Would Like Input - CABG

Nurses General Nursing

Published

Can't stop thinking about my pre-op CABG... Any input would be greatly appreciated!

My patient was admitted for recurrent CHF exacerbation, mostly having SOB that would come and go. So she was admitted, had positive cardiac cath, and scheduled for open heart the next a.m.

Last I knew, she was still intubated, over 2 weeks post op.

Her Hx included lung ca and R lower lobectomy. Im the one who completed her pre op orders. CXR showed possible small pleural effusion. For some reason, it did not occur to me until later that day that PFTs were not ordered for her.

I don't know if they routinely check PFTs pre op at this facility but does anyone know if this could have made a difference in decision to operate? I cant remember the extent of occlusion per her cath. Also, what are the chances of recovery for someone intubated this long?

Thanks!

Unfortunately nurses look at their patients charts "just to see what happened to them" and not necessarily as a learning experience.

Looking at outcomes is part of learning.

Again, some degree of the use of HIPAA is just reactionary. I'm not gonna wrestle anyone over though--I just think it a sad think that people can't learn. In the days before HIPAA, my colleagues, other doctors, and I learned a ton about patients through following them throughout their course in the hosptial--and through their previous records. I can't tell you the name of the person I learned X and Y over clnically speaking, but I do know that information helped us grow--and we have no idea who the people were to this day. For one thing, it's just too many patients & years, and B., there was a point where the holistic aspect of care was able to take a back seat while we looked at, well, the medical and pathological aspects of what transpired with them. Of course when they were in our direct care we employed both knowledge and a holistic approach. But there comes a time when you have to look at information and data objectively and scientifically in order to learn.

Anyone that is just snooping so they can go back and tell someone, "Well you know what happened to Mrs. Z in ICU bed 3, . . .blah, blah, blah, isn't about learning or being professional.

Specializes in Emergency, Telemetry, Transplant.
How could this be proven if a nurse was brought into question? I am genuinely curious because I have looked up patients the next day--recently to see if my patient who was stroking out got TPA after I finished my shift. I was looking at his labs and the MAR. This was a violation?

To be honest with you, I'm not sure where the burden of proof lies. Do you have to prove that you were looking at the chart as a learning opportunity? Or, does the hospital, regulatory organizations, etc. have to prove that you were just 'snooping'?

Our hospital is certified by TJC as a stroke center. When they come for our recertification, they comb through the charts of every pt that got TPA. The EHR will specifically name who opened the chart and when. When they look closely, I'm don't want my name on that chart hours or days after I was done caring for the pt. If I want to learn from what happened, I can go through the proper channels (our department education, the stroke APN for the hospital, etc.) to get access to the chart. It is not a wise decision to decide for me to go on my own to peruse a chart and call it a learning experience.

Specializes in Emergency, Telemetry, Transplant.
Looking at outcomes is part of learning.

I'm not gonna wrestle anyone over though--I just think it a sad think that people can't learn.

I totally agree with both statements. However, there is a proper mechanism to look at an outcome to learn from it. Going on you own to look at a chart from days ago is not that proper mechanism.

Specializes in ICU.

How the heck did this thread become about HIPPA violations?

OP had a true concern and interest in learning about the outcome of her complex patient. That's what this is all about.

I've done it too, OP, so the police can come get me too for a HIPPA violation. I've taken care of a critically ill cop who pretty much came back from the dead and I have asked police officers how he was doing.

So, I am of the ultimate of all HIPPA violators for true care and concern.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

It is HIPAA not HIPPA. Sorry pet peeve.

Technically, it can be considered a reason to ask someone why they accessed a patients chart. State surveyors don't really "see" the access records unless there are irregularities noted. Yes the records are routinely checked and computer readouts are given to the individual managers (in my experience) where follow up occurs. Your reason for looking into the record can't be that you were curious about your neighbor.......but checking on a patient the had been in your care during that hospitalization is usually an acceptable reason to access that record.

However, I have worked at facilities that were......shall we say....zealous about the EMR and would even question me when I accessed a record for another facility ( with the release of records attached) and accessing the record when I assigned beds to appropriate floors......you need judicious about accessing record...a phone call to the unit would probably be a better choice.

But....MOMRN is right the post is about the outcome of the patient that remains on the vent after a CABG. Lets stick to the topic

Specializes in ICU.

If you're still on the upward swing of your career, you'll get plenty of learning experiences over time.

Don't be nosey. Out of sight, out of mind. Next!

Specializes in Intermediate care.

Pft are not typically ordered for CABG. You did nothing wrong. It is a huge surgery and unfortunatly they don't all go as planned. Some patients everything flea beautifully and they r out of the hospital in like 4-5 days aka "High flyers." Some are high risk and don't recover as nicely. We once had one that stayed with ha from October to January. She was very very high risk. Even to this day she comes back from time to time. Surgery is risky and it can happen to healthy people and unhealthy people.

Specializes in ICU.
It is HIPAA not HIPPA. Sorry pet peeve.

Technically, it can be considered a reason to ask someone why they accessed a patients chart. State surveyors don't really "see" the access records unless there are irregularities noted. Yes the records are routinely checked and computer readouts are given to the individual managers (in my experience) where follow up occurs. Your reason for looking into the record can't be that you were curious about your neighbor.......but checking on a patient the had been in your care during that hospitalization is usually an acceptable reason to access that record.

However, I have worked at facilities that were......shall we say....zealous about the EMR and would even question me when I accessed a record for another facility ( with the release of records attached) and accessing the record when I assigned beds to appropriate floors......you need judicious about accessing record...a phone call to the unit would probably be a better choice.

But....MOMRN is right the post is about the outcome of the patient that remains on the vent after a CABG. Lets stick to the topic

Autocorrect on my iPad. I'm well known for my autocorrect bloopers in text and on facebook.

Your patient souds like it could be a twin of my pt. She ended up dying about 1 month after surgery. This was after several intuabtions/extubations, chest tube removals/insertions, making it to the floor then having a rapid response called for respiratory distress...

Specializes in Intermediate care.

Yea this is a violation to look up patients charts. I would just stop now if I were you. Even if it is out of curiosity. Lets say I look up Joe blow on 3rd floor and my unit is 5th floor. His case looks interesting ....he was diagnosed with encephalitis. Hmmm don't see that often, I'm.just CURIOUS so I'm going to read his chart as a learning opportunity .....HIPPA violation. That is no different than what you are doing. Stop looking at her chart. You have no business being in there, no business asking around. Let it go....not your patient, not your business. Id be VERY upset if I knew a nurse not involved in my care from another unit looked through my charts out of curiosity. Think about how you would feel...

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