We discharged a patient last week to short-term sub-acute rehab in a nursing facility. Usually this would be the end of my involvement, except I got paged by a family member who had been very involved in the patient's care (and not in a way that made me want to stab him!), and ended up giving the rehab facility a call on the patient's behalf to push to make sure they were following the plan we'd sent the patient out with, and taking care of his needs appropriately.
And... now I understand why my parents are afraid of ever ending up in a nursing home.
"One of the things the family member told me he's concerned about is the diet his father's being served. As the social worker said in the discharge, he's supposed to be on a cardiac and diabetic diet, so I just want to make sure that's what he's getting."
"Oh, yes. Our cardiac diet is the same as our regular diet. And the diabetic diet here means we do not give him the ice cream."
"Yeah, we're hoping to keep his salt levels managed."
"We follow all state regulations for the diet."
"It's just that I was told that he was getting some meals that didn't seem particularly heart healthy-- meat loaf, chicken parmigiana, clam chowder, things that apparently he was finding very salty. So I just want to make sure."
"We don't add salt to our products, but many of the products do come with salt in them. The soup is from a can, and I believe there is salt added."
"Canned soup is very salty, sure."
"And the meat loaf, I'm not sure how much of that we prepare on-site and what packaged products we're using."
"Is there at least a way for him to get the nutritional information so he can make appropriate choices?"
"No, we don't provide that information to patients. But we follow all appropriate laws and regulations."
"Is there a dietitian on staff?"
"And he believes these meals are appropriate for patients with these restrictions?"
"We follow all laws."
"The family is also concerned about wound care. The patient apparently says he was woken up at 2 AM to have his dressing changed, but the nurse didn't have the right supplies, and left his wound uncovered until the day shift came in, hours later?"
"That does not make sense."
"I know. It didn't make sense to me either. It seems really inappropriate."
"No, it doesn't make sense because there wouldn't be anyone on staff to deal with any issues at 2 AM. I don't know who would possibly come into his room at 2 AM. No one would be able to address a wound at 2 AM."
"So no one is available for medical emergencies?"
"No, our PA is here from 9-3, Monday to Friday, so all issues are dealt with then."
"Wait, is there even a doctor? It's just a PA?"
"The doctor comes on Tuesday mornings."
"This complies with all regulations."
"So a doctor hasn't even been involved in his care yet, since he came in last Thursday?"
"No, the doctor will see him on Tuesday, if he has time."
"And how is his therapy going?"
"I don't see any record of any therapy yet."
"Yeah, that's what the family said too."
"Would you like me to arrange therapy?"
"He's supposed to be there for therapy, yes."
"I'm not sure that was in the chart."
"I do see something about an allergy, though."
"Yes, he has an allergy to penicillin."
"Oh, I'll write that in. It just says allergy, but doesn't have the details."
"That's an important detail."
"I'm writing it down."