I recently encountered yet ANOTHER incident whereby big Pharma/Medical Device Companies are re-writing hospital policy and procedure and even going against nurse practice acts, in order to sell more wares.
Case in Point:
New epidural pump being introduced within hosp. by two RN's representing a well known medical device/medical supply company. This new pump has a BOLUS feature. These RN's were teaching all participants to use the pump, including the bolus feature, which, was taught as INITIAL BOLUS......I questioned this right away. I was ALWAYS taught that ANY epidural infusion was to be bolused only by a DR.....esp. INITIAL BOLUSES, because RN's are not trained to know epidural placement, etc.....it isn't like getting a blood return on an IV and knowing that you are "in the vein"....not to mention all the very very bad things that can go wrong...ie, dura rupture, cath migration, resp. arrest, too high of anesthetic action, paralysis of extremities, cardiac arrest, etc....
SOOO, when I asked, "Isn't this supposed to be done by a DR?, the two RN's said, "well, in some places, it is true, but we teach this feature anyway." When asking what the nurse practice act states for our state, neither of these RN's could tell me what the position was by the BON on this issue.....when asked further, "what does hosp. policy and proced. say?", they were equally unsure.
After some investigation, the dusty policy does not even ADDRESS INITIAL BOLUSING....it only vaguely speaks of increasing the continuous dosing "per doctor's orders."
What are your thoughts on this, and what does your institution say about vendors who come in and teach through inservices something that is counter to acceptable practice or written policy?
Specializes in cardiac/critical care/ informatics.
And to answer your question of "no, I don't know what that is or what it has to do with pulling epidurals"....
My questions have to do with understanding the level of teaching you received, as you indicated earlier, in a previous post that you didn't see what the big deal was....or something to that effect....
I wanted to know if you really understood epidural anesthesia as related to dermatome levels....(these are basic teaching tools used to help nurses monitor the level of anesthesia and how deep the anesthesia is...ie, you don't want an epidural dermatome level to get too high anatomically on the body, say, over the chest area, because it can affect respiratory status....) Since you also stated that you regularly pull these, I was curious to know whether or not you understood through your competencies the things that can go wrong, and the things for which many nurses have been sued....
ie, not reporting neurological changes....ie, "I can't feel my legs"...."I have a terrible headache"....etc....."only one side of my body is numb...I can feel the other side" (unilateral anesthesia)....
I think it's good that an anesthesiologist inservices you on this device....but again, my concern is that the teaching that is happening in some hospitals comes from VENDORS,not anesthesiologists, and many nurses taught this way, will not know cardinal signs of trouble to watch for....they will just bolus their patient and think they are doing the right thing, because, by golly, they went to A INSERVICE on it!! THey won't know what their BON says, because they foolishly believe that because their hospital is a Magnet hospital, or because it was an RN trained by a company, working for a company, selling a device, "that it just must be okay!!".....and sadly, THAT ISN"T THE WAY IT IS!!
The place I work at right now, is also a magnet status hospital....but they still let the vendors in to teach initial bolusing....which isn't in our scope of practice here....
To me, THIS IS A BIG DEAL....because it's my license on the line....and mostly, it's my patient's safety on the line....
crni
well our epidurals are used for post thoracotomy patients, so there isn't numbing involved it is placed differently than L&D patients. It is for pain control. We monitor thier sedation, and of course vs, tele, and pulse ox.
jmgrn65, RN
1,344 Posts
well our epidurals are used for post thoracotomy patients, so there isn't numbing involved it is placed differently than L&D patients. It is for pain control. We monitor thier sedation, and of course vs, tele, and pulse ox.