RT refused to give NEB! - page 2

At our facility, RT administers all nebs. We have a patient who is in with aspiration pneumonia. His O2 sat was in low 80s and was in distress. He asked for a treatment, which was amazing because... Read More

  1. by   crysobrn
    I'm sorry about all of the bad experiences with the RT's. At our hospital we have mostly great RT's and a few not so good ones LOL. I'm married to one of the good ones so of course I get to hear his ranting a lot. Our RT's at night cover the entire hospital alone. They do all ABG's, EKG's, Nebs, a lot of suctioning as the nurses many times dont' feel comfortable doing so, vent care/checks etc. Anyway his big problem is getting each dept to know that he has to prioritize. ER does not necessarily take precedence, when you have a stable patient and we have an unstable baby he has to make the choice what to do first. Same with treatments on stable patients that are in no distress.

    We have some dr's that order tx postop to prevent pneumonia and others that order tx for fever... The opinion of the RT's as I've heard is that these and many other indications (including coughing) are not reasons for a tx. They take the RT's away from other pt's that could use a tx or something else that he can do.

    As far as an RT refusing a tx that is ordered I'd write them up!
  2. by   lsyorke
    Quote from queenjean
    It seems like I'm hearing this "A treatment won't help a cough" more in the last couple of months. I wonder if there is any new trends in RT that recommend holding off on aerosolized treatments and instead giving oral meds? Or if it is just a couple of otherwise great RTs being lazy or overworked or just grumpy?
    I've been hearing, "If they're not wheezing a treatment isn't needed"!
    :
  3. by   chenoaspirit
    We have some good ones too, but most have the attitude I first posted about. I discussed it with the nursing coordinator, and she said we are aloud to administer a neb because it is a medication. But honestly no one has shown us how to. RT are the ones who do it, but if necessary we are aloud to. I have asked them to show me how to do everything they do, especially when I am pulled to ICU. I want to know how something works or how to work with a machine. That way when/if the time comes, I can handle it when they refuse or dont have time. As for the RT's who posted a response, I commend you. You are truely a jewel. I wish the RTs at our facility had the type of attitude you do. It takes all of us working as a team for the benefit of our patients. Ive seen nurses page RT to connect hydration to O2, I always told them not to bother, I would do it. I always try to do whatever I am able to do before calling them. And they know this, but still get this attitude when I need them.
  4. by   TazziRN
    Best way to know how if RT won't show you: take a neb set, sit down, and put it together. If the solution comes in bullets, empty the bullet into the chamber and hook it up to 6-10 L and voila!

    If you can't figure out the assembly (and it's not always easy!), look at one that is already put together in a pt's room to get an idea.
  5. by   canoehead
    I have also many times had RT's refuse to come and give prn nebs. They say to just increase the O2 until the scheduled neb. I think the hospital needs to provide for RT's to reassess patients for improvement or worsening between treatments, or at least allow the RN's to do it and give a neb if necessary.

    I also don't understand why the RN staff need to call for orders that an RT has requested. If RT thinks a patient needs suctioning or nebs, and they provide the treatment it makes sense that they call with their assessment and ask for the order. Being an RN middleman can get frustrating with all the communication problems that go along with relaying orders and knowing who can/can't do what.

    I grew up as a nurse having RT's only for vents. As far as nebs or O2 goes I am happy to have them come along and consult or help, but when it comes to a time sensitive treatment, or constant reassessing for prn stuff I am happier if I can keep track of that myself.
  6. by   kate1969
    albuterol is supposed to be prescribed for wheezing only, if there are secretions in the airway that would tend to cause a wheeze, then albuterol would be in order, if their bronchioles are inflamed and causing a wheeze, then albuterol would be in order. If a patient is coughing, you would want to assess them and find out why, it could be because of the reasons above, but there are other reasons patients cough...as you all know, but still, the RT shouldn't be rude about this, they should want to be helpful anyway they can. I worked in a hospital on the night shift and they always gave me the 7th, 8th, and 9th floor, and the residents were very eager to continue to write for unnecessary neb therapy. they would label a lifetime non-smoker as copd and order them on q4hr nebs, those patients had very clear breath sounds, but the residents would still write for nebs...in that facility I had no authority to d/c the treatments or even consult the residents to contradict their orders...I was powerless, and each night I would have 50 therapies per night...that's a hefty load for 1 RT. I hated that because I could barely assess those patients much less an existing copd'er that needed a PRN treatment.. That job sucked, but as much as I was overloaded, I would never tell a nurse that I couldn't do it unless I was in a code situation...you just have to prioritize..it gets hectic in those situations for all involved, but rudeness is uncalled for in any situation!...especially for a degreed professional....
  7. by   withasmilelpn
    We have RTs at our LTC and rehab facility, but they mainly stay in our vent unit, and will come up and do trach changes if needed or assist with codes. But for the most part, nurses are responsible for all breathing treatments. They are pretty easy to do, actually. I would say if your patient has a cough, take a listen to their lungs. Then instead of telling them they have a cough, you can be more specific when you ask for their assistance and they might be more responsive.
  8. by   Little_Babycatcher
    Quote from cheshirecat
    We do not have RTs. The RN gives all nebs during her/his med round. If a patient needs 2 hrly or prn nebs we give them. Why can't you give nebs?

