Do I report this?a long post!

[kookyscientist]

If this situation happened to you would you report it, and if yes how do you go about doing it?

A nurse is pulled to my floor and is there for about 3 hrs when this happened. The wife of one of her patients stops me as I walk by his room and asks if something is wrong with her husband since it is cold in his room yet he keeps kicking off the blankets. I thought maybe he has a fever so I go in to check. The first thing I hear is the congestion of his airway, sounds like he needs major suctioning. So I proceed to do his vitals. His oxygen is at 89%. He has a nasal cannula on, so I check the connection. First of all it is not turned on, second the tubing is not connected to the wall. I then went to tell his nurse (I am a student nurse by the way)and tell her what happened. She says hook him up and put him on 2 liters, no he doesn't need to be suctioned. I put him back on and his O2 went up to 96%. I went to another nurse and asked if she would look at this pt because I think he really needs suctioning, and tell about the oxygen not being hooked up situation, where she then defends the other nurse and doesn't go in to look at him. By the way this guy had Bypass heart surgery, and then a TIA while at the hospital.The whole time I was in there with him he couldn't talk and kept his eyes closed. Well I went to lunch with a nurse and in the middle of eatting she was called out to that guys room because he went into V tach. He wound up being intubated, has pulmonary edema, and was rushed to ICU by a team of 8 people. The whole time this went on I was the only one consoling his wife who was freaking out. What would you do if you were in this situation?

[Youda]

You didn't say what kind of facility you are in. LTC? Step-down?

A concern I have is that we don't really know what the other nurses did or didn't do for sure. They may have slipped in the room while you were somewhere else, did an assessment, and believed the guy to be OK. (Although I don't know how they'd come to that conclusion if he had pulmonary edema and an abnormal heart rhythm!!!)

Another concern I'd have is the patient outcome. Would his condition have been significantly changed by earlier intervention? Was emergency transfer avoidable? (probably not, by the way). However, if the patient should expire, and the wife remembers that she was trying hard to get someone's attention . . . it is possible that this could end up in court. So, like sjoe said, document for your own records.

I also suspect that you are unsure of yourself so you didn't press the issue when "the nurse" said he didn't need to be suctioned when you felt that he did. In the future, you need to get more insistent. Say something like, "Please come assess Mr. So-S0 now. I believe he is in distress." You say it that way because you did not do an assessment, so you really didn't KNOW he needed to be suctioned. You arrived at a conclusion before you had all the facts. That's OK, I'm just wanting you to develop critical thinking skills, too! :) You report what you actually see and hear, not your conclusion. So, report to the charge nurse that Pt. is cold, nonresponsive, audible wet labored respirations, family member at bedside is upset, etc. Report what you see and hear, not your conclusion.

After you report that, your responsibility ends. If the nurse won't go assess the pt., you can ask him/her why or what her rationale is for not seeing the pt. That will also give you an opportunity to report to her in more detail why you believe the pt. is in distress and needs immediate attention.

I think part of the problem here was a communication problem. Some of the suggestions above might help eliminate those. However, if there were true negligence, then, yes, it needs to be reported as high up the chain of command as you need to go to have the problem dealt with. But, again, once you report it, your responsibility ends.

I'm so glad to see someone who is caring and concerned about your patients! You're going to be a great nurse! Love your avatar, too!

[kookyscientist]

Thanks everyone for the advice. I don't want anyone to think I'm pressed on the issue of whether the pt. needed to be suctioned or not. I definately was not drawing any conclusions to whether or not it affected the pt. When I told the nurse about the patient I only suggested that "maybe" he needed to be suctioned. I said that because I figured that if someone told me "hey your pt. isn't breathing right...has major audible congestion going on, sounds like he needs suctioning, he can't answer me and can't open his eyes." then maybe I would bother to go in and look. I am still in school and don't know it all by any means and certainly wasn't trying to act like I do. Maybe he needed Lasix, maybe he had V tach because of his respiratory distress, I don't know. But we work on a Post CABG floor, or step down ICU. So I just figured that these patients are critical and should be checked on when someone has a concern, not blow it off before you even bother to see for yourself. I went to work today to drop some things off and asked that nurse what ever happened to that pt. She said she didn't know but did say that she should have checked on him when I went to her. So by that I gather that no one did go in and check on him. I guess Youda is right that I was unsure of myself, I guess I would be after going to 2 different nurses and being blown off. But I know now to be persistent.I really appreciate everyones feedback. Thanks again.

[P_RN, ADN, RN]

At our place everytime a patient goes to the unit you have to make a written report. [\/] "unexpected transfer to monitored bed." The report would only have the patient's name and something like patient's vital signs unstable, pt sent to ICU/CVCU/MTU whatever. That way risk management sees you knew this was an event and can look into it.

[Youda]

It's hard to get all the information into a short post. Wow, I was thinking this was a LTC. If you work on a step-down ICU, and the nurses hadn't checked on their patient, with or without someone reporting symptoms . . . not good. Not good at all. You aren't expected to know more than the nurses, so it's understandable that you would be unsure of yourself in that situation. The basic nursing is: change in condition must be reported to the doctor. There are probably more recent articles written about this kind of thing, but if you can dig it up, there is an great article on this kind of situation in RN Magazine, October 1988, an issue devoted to nursing ethics. There is a very thorough, no-nonsence, practical guide about what to do when a colleague is unsafe. Good luck to you in your studies!