INTRA AROTIC BALLOON PUMP RATIO/RN/PT

  1. RECENTLY WE WERE ASKED TO PAIR TWO BALLOON PUMP PTS TOGETHER AS AN ASSIGNMENT FOR 1 RN
    WE REFUSED BECAUSE WE STATED IT WAS UNSAFE. THE SUPERVISOR REPORTED THIS TO THE DEPUTY DIRECTOR WHICH HAS STATED THAT IF WE REFUSE
    WE CAN BE CHARGED WITH INSURBORDINATION. WE HAVE COMPLAINED TO OUR UNION BUT TO NO AVAIL
    SINCE THEY SAY WE CANNOT REFUSE AN ASSIGNMENT EVEN IF WE FEEL IT UNSAFE. SO I WOULD LIKE TO GATHER DOCUMENTATION FROM OTHER INSTITUTIONS AS TO WHAT IS THE RATIO FOR THESE PATIENTS.
    I APPRECIATE ANY RESPONSE TO THIS ISSUE.

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  2. 24 Comments

  3. by   Rae
    In my facility and our sister hospital, it is written into policy that any pt on a balloon pump is a 1:1. Why would a facility put itself in a position for possible litigation due to endangering the pt's life instead of paying the salary dollars needed to give adequate care? I would think that in a court of law if you stated that your standard of care in the past was to provide 1:1 care to these pts, the hospital would then have to justify the change in practice.
  4. by   bluesboyj
    I agree that pairing IABP patients is unsafe. All the hospitals I've worked, the policy has been 1:1 staffing except on a very rare occassion having to pair with a STABLE pt and the IAB pt has to be stable preferbly 1:2 or 1:3 frequency. These days of managed care have made hospitals very money hungry and the only thing they understand is a BIG!!! lawsuit. They figure why pay experienced nurses good money when we can get new, inexperienced nurses for less $. Besides if the hospital gets sued, they'll probably sue the nurse(s) anyway. It's not their license/livelyhood on the line. People don't seem to mind a sports star or movie star getting paid millions of dollars a year to perform and worst case scenerio-team loses/movie bombs. We get paid far far less than that to perform with peoples lives and worst case scenerio-someone dies. Who performs the more important duty and derserves more money?
  5. by   LRichardson
    I'm in Oklahoma City... there is no written policy stating that IABP patients are 1:1... in most cases they are 1:1 but it's not because they are on the balloon pump as much as it is because they are extremely unstable.. however, there are times when another stable patient will be assigned based on the stability of the IABP patient.. in our situation i believe the 1:2 ratio has been fair and safe... I've also seen flexibility in that IF the stable patient or the IABP patient become unstable the assignment will be changed even if it is midshift... to accomodate the accuity of the patient and ensure their safety...

    i think we get nervous about these types of situations because they're like a slippery slope.. we're used to having 1:1 IABP ... but we recognize there are occassions where we could handle another stable patient.. however.. if we give an inch will they take a mile?? and next week i'll have two unstable IABP?? cuz we all know that when you talk to BUSINESS people about patient acuity they have not a clue.. sigh.. in their minds if you can do it in one case you can do it in ALL cases.. sigh.. hate to beat a dead horse but it still comes down to RESPECTING the PROFESSIONAL opinoin of a qualified, experienced nurse.. trust us to make the best decision for the institution AND the patient.. we CAN do it..
  6. by   bluesboyj
    I agree with LRichardson taht a stable IABP pt can be paired with another stable pt. Unfortunely, ours is now a business not driven by the mission to help the ill but is driven rather by the bottom line. It all really started with DRGs. The DRG said MIs are well enough to go home in 3 days whether they really are or not. Stay <3 days, hospital keeps all 3 days worth of $, >3 days, hospital loses $. I'm using 3 days as a illustration, your milage may vary. As nurses, we usually know best what needs to be done for the patient, not someone behind a desk with no medical knowledge denying care based on a book or chart in front of them. And gatekeeper physicians are watching out for their pocketbooks because that's what managed care has done. Profit goes UP and care goes DOWN.

