Before Helen left the hospital, I confirmed that all her medical records would get to the skilled nursing facility (SNF) she was going to, and that the nurse at the hospital called to provide last-minute updates that weren’t in the records sent electronically earlier.
However, the nurse receiving Helen at the SNF complained that she didn’t have any of the information she needed: When was her last bowel movement? Why did she still have a catheter in? When did she last get pain medicine? What was the level of Coumadin in her blood? Is she supposed to wear the brace on her leg even when she’s sitting up in a chair, or can she use a wedge to keep her legs positioned properly?
“Normally they call when they’re sending someone. But I didn’t get any call about Helen.”
“But I was standing right there when they called!” I was baffled. “They talked to someone named Janice or Janet, gave Helen’s name and explained everything.”
“We don’t have anyone here named Janice or Janet,” the nurse replied.
We never did find out what phone number the hospital called – giving all of Helen’s information to someone not involved in her care.
Further, it turned out that the records sent electronically consisted solely of intake paperwork from the emergency room. There was no surgeon’s report about the operation; no doctors’ notes or orders (instructions); no nursing notes; no lab reports. The packet the ambulance driver brought had only the same intake paperwork in it.
The surgeon had said that the sealed bandage should stay on the surgical incision until Helen’s follow-up visit two weeks later. He had also described how to use a brace and wedge to prevent damage to her newly replaced hip.
But these details didn’t make it into the discharge instructions, so the SNF didn’t follow them. For example, they immediately removed the bandage, even though I explained what he’d said.
The nurse said, “I understand; I’m familiar with this type of bandage. But unless we have medical orders signed by the doctor that say that he examined the incision and it is fine, and instructing us to leave the bandage on, we have to take it off. We’re responsible for her and have to know what condition she’s in when she arrives – unless the previous doctor gives us this information in writing and specifically says to leave the bandage on until she is seen in his office. Then he is taking responsibility for the condition of the incision and the skin under that bandage.”
Every other missing piece of documentation caused another problem.
Next week’s column explains how you can avoid similar issues when a loved one transfers to a skilled nursing facility.
