A med-surg RN learning the ED way

  1. 2 The other day the ED doc was to do a closed reduction to an ankle fx with conscience sedation. I asked if we could do a time out because I thought that was a standard of care across the board. The ED doc did the time out then called it pointless right in front of the patient and his wife. I know that it was plain as day the mans ankle was messed up but was I wrong for asking for a time out before giving the man medication? My thought process was #1 it is a patient safety issues and he is not going to die if we take 30 seconds to verify. #2 you never know who the patient is or his family and I don't want to get caught up doing wrong especially when it is easy and safe to do right.

    I felt really stupid after the doc made that comment and I know it was not directed toward me (at least I hope). I don't want to have to defend myself or have to "check" a doctor because his smart mouth.

    Thanks!
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  3. Visit  nursingclassof2009} profile page

    About nursingclassof2009

    nursingclassof2009 has '4.5' year(s) of experience and specializes in 'I have learned a little bit about a lot'. From 'Fort Wort, TX'; 31 Years Old; Joined Aug '08; Posts: 13; Likes: 11.

    14 Comments so far...

  4. Visit  herring_RN} profile page
    2
    You were right. I neither work in the ED nor the OR. In critical care we do a time out. What if the patient is allergic to the ordered medication? What is there is no signed consent? Many other "what ifs" can happen. Best to always do it.

    About Universal Protocol: http://www.jointcommission.org/facts...rsal_protocol/

    The protocol: http://www.jointcommission.org/stand...mation/up.aspx
    canoehead and bebbercorn like this.
  5. Visit  bebbercorn} profile page
    1
    Every invasive procedure warrants a time out. You're in the right, obvious or not. It takes 30 seconds.
    canoehead likes this.
  6. Visit  jadelpn} profile page
    2
    Recently, a hard stop time out has become a standard in most units in most facilities. Make sure that you document a hard stop time out occured, that the patient was informed, etc. In the hustle and bustle of the ER, patients and their families can and do get overwhelmed. Most have little idea what a closed reduction is. And the last thing that anyone would want is to have a family or patient say "wait a minute, your gonna do WHAT?!?!?!" after the procedure has begun.

    I would think about bringing this to your NM. See if you can put into the standards of practice and your ER policy to have a hard stop time out for procedures that require concious sedation. It takes about a minute to ensure that everyone is on the same page. This is a patient safety issue. I would think that nursing needs to think about this as well, due to a patient needs to be monitored after the procedure by a nurse, and that means that one of you will be taken out of rotation for a least an hour to recover this patient.
    hiddencatRN and TheSquire like this.
  7. Visit  Esme12} profile page
    0
    moved to Emergency nursing for best response
  8. Visit  emtb2rn} profile page
    4
    Conscious sedation always gets a time out check prior in my ER. Standard protocol.
    HikingEDRN, hiddencatRN, JBudd, and 1 other like this.
  9. Visit  Steph001} profile page
    0
    At the end of the day, you need to do what is right for your patient (and protect that license!), if YOU felt that you needed a time out prior to the procedure, I think you were correct to do so!
  10. Visit  Anna Flaxis} profile page
    2
    Conscience sedation?
    poppycat and Altra like this.
  11. Visit  theatredork} profile page
    0
    I think it's now referred to as "moderate sedation". It's just enough sedation for the patient to comfortably tolerate the procedure without heading into anesthesia territory.
  12. Visit  jadelpn} profile page
    2
    Quote from ~*Stargazer*~
    Conscience sedation?
    I believe auto correct flubbed that one up--CONSCIOUS sedation was perhaps the intent.
    WordWrangler and Esme12 like this.
  13. Visit  JBudd} profile page
    1
    No, it isn't pointless; the very fact that we had to start doing specific timeouts was because of serious errors. ED is no different than anywhere else, mistakes can happen. Our timeout is tied to the charting, and the followup specifically asks if time out was done.
    jadelpn likes this.
  14. Visit  wooh} profile page
    1
    Perhaps he wasn't being obstinate with you, but trying to reassure the patient/family that he wasn't about to commit some huge error when you corrected him?
    Patient sees the RN stop the MD. Patient who is already nervous might get even more worried. What was the MD going to forget? Am I going to die? How incompetent is this person about to do something to me that the RN has to stop him and give him reminders? Does MD have a clue what he's doing????
    So to stop that train of thought, MD reassures with, "Don't worry, it's just a silly policy that I forgot, not something that makes me an incompetent MD, nothing that should make you think the RN had to stop me from killing you!"
    Altra likes this.
  15. Visit  ♪♫ in my ♥} profile page
    0
    Doc was being a weeny... nothing more, nothing less.

    Of course you're supposed to do a time-out... and verify that pt was consented... and that doc reviewed the H&P...

    Doc knows this stuff to be the case and is just being a jerk...

    How do I know that the doc knows? Because s/he did the time out, even with the 'tude.


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