Condition H

[LaNorteBellaRN]

good day everyone - happy 4th :)

i had a question i wanted to put out there for opinions.

do any of the organizations you work for have a "condition h" procedure in place. for those of you who are unfamiliar with it (i was until very recently) i've pasted information below with the source link. if your hospital does have this procedure, how has it worked? is it effective? what are your opinions in general, even if your hospital does not have this in place. i look forward to the discussion. thanks :)

https://www.patientsafetygroup.org/uploads/projects/162/wallsigndraft2.doc

the story.

josie king was an 18 month little girl who died because of hospital errors in one of the best hospitals in our country. through the creation of a patient safety program, the king family's hope is to help prevent this from ever happening to another patient.

the josie king call "condition h" has been created here at upmc shadyside out of our desire to provide our patients and families an avenue to call for immediate help when they feel it is needed. josie's mother, sorrel king, has worked with upmc shadyside to design condition h. we are dedicated to making the hospital the safest place possible for patient care to happen.

condition h -- what does the h stand for? help -- "condition help" patients and families can call for help by initiating a "rapid response team". a rapid response team is made up of designated members of the hospital's healthcare team, including at least a doctor and nurse, who come to the patient's bedside in an emergency and manage the situation, much like an ambulance team does in the community.

the reasons for the condition h can be:

• a report from a family member or visitor to a healthcare provider (i.e. nurses, physicians) of a serious noted change in the patient's condition that is not being addressed
  
• an emergency situation where a noted change in the patient's condition is not being recognized by the caregiver or does not receive the attention deemed appropriate by the family.
  
• if after speaking with a member of the healthcare team, confusion or conflict of what needs to be done for the patient is evident.

who will respond to a condition h? an internal medicine physician or nurse practitioner, the administrative nursing coordinator/supervisor. a floor nurse, and a patient relations coordinator, when in house.

we hope that you never need to call a condition h; however, this valuable resource for patients and families is another way that upmc shadyside hospital is partnering with patients and families to provide the highest quality and safestcare possible.

[TazziRN, RN]

Unfortunately, if pts and their families hear about this, I can see them demanding this condition be called over issues that do not warrant it because of ignorance.

[catlady, BSN, RN]

Heaven help the nurses at Shadyside, and anywhere else that implements this dreadful policy.

"Families Gone Wild"--the video--will be coming out soon.

Did no one think about how this will translate into practice? No, just take a bad situation (and we don't know exactly what happened in the original case, do we?), and hit it with a sledgehammer.

[EricJRN, MSN, RN]

While I'm not sold on the idea in general, I do think it was smart to include patient relations on the response team, because I can see many of these calls arising out of dissatisfaction and frustration rather than acute condition changes.

[burn out]

I hope there is a full time position for the CODE H team becasue I can see this taking up alot of time and alot of abuse. As if the floor nurses don't have enough to do anyway. Which takes a priority a CODE H or a CODE BLUE?

[ANnot4me]

I think it is a great idea -- at least in theory. If the team is given the power and support to deny/limit access by those who abuse it, but I can't see this happening. Once the word got out, one team could not manage an average size hospital. But wouldn't it be great... Take a big load off of the floor nurses (assuming all these positions were dedicated to the task and not in addition to normal duties--right!).

[LaNorteBellaRN]

i googled "condition h" and the first thing that came up was a powerpoint presentation that explained the procedure and the need behind it, according to one organization.

www.ihi.org/.../2005_11-medsurg/nov_1/implementing_ rapid_response_teams_that_include_patient_family.ppt

patient safety initiatives have really taken the spotlight here in canada, and when i worked in fl it had already been in the spotlight for many years. as a nurse, with my experience and in my initial schooling, i have always regarded the patient's or family's perception of their overall condition as very important. i remember in my second year of school i had a psych patient who was going for a broncoscopy and on his way out the door he gripped my hand and glared at me saying "i'm not coming back alive". i had no reason to believe this. he was admitted for mental health issues and was in no distress whatsoever. he never did come back. he coded in the pacu and was unable to be resuscitated. believe your patient, and trust their families when they say to you "something is not right here".

