Well, it’s been a struggle keeping Hattie out of the hospital. She had a fever for two days and clearly wasn’t feeling well. A urine culture was sent and everyone was encouraging her to drink fluids. Her urine looked clearer and lighter in color with the extra fluids, but she wasn’t feeling any better. Carol, her daughter, suggested sending Hattie to the hospital. Anna, Hattie’s nurse, was feeling the pressure related to Hattie’s change in condition, Carol’s desire to have her mother admitted, and knowing our nursing home’s goal to reduce hospitalizations. Anna called a staff huddle to discuss Hattie and invited me to attend .
First, we checked with the lab to see if there were any preliminary results from the urine culture but it wasn’t ready yet. Anna reported that Hattie seemed more confused. Sherry, the nursing assistant, checked her temperature and it was 0.5 degrees higher than earlier. We discussed what we could do and went into action. Anna called Hattie’s doctor and used the SBAR communication form to give him an update. Anna recommended trying an IV antibiotic and keeping her at River View. Anna told me the doctor didn’t seem to know, or remember, that we could administer IVs. The doctor ordered IV Gentamycin for 24 hours and asked that we call him with the lab results. He wants to switch her to an oral antibiotic as soon as he can. He also asked to be notified if Hattie’s temperature got any higher, she complained of nausea, or any other changes. Sherry went to assist Hattie with her lunch, encouraging her to eat and drink. I called Carol and informed her of the plan. She seemed relieved.
Hattie started to improve after the IV was started. Within several hours her temperature went down slightly, she was less confused, and she even asked for some ice cream. The lab results are back and Anna is going to call her doctor to get the antibiotic changed to an oral med. So luckily, we kept her out of the hospital. That said, we still have some system issues related to changes in condition.
Where do I start to look at how we can change our processes to prevent unnecessary hospitalizations ?