years ago, our wound care has, also. Amazing!! It is pretty standard these days for facilities to have wound nurses, if not, wound teams. And, not knowing the patient, it sounds like he has poor circulation due to his diabetes and was lucky the toe was has far as they went with the amputation. The bruises on his stomach could have been from Lovenox shots to prevent blood clots. His other wounds, though, should have not occured. But it is hard to defend or accuse not being there personally.
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Ajaxkid
Ajaxkid

April 16th, 2006, 4:28 am #5

Well, that's one thing I can say about our hospital that IS good....

I posted something the other day about lack of time to properly feed those that need it. Our unit is bad about that.

But, we're known for general wound care. Of course, one cannot generalize about all hospitals, but I know ours is really good about decubitus. Techs (as myself) and nurses are really good about turning patients, checking them over thoroughly, and treating anything that even looks like the start of a pressure sore. We have several wound care nurses who float around the hospital and both take care of the patient and thoroughly instruct the nurses as to how to care for the patient --- actually, they will talk to me as a tech too. We use pillows prodigiously. I spend a fair amount of time with the patients that need it, positioning two pillows behind back and shoulders, and other pillows between knees or feet or whatever is needed and turning every 2-3 hours.

So, I can say we do send people back to LTC's in much better shape than they come in. Actually, I assume CNA's know that the greatest source of decubitous is not hospital or LTC(???), it's lack of good home care. A lot of people, with the best of intentions, allow the people for whom they are caring get pressure sores at home. That's one of the best arguments for bed-bound people to be institutionalized. It may sound bad, but LTC's generally do a better job of handling bed-bound people because they have more resources, not because they 'care' more.
Yes, you are talking about a whole facility in which its training and focus is on preventative measures as opposed to, say, untrained family members who may be ignorant of such things... not to mention the fatigue that comes with caring for someone in a compromised condition (i.e. too damn tired to turn Grandpa every two hours in bed after working with him all day).
The worst decubes I ever saw were on a skeletal old gal who was contracted into a fetal position and had decubes on each hip that you could put your whole fist into. She came from home. Watching the nurses change her packing was like watching a magic show. The packing just kept coming and coming and coming. We almost had her healed when she died.
As for hospitals, I say it's the same as nursing homes... it just depends on which ones and the standards they maintain. However, they do not have the excuse of ignorance.
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Catherine
Catherine

April 18th, 2006, 7:06 pm #6

hello everyone,i hope this does not affend any of you that work in the hospital,if it does im sorry as im not trying to affend anyone.But we have a resident that went out to the hospital last month over his toe,well they had to amputate the toe which looks awful.But he came back from the hospital tonight with a stage 3 decube on his right middle toe,open areas on his bottom,bruises all over his tummy and by his scrotum,his bottom and scrotum and sack looks like raw hamburger,now grant it he did not leave the nursing home like this,he is now a 3 person assist,is incotinent to BM,now has a catheder,they send no new orders for him,no pain meds,no antibiotics,his toe that was amputated,well they have dressings inside of it,the area is very red, and stinks.This has saddened us big time because the poor man use to walk,use to take himself to the restroom,all this before he went to the hospital.Why is itthat sometimes residents comes back from the hospital in worse shape then when they went.We are all very saddened by the sight of this poor man.He is a diabetic also.Sometimes i think we care so much that we think of the residents as our own family.
You are right about that. I too have seen residents come back in worst conditions than before they left the nursing home. I was surprised to see this because hospital are large with all kinds of technology, medical knowledge and have all the tools and medications to care for patients, only to see them come back worst! I wondered many times, what happened! My guess is that in hospital the nursing see their patients come and go with very little concerns, and in the nursing home, we grow attached and concerned about our residents. Also, we know that when decubitus breaks, we as CNAs will be the one to care for the break down on the skin. We have to see resident suffer through decub, and there is a lot of efforts placed on us to try and prevent them. Hospitals staff/nursing just look at patients as temporary residents and they will not see them again. It is sad, but unfortunately, that is the way it is.
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Joined: February 5th, 2004, 12:21 pm

April 19th, 2006, 11:17 am #7

Sometimes when patients come from LTC in the ICU they are just to sick to turn. Even putting them on their side just to quickly wipe their butts and change their sheets will drop their pressures or sats. Nutrition also plays a big part in skin break down. In the hospital they may not want to eat. Anesthesia seems to have a bad effect on the elderly they just don't come out of it as well. When they leave us their skin may not be what it was but they made it home. (Which may or may not be a good thing in some cases) We do the best we can.
Mary
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