Oxygen order changes

  1. Hi there

    our hospital is recently changing its Oxygen policy. It will require us to get a new MD order every time we titrate oxygen in pediatrics. If we change from nasal cannula to venti mask we need a new order, if we titrate down from 1 liter to 0.5Liters we need an order. If we go up we need an order. We work nights and in pediatrics you can play with oxygen and equipment all night depending on how your kids sleep and their ages and if they roll over. It just seems excessive and doesn't allow our critical thinking. I'm wondering if this is the new norm out there??
    thank you!
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    About Danztam

    Joined: Feb '18; Posts: 2; Likes: 8
    Specialty: 1 year(s) of experience

    19 Comments

  3. by   Sour Lemon
    That sounds like a nightmare. I'm not in pediatrics, but our orders are usually "titrate to keep O2 sat blah blah blah ".
  4. by   PedsRN2016
    I work in peds, as well, and truly cannot imagine having to call at night for every half liter adjustment! We usually have ranges and possible equipment...you do need a different order for a high flow nasal cannula instead of a regular low-flow. Otherwise, our max may be 8, 12, or 15 liters depending on the age/size of the patient. Most of the time, we can wean based on the patient and our judgment, however, occasionally the physician will put a minimum liter flow, as well. Either way, we usually have a solid range of at least 4 liters that we can adjust up or down, as needed!
  5. by   Been there,done that
    Oxygen is a drug. Nurses cannot change the flow rate , or method of administration
    unless you have a standing order.
  6. by   KelRN215
    Was there some sort of event that led to your employer making this change?
  7. by   brownbook
    Well......you can call the doctor every 1 - 2 hours at night when you change the oxygen, see how long they put up with it! I'd be tempted to change the flow by 0.5 liters up and down 3 - 4 times a night on every patient!

    Duh, of course it should be titrate to keep the O2 sats above blah blah blah.

    As others said, does anybody know what happened, what event, caused this?
  8. by   Sour Lemon
    Quote from brownbook
    Well......you can call the doctor every 1 - 2 hours at night when you change the oxygen, see how long they put up with it! I'd be tempted to change the flow by 0.5 liters up and down 3 - 4 times a night on every patient!

    Duh, of course it should be titrate to keep the O2 sats above blah blah blah.

    As others said, does anybody know what happened, what event, caused this?
    I have a feeling that no doctor dreamed this new policy up, but I could be wrong.
  9. by   meanmaryjean
    That'll last about a week..
  10. by   Danztam
    Hi yes no the docs didn't come up with this policy and aren't too thrilled, they are Peds hospitalists so the RT dept is rewriting this policy and not asking for our input or theirs. I understand oxygen is a drug but if you can still do insulin ranges in the adult world why can't you do some sort of range in Peds for oxygen. I mean it's ridiculous because with children and oxygen you could be playing around all night sometimes. I feel it will be a barrier to weaning overnight. No one wants to wake up the docs if they finally got a little shut eye. Oh and there was no event. Nothing happened. We do separate orders for high flow.
  11. by   sallyrnrrt
    When I worked full time as respiratory therapist in a small rural hospital, the physicians developed a respiratory protocol.....we could make changes, even Nebr. treatments....... & methods of delivery
  12. by   bugya90
    We have a standing order for all patients on oxygen regardless of age. Not sure of the exact wording but nurses and respiratory therapists can titrate the oxygen up to 4 L and we can change from nasal cannula to non-rebreather. Anything more than 4L or non-rebreather we have to get an order. It's really nice because when PT and OT are working with the patient we can bump their oxygen up and not have to page the dr.
  13. by   Buckeye.nurse
    At my facility, we must have an order to initiate oxygen therapy (if it is an emergency, then obviously we would place the patient on 02 while paging the doctor). A typical order reads as such... 1) delivery device--nasal cannula 2) flow--1-6 L/min 3) 02 sat parameters--titrate to keep 02 sat > 90%, or 88%, or 92%..whatever the physician feels is appropriate based on the patient and their history.
  14. by   perfectbluebuildings
    That sounds absolutely ridiculous. Will it be the RT having to call the doctor all night about O2 changes, since that department came up with the policy? I am guessing not... I am guessing, somehow, that all of that responsibility will fall on the RN.

    And seriously... like you say... O2 requirements can change hour to hour, even minute to minute for some of these kids!! Whoever came up with that policy has obviously never worked a night shift with pediatric respiratory patients. The order at my last place of employment was, titrate O2 to keep sats>90%, sometimes "up to [4L/8L/50% etc]." then notify the MD if higher concentration of O2 was needed. But it sounds like they want you to call every single time a patient falls asleep and desats, or needs extra O2 after trach suctioning, or has a rough CF night, or anything. I hope that policy does not last long for you all because that's absolutely ridiculous. Good luck.

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