Today I had an admission coming from a facility in Delaware. The daughter-in-law would be bringing him down to our facility. When I had talked with her several days ago by phone, she had described Mr. Jarvis as an active, talkative, yet confused man. She said he could walk, feed himself and for the most part, he would wander around on his own. To me, he sounded like the “typical” dementia resident. I contacted the facility in Delaware, trading paperwork for paperwork. My form C130 is their form K984. We trade back and forth until we each have the necessary documentation to satisfy both of our governing bodies. Finally, Mr. Jarvis is ready to be transferred to Virginia.
I had met his daughter in law yesterday. She seemed chatty, animated and excited to have Mr. Jarvis moving in. She was confident she could transport him the four hour drive alone. Based on the paperwork, he seemed like an easy guy to handle.
Around 2 pm today, she pulled into the facility, Mr. Jarvis in the passenger seat. Mr. Jarvis was not the same as he had appeared on paper. This was not the man described on form C130, or on form K984. This was not the man the MDS form or Form UAI said he was. This man was in physical distress.
Once out of the car, my team of nurses assessed him within minutes. His vitals were off the charts. His heart rate was zipping in the high 150’s. His O2 levels were dropping in the 80’s. His body was trembling from a temperature of 104.6.
Without a moment of hesitation, we called 911. Technically, he was not a resident of our facility. Form 00243 had not been signed. Document AP11 had not be electronically signed. I explained his “status”to the 11 firemen and 6 rescue workers that showed up. I exchanged forms with the rescue worker, careful to give him all of the forms provided to me from the facility as I explained my version of events. The daughter-in- law quickly produced another set of forms that I had not seen. The Discharge Form 29C. This form showed Mr. Jarvis leaving the facility today with his daughter-in- law. His vitals were signed off as having been checked and the readings were excellent. Based on that form, Mr. Jarvis was healthy as a horse. His blood pressure was 120/80,heart rate in the 60’s, temp 98.6, O2 level was 100 percent. Hmmmmmmmmm.
I asked his daughter in law how he acted in the car. She replied that “he acted like he was cold the whole way so I turned the ac off.” For fifteen minutes, she elaborated on what the staff had explained to her about his discharge, and explained all the discharge paperwork to her. She thought maybe the other facility has sedated him for the trip.
Every person involved in this man’s care completed all the forms; dotting their I’s, crossing their T’s, but missing what was obvious to the careful observer. We spend hours and hours writing reports, filling out forms, electronically sending medical data around the world, yet we can not see a man in apparent distress. Shaking, profuse sweating, sleeping and gasping for air are not signs of being cold or evidence of what is jotted down on form 546a.
Forms, forms, forms. Forms mean nothing to a person needing care. Forms are our way of covering our own behinds from legal battles and insure we are in ” compliance”. Nurses hurry through the paperwork, because they have so much to do;not noticing sweaty trembling hands. Nurses quickly jot down vitals, simply because they don’t have the time to take them…….but our paperwork is in order.
Mr. Jarvis is in the hospital….my fax machine just received 10 pages of forms about him………………….