Standard Procedures for ER's/ Hospitals & CPAP?

[SleepyEyes21]

Hello All, Can anyone give any feedback as to whether there is any kind of industry standard or protocol of care, for CPAP patients that come into an emergency room or hospital admission?

My most recent experience of both was this: on 10/2, I admitted to the local community hospital via ambulance with fever and intense nausea. I informed my (very rude) nurse that I was on CPAP, to which she replied, "...that doesn't matter..." [Really?? What happened to the ABC's of intensive healthcare..Airway-Breathing-circulation?]

The ER doc gave me a combo of compazine and benadryl via IV for the nausea, then sent me for a chest X-ray( approx.1:30 a.m.) My nurse accompanied me to X-ray, and told me to stand up. I did, and instantly fainted. From that point on, I have no idea how I got back in the bed. I was in and out of consciousness; they then sent me for some kind of scan, which told them it was acute appendicitis. Then they started pushing morphine and set me up for emergency surgery. From the time I passed out at the X-ray machine, until after my surgery at 3:00 p.m. later that day, I had NO CPAP or oxygen on me or offered to me, and I was in a prone position at all times; most of the time, I was asleep, due to being given morphine/ medications.

I was discharged from this admit on 10/6, and re-admitted to the ER and hospital again on 10/8 due to complications from medications. I admitted to the ER at approximately 11:30 a.m. I informed them I was a CPAP user; they said they did not have a CPAP machine in the ER (I later found out from Respiratory this was not true.) On this second admission, again I was laying in the prone position, was left alone multiple times unsupervised, and went without CPAP or oxygen being given or offered from approx. 11:30 a.m. to 4:20 p.m. in the ER, and from 4:25 p.m. - 9:30 p.m. on the hospital unit I was assigned to.
During this second admit, I willed myself not to fall asleep altho I was exhausted and sick; I did ask for CPAP repeatedly. ER said they didn't have it, so I asked them to call the floor to have it ready for when I got there. Apparently, that couldn't be done for whatever reason, and it took an additional 5 hours for Respiratory to get to the floor once I got there.

Doesn't an ER or hospital have some kind of liability in a situation where a patient requires CPAP to breathe normally and it is documented in their systems (like mine is), and they don't provide the care?

Thanks for your information on this!

[LSAT]

I don't know about the ER where you normally are on monitors, but on overnights there definitely should be CPAP availability. From my experience at our hospital, I was offered a CPAP when I was admitted my first night and I had my wife bring mine for the next night. I found that hospital CPAPs are OK, but their masks suck...always bring your personal mask.

[BlackSpinner]

Document (as you have done) and send it to administration of the hospital and your states boards. Send it registered requiring a signature.

[SleepyEyes21]

I don't know about the ER where you normally are on monitors, but on overnights there definitely should be CPAP availability. From my experience at our hospital, I was offered a CPAP when I was admitted my first night and I had my wife bring mine for the next night. I found that hospital CPAPs are OK, but their masks suck...always bring your personal mask.

Thanks for your feedback, LSAT. If I know I'm being admitted, I do bring in my own mask/backup cpap. This was an emergency admit, and unfortunately due to complications from the appendix surgery, I landed in the ICU for three days afterward. I used their FF mask, and it did suck. Plus their machine did not have a humidifier. Eventually, I changed to their nasal mask on my second admit (also not planned), and it was much better than the FF, although the headgear was about the cheapest I've ever seen (from Resmed.) The RT's were able to add some humidity to the CPAP, however, there was no way to heat it. So cool air with CPAP combined with dry cool/ cold air in the hospital room created conditions for frequent nosebleeds for me. Just an FYI for anyone else sensitive to that kind of thing for the future.

[SleepyEyes21]

Document (as you have done) and send it to administration of the hospital and your states boards. Send it registered requiring a signature.

Hi BlackSpinner - thanks for the tip! This gives me an idea to look in the direction of the department of health for the state to see if there are any standards of care here.

