What would you do? - page 2
by elfinM 3,179 Views | 15 Comments
This recently took place in front of me, (not in my care) and involved a charge RN. It has really bothered me and I wanted to see what you all thought. Male, 57, suspected MI day before. Had vomited some dark emesis previous... Read More
- 0Jan 31, '12 by Esme12 Senior ModeratorYou have had other issues with this floor/manager in the past. I'm not so sure this floor is a good fit for you. Your O2 sat should not be higher than your B/P. Pallor, dark emesis, lowB/P, EKG changes screams GI bleed what was the HCT/HgB. I would have called a rapid response and placed the patient on 100% O2, largebore IV's and gone directly to ICU. Stepdown? was the patient a DNR or something? Wow.
I am not sure with a changed intervention would have changed this patients outcome for something ominous was going on but taking this route didn't increase his changes any...that is for sure.
- 1Jan 31, '12 by VICEDRNWill take the other tack here...if you really felt that strongly about it, you should have called the RRTeam yourself. Nursing isn't about being popular; its about the patient. Now is a heck of a time to pass judgment on others and how they acted when you, in fact, didn't act in the manner you thought most appropriate.
I see nothing wrong with the rapid transfer and intubation in ICU. Sometimes the providers prefer to do it in ICU than those little tiny floor rooms. Intermediate care is the incorrect bed assignment and the 1.5 hour delay is absurd.
Speak up if you want to be heard next time. Or just holler and pitch a diva fit.
- 0Jan 31, '12 by Aurora77Quote from VICEDRNThat jumped out at me too. The pt should have been out of there pronto, the 1.5 hour delay is insane. It was obvious to anyone with a pulse the pt is doing badly, get them off the floor, the faster the better. That's what we do on our floor.Intermediate care is the incorrect bed assignment and the 1.5 hour delay is absurd.
I also agree with calling your CAT team. The motto of our team is "if you're concerned, so are we." Call 'em, worst that can happen is you get yelled at. Pt probably wouldn't have made it, but you can sleep a little easier at night.Last edit by Aurora77 on Jan 31, '12
- 1Jan 31, '12 by elfinMHere is an update. I could not have called the RRT as they were already packing up and getting ready to leave the floor when I saw the pt turning several shades of blue. If I had been there earlier I would have called the RRT as I do NOT care about popularity. I have since talked with a trusted co-worker and have spoken with my boss. He says that what happened was done correctly and that he would stand by what they chose to do. I explained what I would have done and he said "that was another way to handle it". It is my understanding that this is going to be reviewed by the ICU due to the way it all happened. I will always do what is in the best interest of the patient, as my job is to protect the patient, not make friends. I do thank all of you for your thoughts and I wish I could have changed the outcome, but I don't think that was possible. I will keep you updated as to what happens. Thank you all again for all your viewpoints, it helps to see it in a different ways.
- 0Feb 1, '12 by bbie17I agree with everyone's comments. I think what went wrong is not the fact that RRT was not called, but that the pt was not transferred immediately to ICU. Perhaps the RN who contacted the MD did not accurately describe the situation...? I just can't imagine a physician transferring a patient who couldn't breathe and had a BP of 50/0 to an intermediate unit.
When a patient dies, a sense of guilt or "wanting to do more" tend to tug at our hearts, whether we are just bystanders or someone who directly handles that patient's care. A death of a patient impact us in so many ways and it especially has a great impact on the people who provided the care. I believe the charge nurse and the RN both want what's best for the patient. Having RRT at bedside may or may not change the outcome of the situation. I think it's best to provide support for your coworkers, as I'm sure everyone involved is walking away with some kind of lesson to help them become a better nurse.