Re: New position in stress lab
1..No MD in the room, in the area. Over in the clinic you can call internal med to come over if there is a problem or concern.
We ALWAYS have a Cardiologist or a Cardiology Fellow NEXT DOOR, with an RN in the room for the ETTs and Nucs. If the RN is absent, the Fellow or Cardiologist is IN THE ROOM during the test (Stress Lab Technologists run the machines).
.2. No code blue button in the room. No paging system over head. In the evern of a code, you must dial 8 for an ourside line then 911.
We would call the Cardiologist or use the phone to call an in-house Code Blue if needed. Our Stress Lab is in a Medical Center, so the Code Blue Team is readily accessible.
3. One RN in the room to monitor the continuous EKG and the patient.
As stated above, we have an RN and one or two Stress Lab Technologists in the room during the Stress Tests (whether they be ETTs or Nucs). Cardiologist or Cardiology Fellow NEXT DOOR and readily accessible.
4. Crash cart down the hall.
Crash cart is in the room at all times. We always have sublingual NTG and Albuterol inhalers in the room as well, for quick use.
5. Only stress tests which require IV meds get iv's otherwise iv's are inserted if needed.
The patients undergoing MPIs (Nuclear scans) all have a saline lock (they've been injected with the radioisotope and imaged before they report for the stress portion of the exam). Patients undergoing a 'regular' stress test (ETT) do not have an IV.
6. when asked if could be sent to a class to learn about stress testing and how to do them, what to watch for etc. was given a book.."Secrets of a Cardiovascular Nurse" Read this and highlight what you want, just return when done.that was the note left on it.
Our Cardiologist in charge of the Stress Lab has been revamping our policy/procedures. We received training from the Cardiologist in our first rotation there, and we regularly sit in on the reading/interpretation of the ETTs and MPIs by the Cardiologist (they're often teaching Residents and Dental Anesthesia Fellows who rotate through the Stress Lab as well). If we RNs have any questions about the appropriateness of doing an exam, or question of a murmur (AS) or question about switching from an Adenosine Stress Test to a Dobutamine study, or a question that arises during the patient interview, or ANY other question, we consult with the Techs (who have been doing this for years) and the Cardiologist or Cardiology Fellow. I do not claim to be any kind of expert in this area, am still learning, IMO.
I'm sorry to say, your situation does sound
unsafe. Who is in charge of the area, and can you schedule a meeting with this person immediately? How were the studies done before you were hired (was another RN there)?
Perhaps you can institute much-needed changes, with Risk Management to back you up, in the interest of PATIENT SAFETY (and so you don't put your license in jeopardy by not addressing these issues in a 'reasonable and prudent' way).
Let us know the outcome. Good for you, for pinpointing the problem areas.
If management is unwilling to work with you to improve the process, you know what to do.
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) Anyway, I am going to go to a larger hospital for training and am very excited. Thank you for your wonderful help. I really appreciate it.
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