Giving O2 without an order?? - Page 2Register Today!
- Jun 12, '12 by zumalongNever be talked out of calling dr with problems. This patient could have thrown a clot or if he was a Copd pt too much oxygen may have suppressed his resp. You can't change what course you took this time, but next time contact who is on call. Follow your gut and CYA. For the patient's safety and your hard earned license
- Jun 12, '12 by Born_2BRNI was once as a new RN put a bandaid on a patient after he scrapped himself bleeding everywhere. I notified the physician that he hurt himself and supervisor knew, but I got written up because I didn't have order to put a bandaid on the patient. So yes you do need order pretty much on anything related to patient care. In hospital you have some room to breath for instance you can change an IV site PRN or facility policy without physician order. The nature of the beast in nursing. I myself still learning and everyday is a learning experience.
- Jun 12, '12 by Been there,done thatTreating the shortness of breath is one thing...
that falls within common sense and your facility's protocol.
The CAUSE of the desaturation needed to be addressed by a physician...who cares what time it was.
- Jun 12, '12 by AltraI'll repeat what I have said before here at AN ...
If you are ever taking care of me, and find me in respiratory distress ... unless we all agree that it's my day to die please, PLEASE crank up that O2.
I completely agree with the above posters that after obtaining vital signs and applying O2 ... that was the time to call the physician, not hours later.
- Jun 12, '12 by Cat_LPNNo, it was not ok that you documented giving o2 without an order, especially saying that the on-coming shift would 'get the order' for you. That is like shooting yourself in the foot! If you did not feel the pt's condition warranted a call to the MD, you at least should have written the order for PRN o2- and 'may titrate to 3L as needed to maintain sats'. Yes, the oxygen was the correct intervention initially, but none of that matters in the legal world if you don't have an order. I would have written one.
I probably also would have called the doctor too for CXR orders, labs, or whatever else they wanted, because obviously there is something going on with the pt. I don't care that it's late, nursing is 24/7. 75% is low for someone who usually sats normally. Pt condition changed on your shift, and as a dayshifter I would have been furious that the night shift gave to me a potentially unstable pt that had nothing done for him thus far. That would not fly in my facility. Why wait for patients to get worse, just so we don't have to 'wake up' doctors?
- Jun 12, '12 by ~*Stargazer*~I agree with the others. This was a change in patient condition that should have been reported to the MD right away.
As far as giving O2 without an order, if it can be reasonably assumed that any prudent nurse would have done the same under those conditions, I think you're okay. But keep in mind that it could also be argued that any prudent nurse would have called the doctor!
As far as CO2 retention, if someone is in acute respiratory distress, I'm giving them the O2, at whatever flow rate they need. CO2 narcosis takes time to develop, longer than respiratory failure because you didn't give oxygen! Once stabilized on oxygen, if it is determined they are a retainer, the flow rate can be decreased to maintain a lower saturation, or if still experiencing increased work of breathing, they can be put on bipap.
I'm also wondering why the duoneb wasn't tried? This could certainly have been an episode of bronchospasm, which would only be helped by the duoneb. Did the patient have a history of asthma or COPD?
- Jun 12, '12 by strawberryfieldsThanks everyone for your replies yes I did give the duoneb first the patient told me it was helping a little but his o2 was still 78-79 so I got the oxygen. I'm a new nurse so I am learning. What is awful is that where I work everyone seems like they are afraid to call the md ... I was ready and willing but they advised me not to call this late. We have a dr that gives us times you can call him and if you call him outside of that time frame he yells at you. You all are right and this is my license if he wants to yell at me so be it .. On call dr is no joke. One of the nurses I work with had a really high blood sugar reading and it said call the md and I was like are you going to call ? And he said, "why make my night more difficult ... When the dr is just going to tell me to tweak the insulin?" it was 410 and the order said 400+ call md. This is something I want to bring up to my facility in the next meeting.
- Jun 12, '12 by Esme12You can be sued for liability and lose your license for not calling him. You just get yelled at for calling him. For 34 years I have chosen the get yelled at option every time. That's what they get paid for.
Do I care that they are disturbed? NO!
- Jun 12, '12 by strawberryfieldsNow you have me worried :/ sued for liability and lose my license even though we have an order now and the dr has seen him and he's fine?
- Jun 12, '12 by hiddencatRNQuote from sauconyrunnerAgreed. In many hospitals that would warrant a call to the rapid response team.I really do not think the worry here should be that you gave oxygen. My concern reading this is that you have a patient who normally is sleeping well, find him sitting bolt upright in bed, and with a sat of 75%. Yes, you treated with Oxygen and the pt improved, but WHY did the patient have such a sudden change? Everywhere I have worked (And I admit, i have only worked in Hospitals, it sounds like you are in a long term care kind of place, since you know the pt fairly well) that would be an immediate call to the MD, not a follow up in the morning. I realize your supervisor told you to follow up in the morning, so in that sense you would not need to worry, but why on earth- with a very sudden change in Airway and respiration, would you not call that physician immediately.
Quote from strawberryfieldsSo the patient's ok NOW, but what if whatever caused the SOB reoccurs, but this time more acutely? The patient is STABILIZED, not stable, and finding out why there was an episode of SOB that woke the patient and required oxygen is not a "follow up later" situation.Now that the patient is stable with an o2 at 95% and responsive+ totally concious was there a need to call the doctor at 3 in the morning ... I didn't think so.
Particularly in an area like rehabilitation, where folks can develop clots and emboli....SOB is not something to take lightly.