    I'm in a BSN program and will be starting my first clinical and one of the techniques I learned the other day was how to administer a NEB, so I was confused if this was a particular hospital's policy or if RNs in general don't give them.
  9. by   Sunflowerinsc
    Quote from kate1969
    I'm an RT and I'm very sorry that that happened to you, last noc I was called in to my PRN job and there was a patient there that is a "No code" comfort measures only. I gave him a TX at the scheduled time and he had no PRN orders for nebs, but a nurse, not his nurse, called me and asked if he could have a tx, I looked on my sheets and explained to her that I just gave him a tx 2 hrs prior to the current time in which she called, I also explained to her that he had no prn tx's ordered, but if she could get me an order, I would come and give a tx. Mind you, I was in my office on another floor. She hung up the phone and apparently tried to call the physician. In the meantime, I decided to go up (on my own) and reassess the patient, I was worried about him. I went up there and I could hear him just gurgling on his own secretions..I went to the nurse and explained to her that I could give him a tx, with a prn order however, I truly felt that the patient needed to be suctioned more than anything. Since suctioning is invasive and traumatic for a patient without an artificial airway, I explained to her that I could do that as well for the patient, but I would need an order from the physician. She explained to me, in a very frustrated tone that "nurses could nasally suction patients at their discretion without a physicians order.." I said, "fine, if you can do it that would be great, but for an RT to do this, we have to have an order written in the chart". She proceeded to find the patient's Nurse and have him suction. We were still waiting at this point for the physician to return a call. Anyways, to make a long story short...hehe, the physician called back, gave an order for prn nasal suctioning and for a stat neb tx. The patient however was completely unwilling to be suctioned but he did take the neb tx. I like being an RT, I love my patients and I'm concerned about all of them. I would love to spend every bit of my 12 hrs assessing and treating my patients in a timely manner, however, some of the RT's out there only focus on their current patient workload. I would gladly dump all of that to fix a patient in distress. But sometimes, when your treatments have to be written off because of priority, the RT dept manager likes to write up therapists that write off treatments...(legal issues and all). I feel like saying that they all need to staff enough RT's to perform therapies and staff 1 RT for emergencies, even if that Emergent RT sits at work all noc and does nothing...The safety of the patients in need of emergent care take precidence over the "clear lung sounding" scheduled q4hr tx's...(IN MY OPINION)
    SORRY FOR THE SOAP BOX
    and i'm very sorry that an RT treated you in that manner....

    Katie
    I have been (and still am) a RN for many years and I have NEVER waited for a order to suction when a pt is "gurgling on his own secretions ". If policy is for a order ,get it ASAP but never refused to suction pt. And who do you think gave Resp
    treatments way before there was a Resp department !!! Boy oh boy, I REALLY AM OLD!!! Any others remember A "Bird" machine?
  10. by   charleygirl
    heres a good one. I have been in nursing for 32 yrs. currently work in an very busy ER. Have been terminated from my job and reported to the state board of nurisng for giving a pt a saline blow by without an order. We give medication nebs in the ED all the time without an RT an some do without an order. My reply was it was saline and saline is not a medication. the MD agreed with me. I am still waiting for the boards letter? What do you all think? Do we as registered nurses need a physican order to give saline blow-by?
  11. by   MunoRN
    Where I work this has been an ongoing problem. The RT's now have a policy that states they will determine if Nebs are appropriate for every patient who has them ordered and will change them to MDI's if they feel it is appropriate. Essentially all Neb orders get changed to MDI's, even in the ICU. They same policy autosubs albuterol for levalbuterol even when albuterol is ordered specifically, even by a pulmonologist.

    The basis for equating MDI's to nebs is based on a study that showed similar effectiveness for MDI's when compared to Nebs, although the subjects were stable and were using the MDI's for maintenance therapy, not exacerbations or in the precence of other illnesses. What they missed is that MDI's were only shown to be as effective when "optimal technique" was used. So then the next question is how many patients are capable of "optimal technique" with use of an MDI's? One study showed it to as low as 10%. Another study looked at MD's, RN's, and RT's ability to assist and instruct patients on optimal use, which found that only 39% of RN's, 48% of MD's passed "rudimentary" MDI skills. Only 67% of RT's were capable of monitoring and instructing patients on optimal MDI use.

    The same policy also automatically D/C's all orders for levalbuterol and replaces it with albuterol, even if it is the patient's home med.
  12. by   usalsfyre
    Quote from lsyorke
    I've been hearing, "If they're not wheezing a treatment isn't needed"!
    :
    Considering that albuterol is only effective in reversing bronchospasm, and doesn't act in any other areas than the bronchioles, why the headbanging? Wheezing/bronchospasm is the indication, not pneumonia, aspiration, ect.
  13. by   usalsfyre
    Quote from MunoRN
    Where I work this has been an ongoing problem. The RT's now have a policy that states they will determine if Nebs are appropriate for every patient who has them ordered and will change them to MDI's if they feel it is appropriate. Essentially all Neb orders get changed to MDI's, even in the ICU. They same policy autosubs albuterol for levalbuterol even when albuterol is ordered specifically, even by a pulmonologist.

    The basis for equating MDI's to nebs is based on a study that showed similar effectiveness for MDI's when compared to Nebs, although the subjects were stable and were using the MDI's for maintenance therapy, not exacerbations or in the precence of other illnesses. What they missed is that MDI's were only shown to be as effective when "optimal technique" was used. So then the next question is how many patients are capable of "optimal technique" with use of an MDI's? One study showed it to as low as 10%. Another study looked at MD's, RN's, and RT's ability to assist and instruct patients on optimal use, which found that only 39% of RN's, 48% of MD's passed "rudimentary" MDI skills. Only 67% of RT's were capable of monitoring and instructing patients on optimal MDI use.

    The same policy also automatically D/C's all orders for levalbuterol and replaces it with albuterol, even if it is the patient's home med.
    If the patients unable to properly use an MDI, then they need a neb. Otherwise an MDI is a cheaper option that more closely matches what they will most likely use at home.

    As for the levalbuterol vs albuterol, the Xopenex is vastly more expensive with little to no clinical benefit.

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