Thank you

[PoolQ]

Standard Procedures: not that I have seen. Each Hospital has their own procedures and those they follow no matter what. So my guess is that the hospital you went to does not include does not have CPAP in any procedure that covered you.

The question is-should it be included in their procedure? Obvious answer is "well of course".

Not so obvious answer is "well lets look at what was going on"

When I was in the hospital I always had an O2 monitor on (procedure). Did you? If you did they knew if you were desat'ing or not and they would have done something if you were.

Did they handle it the best that could be done-of course not. they were discounting what you were saying. You had a health concern and no one explained anything.
Not a big surprise to me as they are 100% focused on executing procedure.

Hospital are not fun at all. They have one focus-fix what you came in for. Second they don't want to cause something new while you are in there. Apnea was not going to cause a new emergency. Make you uncomfortable as all get out, well yes. Make you worry when it would be easy to avoid that, well yes. Treat you like a human bean and show you some concern, well yes.

Something the system out here in California did that has made a huge difference throughout the entire health care industry is patient experience. The state reduces MediCal payments to any provider that gets low patient experience ratings. Hospitals now have Director level staff that interfaces with patients about their experience and they have MD level patients advocates on staff. Insurance companies actually care that you are happy with their service (shocker!).

Well I think you get my drift that I think you could have been treated much better! If you had been in there longer I think you would have had CPAP going on and it looks like you did finally get CPAP. I am pretty sure that a standard procedure would have had an O2 monitor on you.

I don't think you were in any "danger", but that's my opinion which doesn't count for much.

[Goofproof]

Standards? There are very few standards in this world that are universally applied anywhere, at best we have hob pog, of rules to apply mostly at a local level. Odd's are you have had Sleep apnea for over 10 years, it hasn't killed you. Many have it and are treated and still aren't making the most of what their treatment could be, they are alive too.

The worry is more likely to kill you faster than SA, make your Dr's aware of your SA, hospital records and intake, at each level. It's their job to keep you alive, it's your lawyer's to provide for your heirs. Jim

[SleepyEyes21]

Standard Procedures: not that I have seen. Each Hospital has their own procedures and those they follow no matter what. So my guess is that the hospital you went to does not include does not have CPAP in any procedure that covered you.

The question is-should it be included in their procedure? Obvious answer is "well of course".

Not so obvious answer is "well lets look at what was going on"

When I was in the hospital I always had an O2 monitor on (procedure). Did you? If you did they knew if you were desat'ing or not and they would have done something if you were.

Did they handle it the best that could be done-of course not. they were discounting what you were saying. You had a health concern and no one explained anything.
Not a big surprise to me as they are 100% focused on executing procedure.

Hospital are not fun at all. They have one focus-fix what you came in for. Second they don't want to cause something new while you are in there. Apnea was not going to cause a new emergency. Make you uncomfortable as all get out, well yes. Make you worry when it would be easy to avoid that, well yes. Treat you like a human bean and show you some concern, well yes.

Something the system out here in California did that has made a huge difference throughout the entire health care industry is patient experience. The state reduces MediCal payments to any provider that gets low patient experience ratings. Hospitals now have Director level staff that interfaces with patients about their experience and they have MD level patients advocates on staff. Insurance companies actually care that you are happy with their service (shocker!).

Well I think you get my drift that I think you could have been treated much better! If you had been in there longer I think you would have had CPAP going on and it looks like you did finally get CPAP. I am pretty sure that a standard procedure would have had an O2 monitor on you.

I don't think you were in any "danger", but that's my opinion which doesn't count for much.

Thanks for all of the info, PoolQ! I wish Florida insurances would start doing what CA is implementing; in fact, probably all the states need to do the same. Now- as far as the ER monitoring my O2- I really can't say for sure, as I was sleeping mostly from the time I fainted at the X-ray machine, until after surgery at 3:00 p.m. later that day. Is it 'standard procedure' for them to monitor my O2? I'm fairly certain they were monitoring my blood pressure at some point in the ER because my pressure was dropping really low.

