Giving O2 without an order??

[strawberryfields]

Last night I had a patient sitting up in his bed at 0300 when I was checking up on everyone. At this time he is usually sleeping so I asked him if everything was okay and he said he couldn't breathe. I grabbed the pulse ox and it was at 75% he had no orders for oxygen but I went ahead and got him 2L of O2 NC. and raised the head of the bed. His oxygen went to 85% on 2L so I raised it to 3L and stayed by his side watching the pulse ox assessing his lung sounds, conciousness etc. It got to 95% and half an hour later I was able to move it to 2L and his oxygen stayed at 93% and he caught his breath and said he felt much better. I asked my supervisor and she told me to document everything and endorse to the AM nurse to call the Dr. in the morning.

I documented about 2L and moving to 3L all of the readings I got from the pulse ox and assessment of lungs and altertness/conciousness AND the fact that I am going to follow up with the dr. in the morning to get an order for PRN O2

My question is was it okay that I gave oxygen at 2L and then 3L when needed without a doctors orders? Is it okay that I documented that I gave oxygen and would follow up with the doctor to get an order? Because i made it clear I didn't have an order for this in my progress notes ... worried :| But I felt I did the right thing..

[Cat_RN, ASN, BSN, RN]

You REALLY need to get over 'the doctor is going to hate you'. You called for legitimate reasons. If he's mad, he needs a new career. It's not our job to worry about the doctor's sleep.

I'm not saying calling the MD for Ted Hose in the middle of the night is OK, but really now, call when the patient needs help.

[sauconyrunner]

The dr came in that morning and he ordered a chest X-ray that was done that after noon he has lower lobe infiltration. And hasn't used the o2 since my sunday shift but now he does have orders for 2-3L OF O2 prn and use incentive spirometer. I actually called that doctor yesterday at midnight about a PTs blood sugar I was monitoring that went up to 515 8) she had a sliding scale that said >300=9u but no further order so i called to see what he wanted. looks like he's going to hate me but I'm going to call him regardless of what my coworkers say.. I'm going to use my own judgement.

That is the spirit!!!! Remember when you think someone is Hating you, that this is HIS/HER JOB. When he starts yelling...or acting like a jerk, you can easily say..."The order you gave says to call with XYZ, so I am calling. Did you not want me to call, then how did I get this order that says I am to call you?" Usually they sort of calm down then, because I mean, they wrote the order. It is very hard to get used to calling MD's at all hours, especially if it is not the norm where you are. And yes, it takes some getting used to, but in the long run, they will either adjust their orders, or get used to it, and the patient is getting great care from you! Good Work...not Easy, but Good on you!

[classicdame, MSN, EdD]

Either have an MD order or a standing order or policy. Never venture out on your own. I would use this incident to insist on getting a documented plan of action so nurses are covered.

[Hay, RN]

sorry, i just can't let this slide. just because the person has copd does not in any way, shape, or form, mean that they are a co2 retainer and that you should withhold oxygen if they are in respiratory distress! and even if they are a retainer, as i said in my earlier post, co2 narcosis takes time to develop. if the person is in respiratory distress, you give the o2 and worry about co2 narcosis later.

i do not see where i said do not adminster oxygen. (:

[Anna Flaxis, BSN, RN]

when your patient is in respiratory distress it is fine as long as they do not have copd which in that case you would be decreasing their drive to breathe.

this is what i was referring to.

[Hay, RN]

this is what i was referring to.

i understand and re-read my post and didn't see where i said not to give oxygen. i worded it not the best which allowed room for misinterpretation.

[minnymi]

i didn't read all the pages of replies, but i can imagine what i would do in this situation. of course, we all know what we would do in situations we aren't in.

i would've put O2 on the patient and immediately called the doctor as i watched the sats rise...literally. i don't know if you have a phone right outside the door or what your setup is, but in my case, i could administer O2 and use the phone right outside the door with the pt and sats in view. i don't care about the time. it should be a pretty short, sweet convo of, "mr. doe's sats dropped to 75 so i immediately administered O2 and right now they are 83% at 2L. can i get an order for the O2 and increase it, or what would you like for me to do?" if i couldn't watch the pt/sats while on the phone....i would've had someone stay with the patient while i called. either way, i would've called.

the charting would be pretty simple after that. much easier than trying to cover your butt. the doctor doesn't care if you lose your license so why would you care to wake him/her up to do the job he/she is getting paid well to do?

[jodyangel, RN]

Yes I would of thrown on the O2, put out a call to the MD, and would of said to him...I put O2 on him is that ok? That would of been my verbal order. Then I would of called the supervisor lol.

I cant imagine any MD having a problem with giving you the order for the oxygen..unless the pt Is COPD.

And I would of told the doc that if this happened again I would be sending him out to the hospital..

[RamTaur]

Obviously, this was a change in condition, and you followed up and assessed your patient accordingly. I think you acted on the patients best intrest with effective results. Was there a respitory thearapist on hand to assist you on the floor? Or any other clinician that was readily availabe to help you in a situation that can go critical. In my experiences, I always try to involve who I can, remember, a team is better than one. As nurses we all have had similar situations. I always as M.D.'s for standing orders, just in case. I'm sure you'll be fine, chalk it up to experience. Peace and good nursing................A colleague................

[turnforthenurse, MSN, NP]

Where I work we have an O2 titration protocol...we can initiate O2 via NC to maintain saturation >92%. There are also respiratory therapists that can be your friend :) I would have put O2 on a patient then call the doc.

This remind me of a time where I had a patient with dementia who really needed to be suctioned...but we couldn't use a yankeur NYC every time we tried, the patient would fight us...days were dropping, the RT was right there so she NT suctioned instead...you need an MD order for that but I'm not going to sit around and wait for the doc to answer my page at 0300. O2 came back up and I called the doc explaining what happened and got the order.

[demylenated, BSN, RN]

This was a significant change in an AAAx3 pt. I would have sat him upright and started O2, but I would have had a fellow nurse call the doc ASAP while I stayed with the pt. Since he has been hospitalized so long, my initial thought would be a PE. Can't believe supervisor said wait till morning. Very dangerous. Everyone is lucky the patient is ok... otherwise there would have been a huge lawsuit... HUGE.

Also, a call to respiratory therapy would have been a good choice.

[sapphire18]

Just wanted to add, if someone is sat'ing 75% I would not be starting them at a mere 2L via NC. Sure I would titrate down as the pt's condition allowed, but that is a pretty low sat!