Street Lessons #3 Know Thy Patient

Ahh, the simplest things.  You need the patient’s name, date of birth,  and social security number if possible.  The name is most important.  If the name is John Smith or Juan Martinez, the date of birth helps.

I was a brand new spanking EMT and we had a patient in classic CHF — I am talking hypertensive through the roof, bulging jugular veins, filling emesis basins with pinky frothy sputum.  We had him on a nonrebreather, on a stair chair, out to the ambulance, and lights and sirens half way to the hospital before we realized we didn’t who he was, and he was still working at breathing too hard to get a syllable out.  No name, no DOB, no social, just the address we picked him up at.  Chalk that one up to two excited rookies.

On most calls, if you leave the house without the patient’s name, this is no problem, the patient can tell you.  In the past, I didn’t often bother with this information if the patient was talking to me.  I figured I could get it out in the ambulance.  I look at the elderly patient and say  “You know your date of birth and social security number?”   The patient looks me right in the eye and says “yes, sir.”  Very good.

On the way to the hospital, after I have done an IV and 12-lead, I ask the patient for his date of birth.  “Yes, sir!”  he says.  Same answer to social security number.  I ask him his name.  “Yes, sir!”

Always get the name and social.

I am in the nursing home and the nurse hands me the envelope.  I take a quick look at it to see if there is a name, date of birth and social security number filled in on the paperwork and that I can read it.  Check.  Check.  The patient is unresponsive.  Out in the ambulance, I am checking the patient’s meds to see if they provide a clue to their condition.  I notice then that patient’s name is Mary Wilson.  The problem is the patient is a man.  I send the paperwork back into the SNF with my partner who comes out with an apology and the paperwork for Richard Johnson.

Here’s one.  Nursing home patient is unresponsive.  Ambulance crew takes patient and paperwork.  Patient’s blood sugar turns out to be 29, but he is not a diabetic.  They give him D50, and he comes around, but is still somewhat confused.  At the hospital they keep him overnight to do tests and figure out why he dumped his sugar considering he is not a diabetic.  Plus he is still confused.  He won’t answer to his name.  Later that night, the hospital gets a call from the nursing home to check on the patient.  Who?  The hospital says, we have no one by that name here.  Later the hospital calls the nursing home back.  We do have someone here from your facility named Edward Thomas.  Ahh, no you don’t.  Edward is right here next to me in his wheelchair.  Whoops.  No wonder the man in the hospital bed won’t answer to his name.  Turns out the patient is a diabetic after all.

You have to check the name.  If the patient can’t confirm it, check for a name bracelet.  No bracelet?  Get a nurse to verify the patient and paperwork are one and the same.

You’d think it would be easy, but it’s not.  The times I’ve been on calls and had a first responder hand me a piece of paper with the patient’s name and information on it, and its been the first responder’s previous patient, and not this current one.  The times it has been the right patient and I have put the paper in my right pocket, but then pulled a piece of paper out of my left pocket and started typing in the name on the left pocket piece of paper.  Not the  patient in front of me.

I try hard now.  I introduce myself to the patient and get the patient’s name or get someone to tell me the patient’s name.  Mistaken identity can lead to serious errors, and those we always want to avoid.

3 Comments

  • devkrev says:

    I think a good corollary to this, when it comes to non-emergent transfers, and discharges from the Hospital to SNFs, is “Know Thy Destination”.

    Once I almost brought a patient three hours in the wrong direction because the paperwork said we were headed to a facility was 4 hours from the patient’s home address. I asked for clarification, and it ended up the patient was headed to the similarly named facility much closer to his home.

    Another instance, we got as far as sliding the patient to a bed before we found out that we were sent to the wrong facility. The SNF was expecting a patient from where we were coming from, so they weren’t surprised when we arrived and had a bed all ready to go. Only when I passed that envelope over and the nurse saw the name was the mistake realized. Luckily, that was just a quick trip down the road to the appropriate destination.

    Somewhere in there, I got in the habit of asking the patient, and the nurse, and the family, and whoever else I could if they could tell me where they were headed.

    • medicscribe says:

      Good one. I’ve had that happen before, but not to that extent. I did have a scene mix-up where we were sent on a 911 call to a local nursing home, but instead of being given the name of the nursing home, we were given the street address and this particular street had several nursing homes on it all in a row. We went to the one we go to the most. Used the center wing entrance as they told us, went in, and after being complimented for put prompt response, we were directed to a patient who we put on our stretcher and grabbed the paperwork and left. In the meantime our dispatcher is asking where we are, the first responders say we haven’t put out yet. We’re already on the way to the hospital we say. Well, as you can imagine the problem was we went to the wrong nursing home, which also happened to have someone ready to go out. They had to scramble another ambulance to get to the other nursing home.

  • R says:

    Re: Correct Reviecing Facility

    I’ve got a friend who used to work for a Seattle based aeromedical service that not only provides helicopter transport (both scene flights and inter-facility) for most of Western Washington but also has Lear Jets to bring people in to Seattle from Eastern Washington, Idaho, Western Montana, and Alaska which are lacking in burn and trauma centers. They usually kept a second plane in Southeast Alaska which would would typically fly patients to Seattle but sometimes would take them to Anchorage.

    He was usually pretty careful about double checking destinations and especially the patients locations since there are places in Alaska with similar sounding names that might be a thousand miles apart or might not have an airport that the Lear could land at. At the time there were Providence Hospitals in both Seattle and Anchorage. Guess what happened after they flew a patient to 900 miles to “Prov”, drove the patient and flight nurses from the airport to the hospital in an ambulance, and discovered that the accepting physician wasn’t on staff at Providence Seattle?

    Yeah, patient was supposed to go to Anchorage.

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