[vaughanmk]

The hospital I work at is making changes to the hospital protocol. I am a new graduate so I am unsure of where or not this change is appropriate, none of the nureses approve of the changes but it was passed anyways.

We are to notify and document the call to the physician for ANY rate change, this includes from SB to SR, SR to ST. It does not allow us to use common sense ei. we are walking a patient and they temporarly to into ST, wea re required to call the MD, even if it is 2am.

My second problem isn't necessarily with protocol. They are trying to take the main tele station out of the CICU/stepdown unit and put it down the corridor into the ICU. One would think it would be the other way around. Bringing it all into the CICU but, we all know how administration works.

Does anyone else have a protocol like this?

The nursing admin. wants us to enforce this call at every change just so that we tick the Dr's off. Then they will force the hospital to chenge the policy again. I do not believe this is good for nursing. We need to make the change not have the dr's dictate what we do.

I need advice if you have any.

[nurse-lou]

That policy sounds pretty stupid too me and one that's sure to tick off the doctors!

What was the impetus behind the change?

[zambezi]

I agree, I think that it sounds silly as you would be calling the docs quite often. I work in CCU and we have many standing protocols depending on the patient/procedure, etc. We only call if we do not have a standing order that covers the change or it is significant, ie: if we have a patient go into rapid afib we follow our protocol, we do not have to call unluess the pt becomes unstable or the HR remains about parameter... we have quite a few standing orders and areas we can use our judgement in...if the patient is symptomatic/BP changes/significant or unexpected change from baseline, etc, of course we will call. If the change is unusual or detrimental, calling is better than not. I don't see the problem if patient goes from SB to SR. Do you have a person that can get together with the docs and figure out some sort of protocol that allows for some critical thinking/common sense to be used.

[CV CNS CCRN]

I suspect this rather etreme policy resulted from one mishap. This is likely a knee jerk reaction to prevent it from occuring again. Surely someone from nursing must have participated in creation of this policy change? That would be a good place to start looking for the rationale. I would streer clear of any close personal "die on the hill" type of statements until you know for sure the "lay of the land", so to speak.

[batmik]

I bet this new policy wouldn't last a week if you actually start following it to a "T" What about the patient who heart rate hangs around 50-70 bpm, that would be many phone calls each time the hr goes in or out of sinus to brady and vice versa.

We have standing order for Lidocaine we treat 10 or more consecutive pvc at a rate of 150 or greater. Though most cardiologist override this and treat symptomatic arrhythmmias. We have atropine for hr less than 40 and symptomatic. For other tachy arrhythmmias we use nursing judgement. We wouldn't call md for 6 sec of svt and never more, we would just document a monitor strips.

We have pt that go in and out of A fib freq during our stay and if the md is aware that this is going on we don't call each time they go in/out of it.

You guys should take a pool on how long this policy will last if you follow it.

[neneRN]

What about a modified policy stating something along the lines, Notify if MD if HR > or < X bpm, sustained longer than X minutes while at rest, or if pt becomes symptomatic/ change in VS, or if pt changes from sinus to other rhythm. These are things you'd end up calling the doc for anyway, but it would be clearly spelled out for those that want the policy in place. Just some thoughts.....

If you guys use preprinted orders at all, some of these areas could have blanks for docs to fill out parameters specific to each pt?