Published Jul 22, 2005
I am currently trying to find anyone with a formal written protocol revolving around hypotension. Every critical care nurse knows how to treat hypotension (treat the cause!!) yet the physicians and administration at our facility have not given an inch in empowering the nursing staff to get things started prior to his holiness arriving or barking out an order. We all know that we do it anyway behind the fort knox doors of the ICU but the Medicine Department at my facility has recently taken it upon themselves to require a written policy be put in place then approved by them. Problem is it takens ten years to pass anything throught the zillion committees that it must pass prior to being implemented. Forget that every critical care nurse in our facility is ACLS certified and knows how to follow those guidelines. Just not good enough. Can anyone help out by forwarding a protocol already in use at your institution. I would greatly appreciate it. Thanks so much!!!
I've never heard of a protocol for HOTN. Doesn't the medical staff realize that you can't just make up a generic HOTN protocol for patients? What if they have CHF? Or ESRD? Or a TAA? It seems a little dangerous to make something up for everyone, when not everyone can handle the treatment you decide upon. I understand that you treat what needs to be treated at the time and let them know how unstable the patient is after you've got a blood pressure back, but not every patient can handle a bolus of 500cc/a touch of ephedrine/a touch of neo/trendelenberg ... and on and on.
I guess what I am looking for wasnt communicated well in my initial post. We all know how to assess for what the patient needs whether it be fluids or pressors or whatever else and assess whether or not the patient can handle it. What I am looking for is a decision tree like the current ACLS guidelines. The Med Ed staff isn't wanting to empower the nurses to treat unless they are doing the ordering. However since the implementation of a rapid response team in our facility we often dont have time to wait for the doc to take his old sweet time to call back and blurt out orders if we want to avoid a rapid decline in the patient's status. They want everything in protocol format before they will give the go ahead for nurses to initiate the APPROPRIATE treatment. This doesn't pigeon hole everyone into the same treatment. The critical care RN has access via computer to the patient's EF, history, recent labs, current chart and any other information on the patient. We have the PACS system and can do an xray and have results to the RN in less than one minute. So the nurse has every bit of the information available to see which limb of a decision tree to go down to treat the patient efficiently. The question I had is: Is anyone already empowered to treat and do they already have a formula that is written in stone (ie decision tree like ACLS) Yes I know that realistically we treat all the time and get the order later but the docs want it formally written into policy that the nurse can initiate treatments in order to get around JCAHO and any other regulatory agencies out there. This is what I am looking for. If anyone has anything they are using please forward it. Thanks so much :)
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