It’s a beautiful spring day in April in Northeast Ohio, and there are four inches of snow on the ground. It’s covering the daffodils and the apple blossoms. This is not unusual nor unexpected, but it’s still unusual and unexpected.
An event like this one makes one think of the unusual and unexpected events that we encounter every day. Our patient came from the hospital without her hearing aid? This may cause a problem, and we have to figure it out. You discover that your 63 year-old patient may not be in as much pain as is documented, but he really likes medication? This may cause a problem, and we have to figure it out.
What about unusual and unexpected occurrences that are not objectively measurable but impact care anyway? Over the course of the last year, especially when emotions were heightened because of non-visitation rules, I heard over and over again from family members who saw their mom through a closed window and stated, “I just know something is wrong,” and they were usually right.
But what’s our response?
• That daughter is just crazy. She’s always been a problem.
• How can he tell anything through a window? All her vitals are good.
• We can get some labs, but that guy just likes to make trouble.
My personal, anecdotal experience says one thing: Listen to the families. Yes, they’re overwhelmed. It is incomprehensibly hard not to be able to hug Dad. Yes, their loved one recovered from COVID-19, and they couldn’t see her during or after her infection due to the lockdown, but they know. They know her; they know what she looks like and how she acts. Even through a window.
My experience also shows objective corroboration of the concerns called in by the “just crazy” family. I got a call on a weekend evening from a son who saw his COVID-19-quarantined mother through a window, and told me he knew something was wrong. I called the certified nurse practitioner, who doubted the subjective information from the son but ordered labs anyway. Monday morning labs showed dehydration and electrolyte imbalance that were at critical levels, with borderline kidney failure. The son knew.
I have often counseled and educated rehab staff on what constitutes a screen. Is it hands-on? No, that’s an evaluation. Is it a review of the chart? Maybe, but only if the documentation is accurate. But therapy screens can often come from the daughter, the nursing staff, the dietician, the housekeeping staff or anyone else who comes in contact with the patient.
The person who empties the wastebasket can be the one who alerts nursing and therapy that the patient is leaning over in the chair and “doesn’t look right.” The daughter can be the one who says, “my mom is having more trouble getting to the bathroom.” Any information about a patient’s status can trigger a therapy evaluation. That housekeeper saw something unusual and unexpected, and communicated it to the right people. Any information about a patient’s status should trigger a response from healthcare staff.
Our observations on what is unusual and unexpected can’t be the only ones. Believe the labs, temps and objective measurements. But also believe the families. Believe the therapists who spend an hour-plus with the patients. Believe your eyes and your senses. Especially now that visitation has resumed, assume that all information from families is pertinent to your care plan. No matter the source, anything that’s unexpected is an opportunity to improve the outcomes for your patients.
Jean Wendland Porter, PT, CCI, WCC, CKTP, CDP, TWD is the regional director of therapy operations at Diversified Health Partners in Ohio.
