Whom if anyone do I tell?

  1. Hoping someone out there has some advice for this situation.....I got to work the other day and a resident of mine had a non-rebreather on at 5 liters of o2....not being a nurse yet I called a family member who is an EMT she informed me that with a non-rebreather you have to have at least 15 liters of o2 or your basically suffocating the person to death....this residents o2 stats were at 68 he was purplish-blue in his face, head and hands, and extremely diapheretic (the bed was drenched) I called for the nurse (I was charging our alzheimers unit) and she came back took the mask off and put a nasal cannula on.....his stats would not go beyond 73 a short time later I took his vitals.....resps were above 30 pulse was above 100....and about 20 mins later he was taking his last breaths while spitting/coughing up a foamy substance.....everything I have read and experienced tells me that this man died from suffocation/asphyxiation....and it is tearing me apart...I don't know what to do or who to talk to about this without losing my job...which was already threatened for calling a family member to ask about the mask....I was told it was against hipaa...which since I didn't mention names only about the breathing apparatus itself I didn't violate hipaa.....anyone have any advice???
    •  
  2. 11 Comments

  3. by   fergus51
    He wasn't suffocated from a low flow and your family member should have known that, though he wouldn't have been getting as high of an oxygen concentration as he would have with a higher flow. Why don't you just ask the nurse what caused the patient's death?


    From a website:

    http://www.umm.edu/outdoor/oxygen_admin.htm
    The nonrebreather is used to deliver high concentrations (as a percent of inspired air, 80% to 90% oxygen at flow rates of 10 to 15 liters per minute) of oxygen. The reservoir bag should be kept at least half full of oxygen. This can be accomplished with flow rates of 6 liters per minute or greater.
    Last edit by fergus51 on Nov 4, '05
  4. by   ERNurse752
    Was he a DNR?

    Sounds like he died from CHF/pulmonary edema, but I don't know enough about him to say for sure. If I were you, I wouldn't say anything to the family, b/c you don't have all the information. If he was a full code status and this happened, management needs to be involved.

    I don't think he suffocated, but he needed more O2 than he was getting from a nasal cannula or 5 L on a mask.

    A nonrebreather should have 10-15 L of O2 running through it...it's pointless to use it otherwise.
  5. by   Tweety
    If the man was that bad off, the extra oxygen wouldn't have saved him. So I agree, he didn't die from not having the mask turned up. He died from whatever medical condition he had. Sounds like you came upon him at the end. Taking your last breath isn't easy or a pretty site.

    If this patient was a DNR, (and it sounds like he was as you haven't described any heroics) it sounds like he was at a point of comfort measures and should have been given something to ease his passing like morphine. This bothers me more than having the incorrect rate on the NRB mask.

    I don't see how you violated hippa when you were only trying to learn about oxygen masks.
  6. by   sjrn85
    Sounds like he died from fulminating pulmonary edema. You could have had the NRB working correctly, and I would be willing to bet his sats still would have been crappy; there would have been too much fluid interfering with O2 absorption.

    I agree with Tweety; poor man sure could have used some MSO4.
  7. by   Noryn
    I am a bit confused as you said you arent a nurse but you were "charging" an alzheimer's unit. Anyway it is good to see people care enough about patients to take extra steps as you have done.

    Typically in a hospital setting a non-rebreather mask is almost the last line before mechanical ventilation. Usually this is just a temporary fix while you treat the underlying problem. You didnt specify if the patient was a dnr. If so then being on an Alzheimer's unit with a 100 percent non rebreather probably wasnt appropriate as further interventions and closer monitoring would have been needed.

    It sounds though as if the patient was a dnr, the disease process was in the terminal stages, and no heroic measures were indicated. I hate to assume too much but the patient almost had to have respiratory compromise before the non rebreather was applied.

    If you read the literature, you can see that even your family member was wrong--in that 10 liters of oxygen may be acceptable for a non rebreather (although in my experience I have never seen 10 liters on a non rebreather--it was always 15 or max). Also make sure that the reservoir bag is inflated and if you watch most hospital/er dramas you will always see this deflated and you can yell out, "WRONG", then everyone looks at you like you are crazy. :chuckle

    I really hope all these comments help ease your mind, and it really seems as if the patient was dying from pulmonary edema. I honestly think the patient dying had nothing to do with the rebreather.

    As far as a HIPAA violation goes, it was most likely not a violation. If you said, "I have John Smith down here and he is dying and the nurse has him on a nonrebreather with 5 liters of oxygen" then yes that would be one but asking a medical question without giving any patient information is certainly not a HIPAA violation.

    As I have said it is really good that you care so much about your patients. In the future though when you have questions, I would hesitate to say things like, "I just called my family member who is an EMT and they say ..........". Just perhaps say something like, "I always thought a non rebreather took more oxygen."
  8. by   SFCardiacRN
    When in doubt about a patient's care or condition first call the patients RN. If needed, follow the chain of command through the charge nurse, patient MD and EOD. Calling friends or family is a HIPPA violation not to mention unproductive.
  9. by   flashpoint
    Using a non-rebreather without high flow O2 is one of my biggest pet peeves. A NRB should flow at 10 LPM minimum...I always put them at 15 LPM in the field...
  10. by   Turd.Ferguson
    If you did not give any information that could result in identification of the patient, it is not a HIPAA violation.

    My med-surg book says that non-rebreathers should run at "liter flow to maintain reservoir bag two-thirds full". (Medical-Surgical Nursing, Ignatavicius and Workman, 4th edition)
  11. by   cher722
    You should have called the administrator of the facility immediately no matter what your status in relation to the situation
  12. by   Noryn
    Quote from cher722
    You should have called the administrator of the facility immediately no matter what your status in relation to the situation
    I disagree with this. I think I have seen my administrators maybe 5 times in the past 8 years. If this happens during evening/night hours you probably wont even be able to contact the administrator and during the day your chances are really low.

    You need to always follow your chain of command.
  13. by   RazorbackRN
    I'm still confused by what you meant when you said that you were "charging" the Alzheimer Unit, but you're not yet a nurse???

close