by Steve Maloney RRT
Recently, a facility requested portable oxygen for a complex diabetic patient prior to discharge. It was reported that the patient and family were capable of managing home oxygen, tracheostomy aerosol, nebulizer, and suction. The man was obtunded and flat on his back in bed. He denied that he knew how to manage his respiratory equipment. He was scheduled for a Friday discharge and adamant about going home. Further inquiry disclosed no supportive people in his home but an infrequent visiting friend. A respiratory therapist took immediate responsibility for comprehensive training prior to discharge. She insisted that discharge was conditional to demonstrating competency in all therapies. It was recommended to provide all supply delivery one day prior to discharge so to begin orienting the family to comprehensive care. Instead all supplies were delivered on Friday.
The medical transport company did the discharge and would connect the patient from the portable oxygen to the oxygen concentrator at home until the respiratory therapist and visiting nurse arrived. The home respiratory therapist found the patient connected to an E cylinder which was not turned on. The visiting nurse contacted a home health agency to arrange for a home health aide the following week. No sterile water was delivered, and the patient stayed on dry oxygen to a Passy-Muir tracheostomy speaking valve until the water arrived. Neither the friend nor patient remembered to rearrange the humidification as instructed after the water was delivered. They contacted the on-call respiratory therapist regarding clarification. The continuity of care was compromised.
The respiratory therapist’s role in coordinating care cannot be underestimated in the discharge process.
“Not a Job, An Adventure” is a quarterly editorial open to the all Respiratory Care Practitioners in New Jersey. The title suggests a personal experience which proved a positive learning experience beyond a daily routine. The NJSRC Board encourages our readers to forward your story of adventure to SCOPE. The board reserves the right to edit the story and request a limit of three hundred words. We invite you to submit your own story or topic related to your job. Feedback and new ideas will help this publication and our profession flourish.
