I have the utmost respect for Respiratory Therapy, even at my current "contracted" facility. Most of them are right on target- and IF they have trouble making it on time for a treatment, or show up a little late on an emergency, I know they are really busy and doing something with another patient on another floor or area. This is different.
Let me set up the Scenario.
Small 40 bed Acute Care 3 Unit Area, 5 Room ER, 8 bed ICU, 12 bed Post-Surgical. 5 Birthing Suites/10 Post Partum/Women's Care Rooms. 20 Swing Bed Rooms, 100 bed Nursing Home/20 of those bed Mental Health Senior Care. There are ALWAYS 2 RRT's (Registered Respiratory Therapists) on staff at ALL times!
One is ALWAYs stationed ONLY for ED and ICU beds. The other covers the 3 story, 3 unit acute care, and swing bed facility. During the day, the RRT Supervisors does the Treatments in the Nursing Home.
Of the 6 RRT's on staff here, (plus the practicing Supervisor=7), all but one are STELLAR! The one I have a problem with is RENOWNED for intubations, and is great "skill" wise. Dependability is NIL!
He is dating one of the Acute Care RRT's, so needless to say, it is starting to affect her as well- but NO WHERE NEAR as bad as him. It's nothing for him to never show up for routine ordered Treatments, I have seen him see a sleeping patient, and walk away. We don't know if he's charging or not- but if I am sure he didn't give one- I initial and circle on MAR for hold.
Clocked in, started shift. It's Me, an ER Tech (CNA trained for ER), and the Doc. I see the RRT clock in, and leave the unit. 4 patients in rooms, 1 awaiting EMS transfer, 1 waiting for ICU bed (massive CVA)*, all stable but awaiting some orders *besides my transfer.
Admitted Asthma/COPD patient, Anxious/Trembling all over. Spo2 84%, BP 166/106. They wouldn't deny CP, and stated 4/10, pressure- but "better now." 3 lead EKG showed Sinus Tachycardia, no ectopy, 153 BPM, resps labored, wheezing, non-productive coughs/congested-31 RPM. Accessory Muscle Use. Pupils pinpoint, diaphoretic, cyanosis Obvious. Paged 3 times while working with patient. Told ER Tech to page over head.
RRT does EKG, Resp Tx's, Oxygen Set-Up, and blood gases (all of which were ordered stat)! No response from overhead, sent ER tech to RRT Sleep Room (3am), No Response!
Of Course, at this time I have started IV plus meds, O2, the first treatment, but am running crazy to get my EMS transfer ready (MVA), and I hear the alarm- CODE/MVA.
Call Code Blue- I get 2 Acute Care RNs (regular ER back-Up Nurses), and the floor RRT who saves the day. 11 minutes after the stat page, he shows up. We work code successfully, get EMS transfer, He did tx's on Asthma Pt, Spo2 95% on 2L NC, Sinus at 89 BPM now, I tell him what else I need, (needed), but it is handled now- "but don't run off." Fell on deaf ears! Found out 1 hour late, he never drew my second set of ABGs, I wrote it up! My first ever time to write up another department!
4 minutes later EMS report enroute Premie 1 1/2 months early, respiratory distress. Stat page over head (didn't even bother paging him- I told him NOT to run off), and by the time he get's there, Doc and I have baby intubated, IV, and in Incubator awaiting further orders, no distress. Mother's doing fine, but is anxious.
I can NEVER get him when I need him, he just "vanishes" for HOURS at the time. He smokes outside, and I have seen him sit in his car outside and just talk on cell.
I have dealt with the same issue at other hospitals where it looked more like understaffing, but feel this issue is just plain NEGLIGENCE! I have begged for the ones I know will not do the treatments to give me the medication so I can!
I know there are sometimes other things going on, but I am the kind of person who, when I finally ask for help, I NEED HELP NOW! I don't pull a nurse, or make a page unless it's out of my hands. I can go for weeks without pulling a nurse from the floor, or overhead paging any of the OTHER RRTs, it's just this guy!
I know working the floor it is common to get blessed out on the phone by an RRT because a patient is requesting a "PRN" treatment, and they are "Too Busy!" Yet I see them all on my next break smoking, and sitting in the courtyard!
Have you noticed a problem getting Respiratory Therapy when you need them?
How can I address this issue without making it worse?
Do you ever do their Respiratory Treatments for them?
ANY ADVISE ON DEALING WITH NO SHOW RESPIRATORY THERAPISTs PLEASE