i tend to agree that instituting a condition h may lead the way to an overuse of abuse of the procedure. i guess it all depends on how the information is presented to the patient and family upon admission to the hospital. i think it's main objective is to prevent a patient's condition from being 'overlooked' or 'deemed' non critical when in actuality, there is real cause for concern.

case and point...the josie king story. sorrell king's story can be found here for anyone who has not heard it http://www.josieking.org/speech.html

is there a need for condtion h in our hospitals? when our patient's or their loved ones really feel that there is cause for concern and their pleas for help are either being 1. ignored 2. minimized 3. mishandled etc... what are their options? wait until the worst possible outcome occurs and then say "i told you something wasn't right." by then of course, it's much too late.

when i initially heard of this concept, my reaction was very negative. i felt there was no need for it. as nurses, what does it say about us as members of the health care team if there are dedicated personel to swoop in an intervene in moments of crisis? isn't that our roles as nurses to recognize these situations and act upon them? certainly nurses understand that our role extends beyond recognizing and reporting these concerns to the physician. what if the physician doesn't "believe us" or feels we are over reacting? certainly nurses understand that it is our role to be advocates and if the physician doesn't act in a way that is in the best interest of our patient, we must persist.....

but then i read what supporters of this initiative had to say. one example is a nurse who lost a neice due to cardiac arrest secondary to a k+ level of 7.6 that went untreated. her sister had insisted that there was something wrong, her daughter's condition was changing. there was much documentation in regards to the physician being notified multiple times of the hyperkalemia. but still there was no intervention. did the nurse do her job? she notified the physician of the labs, repeatedly. does it really matter that she did her job now, today......that little girl is dead.

how many times have we been frustrated as nurses to know, really know either based on our assessment or even what we feel in our "gut" that something's wrong. have you ever looked at a patient and just know they're going to code? have you ever been ignored? told "i'm the physician i'll decide what needs to be done....." i think we've all heard that before at some point in our careers.

initially i thought that having a condition h was absurd. but the bottom line is that our hospitals and our systems are broken. when it comes to patient safety, we'd like to think we always know best, but we don't. so is there a need for condition h? if it saves just one person's life, and i'm sure it already has....then i'd be inclined to say yes.

just my thoughts.

[MIA-RN1, RN]

we watched the videotape of the mother's speech and it was very moving. I don't know that we have the actual Condition H policy in place but it was presented to us to remind us that we have a responsibility towards not only our patients, but their families as well.

[ortess1971]

We have a rapid response team in our hospital but I don't think the families call it. I think it is a staff member(RN, etc)that notices the patient is heading for a crisis situation before they code. Seems to work pretty well.

[Shadelyn]

I've worked at Shadyside since November, and as long as I've been there I've only ever heard one of these called overhead. I'm assuming that they are paged over the intercom just like Condition A's and C's. There is literature posted all around the hospital about this and you have to watch a video about Josie King during orientation. I am interested as to what the responce team does other than comforting loved ones.

[TazziRN, RN]

It's fine, in theory, as long as it's the CARE TEAM that calls the Condition H and not the family. If the family states the pt is getting worse but there is no objective data to back it up, I would be hesitant to call it.

[mtnmom]

I suppose that I need a more thorough understanding of the policy, but initially my feelings are mixed.

Part of me is glad that there is an effort to reach out to the families and give them a voice - I have always encouraged my patients and their families to pay attention, ask questions, and be proactive in their care.

However, I can see potential problems: what about the families who are in total denial about the seriousness of their family member's condition (we all have experienced them)? Is it right for them to create such a ruckus (sp?) and to tie up essential team members who might be needed elsewhere?

Like I said, I know that I need a more thorough understanding. I hope that those of you working where this policy is in effect will keep us updated.