Question: Couldn't apnea have caused a new emergency? Stopping breathing can stop your heart from beating, right?

Also - if apnea is a real medical diagnosis affecting millions, why is there not a standard protocol for ER's & hospitals?

[PoolQ]

"Question: Couldn't apnea have caused a new emergency? Stopping breathing can stop your heart from beating, right?"
Well in theory yes, BUT SA is not a fast thing and caused damage over the long run. Technically you can't experience SA unless you are asleep. From what I have heard it's not so much the stopping breathing that impacts the heart, but after you start breathing again the heart will race to move the O2 around the system and that adds stress to the heart. Something to be avoided, but it's not like having a blockage in the blood flow.

"Is it 'standard procedure' for them to monitor my O2?" here it sure is, it's just a rubber cup they put on one of your fingers and they leave it there, not like blood pressure where they wrap you up and take readings every hour. If you don't already know what this is then the chance of you paying any attention to it are slim indeed. It's typically just one more thing they do.

"if apnea is a real medical diagnosis affecting millions, why is there not a standard protocol for ER's & hospitals?" It is indeed real PERIOD, but so are many things and it is not what you are in there for and it's not really going to effect what they do for you. If your O2 drops for any reason, they will address that.

My issue is that they should have addressed your concerns and treated you like a human bean and not a lab rat. You also need to understand that while everything you have posted sounds very reasonable, there are many patients that go to the hospital that are very unreasonable. The hospital will not vary from procedure no matter what anyone says. When they talk with you they are following procedure and looking for very specific things and not really just having a conversation.

People that work in hospitals have learned a lot of very specific language, both in school and much that is used only between staff. We as patients know little to none of this language and most of the time we don't need to.

Learning some key phrases can help, but they have to be the right ones at the right time.

This last week I had an appointment with my sleep Doc and started off by saying " I tend to underreport" and his reaction was totally different. He sat still and upright, looked directly at me and listened. I started saying what I thought was important and that he had been missing, when I got to "I have problems breathing when I lay down, before I go to sleep" he turned to the computer and said he was referring me to a pulmonologist "right now" as this was no longer just sleep apnea.

When I was told by the DME that it would take 10 days to 2 weeks to get my machine, I called my insurance company and started the conversation with "I just had bypass surgery last December" and told them of the delay. I got my machine the same day, after hours.

It is difficult to know what is important and how to phrase things because we just don't talk their language or just don't know. When you say something to them AND it triggers one of their warning flags they WILL take action, if not they will just continue with their procedure.

[lindalrc]

Of course, with a prolonged ER admission like your first one, you are kind of stuck. But my basic rule is ALWAYS take the CPAP if going any place they might keep me. If a friend/partner is coming along (or following the ambulance), put them in charge of the CPAP and the fight to get it on you. I have taken mine to a colonoscopy and to an ER visit that turned into an admission. The idea of carrying around a mask in your purse/car/backpack/go bag is great. At least your face will be comfortable. Probably best to make sure that anyone you might call on after a hospital admission understands you, your machine, and what parts to get if/when sent to retrieve it. Hope you are doing much better now.
Lindalrc

[49er]

Standard Procedures: not that I have seen. Each Hospital has their own procedures and those they follow no matter what. So my guess is that the hospital you went to does not include does not have CPAP in any procedure that covered you.

The question is-should it be included in their procedure? Obvious answer is "well of course".

Not so obvious answer is "well lets look at what was going on"

When I was in the hospital I always had an O2 monitor on (procedure). Did you? If you did they knew if you were desat'ing or not and they would have done something if you were.

Did they handle it the best that could be done-of course not. they were discounting what you were saying. You had a health concern and no one explained anything.
Not a big surprise to me as they are 100% focused on executing procedure.

Hospital are not fun at all. They have one focus-fix what you came in for. Second they don't want to cause something new while you are in there. Apnea was not going to cause a new emergency. Make you uncomfortable as all get out, well yes. Make you worry when it would be easy to avoid that, well yes. Treat you like a human bean and show you some concern, well yes.