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    Blues Forever
  7. by   barb o
    Our policy is that IABP patients are 1:1. However, when the patient is a stable postop who had the balloon inserted for chest pain as opposed to failure or shock, and when a nurse who knows what he or she is doing is caring for the patient, we will take a second patient sometimes. I agree with blueboyj about people paying massive salaries to sports figures and celebrities and then whining about paying critical care nurses a good salary. Countless times I have heard from patient's family members who see how hard we work "I could NEVER do what you do!" No one ever says, "Gee, your job looks like fun." I also agree that we need to educate the general population about what really goes on.
    I don't have it so bad where I work, but I can't be sure it will stay the same, and I worry about the future because the new nurses coming in many times don't have the desire to learn the specialty. Who's going to care for me when I get old and sick? I guess I'll just have to shoot myself!
  8. by   pickledpepperRN
    1:2 staffing may be safe IF there is a tech to troubleshoot the IABP and if the patient is NEVER alone. Once an RN took a 2nd patient due to admits. Her other patient arrested. During the code her IABP patient (who had been alert and cooperative) awoke, got out of bed, and bled profusely. This patient required 5 units of blood, in a short time could have died. NO PATIENT SHOULD BE LEFT ALONE WITH A BALLOON PUMP IN PLACE! Thank you.

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    Last edit by pickledpepperRN on Jul 5, '03
  9. by   KReinhard
    I don't agree with the term "1 to 1". Patients should be looked at on an individual basis, as to their acuity, not solely on the amount of equipment in the room. The baloon pump is another piece of equipment requiring assessment as is a ventilator or a swan ganz catheter. I've cared for patients that didn't have balloon pumps that required more vigilence than some balloon pump patients I've cared for.

    The real point of this discussion should be maintaining safe staffing levels for ALL patients. I think it can be a safe situation to have a balloon pump patient with another patient when acuities are taken in to account and assignments made accordingly.
  10. by   bluesboyj
    I agree it would be nice if staffing could be done by needs of the individual pt. but it's not going to happen, esp. in these days of a profit driven business. The bottom line of hospitals is the bottom line, not patient care. Fewer nurses, esp. experienced ones, means more profit for the hospitals just like not being aggressive at first in a lot of cases, means more $ for the doctor. Less tests/tx., more $ kept. Human life now has a $ and cents value!!!

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    If Ya' Don't Love The Blues, Ya' Got A Hole In Your Soul
  11. by   Nursedel
    We are encountering the same problem at my facility - being assigned more than one patient if we are taking care of a balloon pump as well. Have already had problems, one with the patient bleeding and one with pump failure. But census is high and staffing is low and they really don't seem to care in administration about the patient outcome or trusting the nurses intelligence in these situations. Currently we do not even have a policy in place. Gets more frightening all the time.
  12. by   runner
    IABP should always be a 1:1. I work in Portland Oregon and rarely do we get a pump, so we use them for teaching opportunities. The patient is not left alone, either the primary nurse is present, or a sitter who has experience with the pump.
  13. by   bluesboyj
    Runner, it must be nice. Where I work we have alot of new nurses who are orienting to IABPs, VADs, CVVH, CABs. I've got 15 yrs critical care experience (10+ w/cab, iabp) who had to pester my manager to orient to CABs (their way of doing things). I got tired of beings aked questions about things I have experience with but haven't yet been asked to orient to so I'm transferring to Neonatal ICU. A whole new experience for me. An example of the above was a "gas loss" alarm on a balloon pump going off and all anyone could do was keep checking the connections and saying they're tight and checking them again while I'm pointing to the problem and had to say here is the problem which was blood in the gas drive line secondary to a ruptured balloon. I'm on of the "strong core nurses" according to my ex-manager, but if that is the case, why wasn't I oriented to everything earlier. I've done adults too long to work with a bunch who are in over their heads. So no more adults for this kid.

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    If Ya' Don't Love The Blues, Ya' Got A Hole In Your Soul
  14. by   hoolahan
    A patient with IABP should be 1:1 no matter what their acuity. Anything could happen. We may become blase about some equipment when we use it all the time but remeber this thing is IN THE AORTA! One patient bends at the groin the wrong way while you're with your other patient and they could die!! It is like leaving a surgical instrument unattended while in the middle of surgery. Have you ever had a balloon rupture on you? We had a bad batch of balloons several years ago and we had 3 ruptures in 1 week! So K Reinhold, while agree that we should ensure safe staffing for ALL patients, IABP patients should not be left alone. perhaps stable balloons can be paired if it is in an open unit and the other stable patient is right next to you in the case of a staffing crisis, or another patient in the unit codes and needs to be 1:1 more, but only until the staffing can be corrected. Just MHO.

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