ok... heres the situation.... Lets all pretend that its a busy night on a rehab floor, and we're hideously understaffed (4 nurses with groups of 12 patients on a 3-11 e shift, 1 nurse doing admissions from 3p-7p, and an LPN on light duty. Her(the LPN) duties include fingersticks for glucose, and assisting with admissions, some meds, vitals et al... no lifting/pulling... anyway.... there are 4 UAP's and an assistant manager from 3p-8pm, followed by one of the staff RN's being charge.)
now, the situation is this... its 5:30PM, although you have 12 patients, its not that crazy yet... you have one one with a 1:1 sitter that the asst manager just dug up, and another who tends to climb out of bed, but has a bed alarm that will go off when he gets too close to the sides, and all 4 rails up. So Far, the alarm hasnt gone off. The LPN Does your fingersticks, and all are relatively within normal limits. Your Admission shows up at about 6ish, dayshift recieved report, and, the patient arrives.
68 WM, Dx of Rehab of S/P Right BKA r/t PVD. HX of TB, has been on the coctail for a few months, Smoker(last cig, 10 days ago).
The LPN goes into the room, notes that the patient looks blue, no difficulty breathing, and rhonchi over all the lung fields. She orders a stat pulse ox, and tells the admission nurse that the patient is blue. VSS, NAD. 2 minutes later, we get the PO2, and it is 68. Subintern is on the floor, respiratory tech is on the floor. O2 3l by nasal cannula started, Since the pt is in no distress, still A&Ox3 no difficulty breathing, we do not want to do an abg yet. The nurse who has this patient in her group is notified that her patient has a pulse ox of 68. D/T the Staff RN being notified, the Admissions nurse figures tha the Staff RN will address the situation. The LPN writes the first note on this patient addressing the situation. 20 mins later, po2 goes up to 82. The Respiratory tech changes the O2 to 40% via venti mask, and does the ABG stat, a CXR, EKG were also ordered stat and done within 10 minutes of ordering. ABG resulted with co2 moderately high, o2 moderately low ( I dont remember the numbers, but they were bad, but not horrible) and the O2 sat was 87. The lpn writes another note as to whats going on, as the staff RN has been nowhere to be found for about the last hour or so...
The LPN consults the Charge RN with the Question "Should'nt the RN have written a note somewhere between the resident on call's note, and the second note?"
The charge RN affirms the Staff RN should have written a note, as it was her patient, and not the LPN's patient. The Charge RN (CRN) directs the Staff RN (SRN)to assess the patient.
SRN: I did that, the patient looked ok
CRN: How were his lungs
SRN: I dont know, the LPN checked that when the patient came in. (its now about 9 or so...)
CRN: So you Didnt assess the patient, even though he has been there for 3 hours.
SRN: I looked at him, he looked ok, and the LPN didnt tell me that anything was going on with him...
Mind you all... this room is right ajacent from the nurses station... figure, you must look into the room if you pass the desk, which you must do if you want to get water for your pitcher and the medcart.
A constant stream of people were in and out of that room for 3 hours in an attempt to bring up his sat without a vent, as he was still NAD... dont get me wrong, but a stream of 2nd Year Residents, and attendings up on the Rehabilitation floor after 4pm is a rarity, and saved for something big.
The SRN never entered the room until the charge nurse directly told her to.
