There are a lot of programs in the UK trying to reduce the hospitalization of older people. However, your duty as a nurse is to assess each person before sending her/him to the hospital. Always read the care plan, because there are families that don’t want to send their relative in hospital.

If you are concerned of a patient condition but is not as bad to send him/her to the hospital you can always call the patient own GP for a home visit. If the situation occurs outside the surgery normal program, you can always call 111 (out of hour’s doctor service) for a medical advice or a doctor visit.

It was Christmas Eve. My patient Mr JA was not feeling very well. The other nurses and I were nervous about his situation. His family were what we call ‘troublemakers.’ On a previous occasion we sent JA for an outpatient appointment, but they had given clear instruction that he was not to go for any appointment or hospital admission, so they raised a safeguarding complaint.

So on 24^th December 2014 I was on duty and I knew Mr JA’s case very well. His legs were very swollen and leaking. Saturation was also very low, approximately 80%. I decided to call 999 for an ambulance so that at least he would be seen by a doctor and they could then decide what to do. After I called for the ambulance, I started gathering all the paperwork to prepare it for the crew. I found a document in the care folder dated 21^st December that if saturation goes below 86% to call for an ambulance. This information had not been handed over at the beginning of my shift as it should have been.

As nurses, we are responsible for our own decisions, and we need to be ready to justify why we choose to act in one way or another. Families can change their minds from day to day, and you need to act in the person’s best interest (which also protects your PIN number).

After I called the ambulance I informed his family about it and they were happy about the decision. Mr JA passed away in the hospital a few days after.

In case the family were not happy for Mr JA to go to the hospital, at least they could inform the ambulance crew and decide together what plans to make for his care.

This is few cases when I personally recommend for you to Dial 999 for an ambulance:

• Resident had a fall and is unable to move his/ her limbs, don’t move the patient, just call 999
• Resident had a fall and you suspect fracture
• Head injury with severe bleeding on Warfarin taking patients
• Resident is unresponsive/ unconscious
• Resident with epilepsy, when the seizure doesn’t stop after 5 minutes even if you administered rectal diazepam;
• Resident with epilepsy with multiple seizures one after another
•  Allergic reaction of a resident to a medication/ food
• If you suspect sepsis (see below the High & Moderate risk criteria following NICE guideline)