Something the system out here in California did that has made a huge difference throughout the entire health care industry is patient experience. The state reduces MediCal payments to any provider that gets low patient experience ratings. Hospitals now have Director level staff that interfaces with patients about their experience and they have MD level patients advocates on staff. Insurance companies actually care that you are happy with their service (shocker!).

Well I think you get my drift that I think you could have been treated much better! If you had been in there longer I think you would have had CPAP going on and it looks like you did finally get CPAP. I am pretty sure that a standard procedure would have had an O2 monitor on you.

I don't think you were in any "danger", but that's my opinion which doesn't count for much.

Thanks for all of the info, PoolQ! I wish Florida insurances would start doing what CA is implementing; in fact, probably all the states need to do the same. Now- as far as the ER monitoring my O2- I really can't say for sure, as I was sleeping mostly from the time I fainted at the X-ray machine, until after surgery at 3:00 p.m. later that day. Is it 'standard procedure' for them to monitor my O2? I'm fairly certain they were monitoring my blood pressure at some point in the ER because my pressure was dropping really low.

Question: Couldn't apnea have caused a new emergency? Stopping breathing can stop your heart from beating, right?

Also - if apnea is a real medical diagnosis affecting millions, why is there not a standard protocol for ER's & hospitals?

If you were on Morphine and not monitored properly, that could be bad news due to your sleep apnea.

http://sleepdisorders.about.com/od/caus ... -Apnea.htm

[nanwilson]

This is what I have done... I have my spare machine in a clear plastic tub along with 2 masks and everything else I need...........including a list of my meds, on my spare night table on the other side of my bed. I have a LARGE notice on the top of the tub and on the side with emergency instructions to take this tub to the ER with me.
I have gone to the hospital twice via ambulance and both times the paramedics saw the tub (don't know how they could miss it ) and took it with us to the hospital. Once in the ER the attending nurses placed the tub as close to me as possible without hindering their work, it went with me to my room once I was admitted and the machine was set up and mask was on me right away. I list the phone numbers for my daughter and granddaughter for emergency purposes on my instructions too. As I said this has worked for me twice, perhaps we should ALL do something like this to at least save us from having to go through what you have just done.
If you don't have a spare cpap, then perhaps a large note placed so that it can be seen, to take your gear with you....OR if you at least listed emergency numbers to contact your family they could get your gear to you asap. What ever works...do it.
Nan

[SleepyEyes21]

Standards? There are very few standards in this world that are universally applied anywhere, at best we have hob pog, of rules to apply mostly at a local level. Odd's are you have had Sleep apnea for over 10 years, it hasn't killed you. Many have it and are treated and still aren't making the most of what their treatment could be, they are alive too.

The worry is more likely to kill you faster than SA, make your Dr's aware of your SA, hospital records and intake, at each level. It's their job to keep you alive, it's your lawyer's to provide for your heirs. Jim

Thanks for your insights, Jim!

[sptrout]

I have no experience yet with CPAPs and hospitals, but the rule we follow based on other non-CPAP experience is hope for the best, but expect the worse (which will be the case). Therefore, #1 always take your own medications with you in their original bottles (hospital are very likely not to have all your medications and may try to substitute something else that is not even close - they tried this stunt on me). If you take your own medications, they have to use them if you tell them to. #2 Always, always have somebody with you at all times that can double check anything they do because they will screw-up. Hate to sound negative about hospitals, but my family has had a lot of hospital experience (in multiple states) and you really can expect to have issues come up. It is well known that one of the most dangerous place you will ever be is a patient in a hospital.

[chunkyfrog]

. . . #1 always take your own medications with you in their original bottles . . .

---Especially prescription eye drops. When I had my mastectomy, the hospital tried to charge me
over $400 for my glaucoma meds. (One drop in each eye) Since I had brought my own, I filed a formal complaint,
and that was the end of that! They tried to tell me that the drops were scanned at the bedside,
but after an audit, that was found to be untrue.