Emergency Plan...

Kate · #1 04-09-2008, 11:26 AM

Do you have an emergency plan written out for the nurses or how do you discuss it? I know we have with the nurses--but something caught my attention the other night (mainly just a nurse who has gotten too comfortable) so I'm just wondering what you do...

The situation here was obvious--Mitchell on CPAP in his big boy bed--if he gets out and you aren't listening carefully, he could easily pull out his trach and do major damage--so I told the nurse this--stressing that she has to really be on her toes tonight-trying to scare her as she isn't the fastest lady on the block-Reminded her where the extra trachs were just in case--she looked at me and said, "Well, I'd call you if I had to do that." I looked at her and said--"UM-you wouldn't have TIME to call me....if his trach comes out--YOU HAVE to deal with it immediately, you can't call me to come down until after you've delt with the situation" They typically call if they have issues-I have my cell by my bed so they don't have to run up and wake me up. This comment obviously caught my attention-1st she really has no common sense-she does an addaquit job with Mitchell--just enough to keep her but nothing more and at this point we can't be choosy.

SO--an emergency plan. I think I need something in writing that they can look over and we can talk over (a refresher) as to when it is appropriate to call.

If they'd have to call 911....when do you have them get you up? (for those w/night care) I'd say call 911 and then get me up--but if the 911 operator keeps them on the line...then what? If it isn't so black and white as to if they need to call--then I'd want them to wake me.

I hope I'm making sense here. I guess the situation the other night was pure stupidity--and yet I want to make certainly that it was all talk and that if the situation happens--they aren't calling me to put the darn trach back in when that is exactly why we have them.

I sometime ASSUME and I try not too-but man, I have to remember that I've learned 70% of my nurses have no common sense.

Thanks-sorry so long.

JWorthington · #2 04-09-2008, 11:41 AM

Yes, we have an emergency plan, and all the staff caring for Sam can put in a trach tube! We have a huge file that documents just about everything about Sam, it has all his doctors contact details, his medical history, even his likes and dislikes. There is a checklist so that the staff check all the equipment is there and is working when they come on shift and they always write handover notes.

Julie

drct1245 · #3 04-09-2008, 12:06 PM

We kind of have a plan... it's probably out dated as it was originally worked out when Ayden first came home. Ours is a little different in that we are right across the hall from Ayden, so all the nurse has to do is yell. In addition, with Ayden, as long has he isn't sick, he is OK for 1 - 2 minutes w/out a trach as he doesn't have the structural damage, his trach is for his lungs. I would say, if 911 is needed, 911 is always called first. If your cell number is preprogrammed, I would say just call that first and let it ring 2x and the call 911. Tell them do not talk to you - even if you answer, just hang up - it sounds like you might have to get that specific. The 2x would probably be just enough to wake you up. (?) But as you have said, the airway is key. Does your phone have a speaker as they can be on the speaker and doing something at the same time. Just a thought...

Hope that helps a little.

Kate · #4 04-09-2008, 12:45 PM

We had/or have one-but I guess it really just isn't specific and now seeing our nurses-or getting to know them better--one really needs specific directions...ON EVERYTHING. It gets annoying, but she hasn't had kids and typically isn't a peds nurse-so she has 2 strikes against her right there. Our agency is very good at screening nurses and not putting nurses who aren't medically capable to handle a situation in a home--so I do trust that she has the nursing skills....just not the common sense (which is why I need to be so specific with this one)

Thanks for the ideas--I'm going to have to think about it and put something together---sheeesh-sometimes I wonder if these nurses are more work than they are worth...unfortunately little baby thinks they are well worth the trouble. I'm hoping that we can really cut down in about 6 months...I can hope can't I.

Mom2TwinsPlus1 · #5 04-09-2008, 12:52 PM

When we had nurses, I thank god we have a tiny apartment, with my door shut even I can hear and wake up for pulse ox and vent (I am a super light sleeper) so they never had to come get me, many a night I would get up to just check on things.

But the plan was they start fixing her and yell for me. I only had this happen once, it was a plug and by the time I got in there she had it well under control, she said she just thought she MIGHT need an extra pair of hands.

With Emma being totally inactive, risk of decan is pretty low at our house. Our man concern is her plugging or getting sick and she usually does this over a few mins, so they could come get me if need be

LKN · #6 04-09-2008, 02:27 PM

We don't have an official plan, but we do ask each nurses at the interview what they would do if the trach came out. If they say, "Come and get you," we don't hire them.

After they are on our case, we tell them that we think of them as the first line of defense. It is their job to put the trach back in or help him, etc. We also make sure they understand that they help him first but yell into the baby monitor to get our attention--one or both of us will call 911.

alizesmom · #7 04-09-2008, 05:23 PM

Since the nurse who froze when Ciara decanned we have started making all of our nurses change trachs with us so we know they can. Even if they say they have done it, we make them. We also tell them to yell for us. Shortly part of our house is going to be made accessible for Alize. This means that he will be out of yelling reach so the plan is to put in some sort of intercom system. Having something written is a good idea. Karen

Kate · #8 04-09-2008, 06:58 PM

Thanks everyone-ya we do trach changes before they can start as well-and she did one so I don't know what the issue is. We're going to have to talk about it though. My feeling is that she is just getting too comfortable with Mitchell being so stable. Great that he is so stable, but makes me leary that she is getting so comfortable. The last time we saw this in a nurse she started making med errors-so I think we need to nip this right away.

I think that she puts way too much confidence in the fact that we are here--I know that when I went to L&D a couple of weeks ago during the night she got nervous to see us leave. I'm not sure what her deal is--she is werid--she also refuses to train in another home.

thanks again