Hello All

I was called to the emergency room by one of the nurses working that night. A patient was being discharged home by the emergency room physician, and the patient's family had requested to speak to the nursing supervisor. When I arrived to the emergency room, the nurse that was taking care of the patient approached me. She pulled me aside, and voiced her concerns. The patient in bed three was sick with a respiratory infection. He had been given intravenous antibiotic and was now being discharged with a prescription of oral medication. According to the nurse, the patient was weak. The patient's family was upset because the patient had missed two days of dialysis and they wanted him transferred to a hospital in Miami so he could have his dialysis done and also continue to be treated for his respiratory infection.

Before approaching the family, I decided to speak to the physician so I could understand this case better and try to solve the situation in the best way possible. This was the second night that this physician had been working in the emergency room, and my first time meeting her. I told the physician that the family of the patient in bed three had requested to speak to me. The physician review of the situation was as follows: The patient had been in the emergency room earlier in the week and he had been treated for an upper respiratory infection. On that first visit it was also noted that his blood urea nitrogen (BUN) and Creatinine blood levels were elevated. The patient had stated that he had missed his dialysis treatment because he had not been feeling well. On that day, the physician had discharged the patient with a prescription for antibiotic medication and discharge instructions to make sure he didn't miss his dialysis appointment, scheduled for the following morning.

On this second visit to the ER, the patient presented with a higher BUN and Creatinine blood level. The patient's family told the triage nurse, that the patient had again missed his dialysis treatment. It was also noted that the prescription from the first visit was never filled.

The physician told me that she was going to discharge the patient because the patient had county transportation that picked him up and dropped him off to and from his dialysis. She continued to tell me that it was his "non-compliance" that had him now with a higher BUN and Creatinine blood level and with a worst respiratory infection. He was to be discharged with instructions to go to his dialysis treatment the next morning and fill-up his prescribed medication.