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My grandmother who is 87 fell and hit her head on fireplace, causing her to go to hospital and get head stapled. They sent her to rehab in a SNF and was released 30 days later. Ok we told them she uses oxygen at night for sleep when she was getting admitted. She was in hospital using oxygen and transfered using oxygen. They used oxygen on her 17-24 hours a day for 29 days it says. Then on the 30th day she was able to breath on her own. Her vitals were great, even her lungs. Nothing on discharge papers needing oxygen at all. Thank God we had some there or she would have died. Her oxygen pulse level was 79/54. I have read that you have to wein them off of oxygen. Is that true? What are the guidelines for the use of oxygen on patient and their release?

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You've already gotten good advice.  I can only emphasize that, if the oxygen saturation rate (SAT rate) was really 79, that's way too low to be considered acceptable, dangerously low.

It is possible she was able to breathe on her own, but if it was at a 79 SAT level, that's NOT acceptable.   Someone screwed up.

Is she still in the facility or at home?  If the former, have an immediate conversation with the DON and raise the issue of the low SAT rate.  90 used to be considered a sort of point of departure; anything lower and oxygen was justified.   But she should also be tested while stationary and while walking and moving around.

I wouldn't think about weaning until a pulmonologist has been consulted; it's not something for a family to initiate w/o medical support, including follow-up home care after discharge from the facility.

Guidelines would generally be what is the best for the patient.  If a night test confirms she needs oxygen overnight, the pulmonologist would advise continuation of that.   Home care nurses post discharge can take SAT rates on visiting and if they drop, the pulmonologist would be consulted to authorize and make arrangements for the oxygen supplier to deliver equipment (if necessary) to make oxygen use 24/7.
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Didn’t you say GM was on oxygen at night prior to her recent episode? Did someone take her oxygen away while at rehab or did I misunderstand?
Was there any meeting with DC planning prior to her discharge home (via phone call if not In person)? I am thinking someone at rehab knew from GM’s past history that she was on oxygen at night prior to her admit there or it wouldn’t have been ordered. Is the order for continuous Oxygen via nasal cannula or use oxygen as needed?
Patients are often required to see their PCP within 2 weeks of DC from a SNF. I would make that follow up appt and discuss or verify GM’s oxygen needs with her PCP. One must qualify for Medicare to pay for oxygen and it sounds like your GM has already been determined to need oxygen prior to her fall.
Lastly I would have questioned the lack of an order for oxygen at home when picking up GM. Did someone go over DC orders with the staff prior to her leaving?
At this point I would get her in to see her PCP to resolve the immediate issue and then get your concerns together and inform the DON at the rehab center of the omission to assure it doesn’t happen to anyone else.
With Covid and SNF staff already stretched unfortunately I can see lots of room for error these days where DC instructions aren’t reviewed thoroughly. Not that it’s an excuse but they will tell you Covid is to blame (everyone is).
Good luck and I hope GM feels better each day.
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Someone dropped the ball. Patients qualify for home oxygen when their saturations are less than 88% for 6 minutes, either during the day or at sleep. They also qualify when they are exercising and the SATs are that level. Like wise Insurance requires recertification after hospitalization. If her sats are really low you need to take her back into the hospital and explain the situation, not the rehab because this is a new issue. She needs oxygen. You can also file a complaint with the Department of Health who will investigate and give sanctions if necessary
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With that bad of a sat there is no likelihood that grandmother will ever be able to e without O2. You will need MD order for o2 at home. What dreadful discharge planning; actually life threatening in the opinion of this old retired RN. Does Grandmother have COPD? Other lung condition?
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Ninersdeedee Sep 2020
Thanks this helped a lot. Great info
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Yes you do wean them off of oxygen. They should have been doing that in the hospital with a series of tests.
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AlvaDeer Sep 2020
I am an old Nurse and my tendency is to forgive facilities and hospitals almost everything. But this was dropping the ball in a BIG WAY and it is lucky the patient survived. Very lucky. I would report this to the authorities, myself.
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