Good judgement skills or not?

[nevergonnagiveup]

I work on a very busy medical floor. I had a patient admitted to floor with a dx of hypoxia. This woman's previous med hx included asthma with use of continious O2 at home. She was to originally be admitted to ICU but the MD stated in his admit orders that if patient's O2 sats were greater than 93% on nasal O2 she could be admitted to a regular medical floor (she needed 6L of O2 via a hi flow n/c to maintain that O2 sat...to me she should have went straight to ICU to be monitored more closely). Upon making my final rounds, I found her doing pursed lip breathing, gasping for air, labored resp with use of accessory muscles and sweating. I checked her O2 sat and she was only 82% with 6L. I placed a non-rebreather mask on her while I attempted to call respiratory to adminster a neb treatment because you could hear the wheezing without a stethoscope. I made two calls and the line was busy. Knowing that time was of the essence, I directed the unit clerk to call a rapid response code (the policy in the hospital is to call a rapid response if their is any change in the patient's condition). The entire code team responded. The patient received treatment after treatment with very little change in her O2 sat. The pulmonologist was called, assessed the patient and decided to transfer her to ICU. After it was all over, I went to the bathroom and overheard outside the door my charge discussing me to another nurse. Her statements were I should not have called a rapid response but should have called respiratory stat to adminster a treatment because I had the whole hospital respond to a code unnecessarily (last time I checked-airway was a priority). I was so upset that my nursing judgement was questioned and even started questioning if I did the right thing. Can anyone offer any advice on how they would have handled the situation and did I do the right thing? Just need some reassurance.

[TazziRN, RN]

Working ER, I would have paged RT stat, but I am also not familiar with rapid response teams. "Rapid response" sounds like you're supposed to call them so that the pt does NOT deteriorate into a full-blown code, and if I'm right about that, you made the right call.

My opinion: if I were you I would ask for a meeting with the charge and the manager, and inform them that you overheard the conversation. Tell them that "my understanding of the rapid response team is to prevent the pt from coding. If I am interpreting the purpose wrong, please tell me. And if you have a problem with how I handle something, please approach me directly or with (manager's name), but please don't discuss me with another staff member."

[caliotter3]

I totally agree with what Tazzi posted. From my point of view, you did what you were supposed to do. Otherwise, why do they have a team called Rapid Response Team?

[Kymmi]

I also agree that you did the right thing. I work in ICU and our rapid response team consists of the ICU charge nurse, 1 ICU nurse, 1 resp. therapist and the house nursing supervisior. The goal of the rapid response is to prevent a full blown code. I've responsed to several rapid response calls in which the patient did have a change in condition however one of the ICU nurses would call the MD for orders quite possibily lasix, breathing TX or any number of other meds which we'd give at the bedside and we'd be able to avoid a transfer to ICU because of it. Most of the times the patients are transferred to ICU however it is done precode because the nurse the called the rapid response was alert enough to her patients changes that she intervened before the patient developed enough distress to code.

I remember one rapid response was a very large man with alot of ascites who wore a CPAP at home. After being admitted to the floor the orders were for O2 at 6L/min. He did great all day long on 6L however when he decided to lay down for bed he didnt bother to tell anyone about the CPAP he wore at home and to top it off the nurse layed him flat in bed. Between the ascites, being flat in bed and not having CPAP on his sats dropped to 82%---rapid response called ...we questioned patient about his apnea, set up up in bed and placed him on CPAP.....his sats rose to 94% almost immediately.....he also had alot of LE edema....MD called and lasix given and we saved a transfer to ICU by assessing at the bedside and treating.

[starcandy]

Isn't the Rapid Response team used to prevent codes??I think you did the right thing considering the pt condition was worsening

[EmmaG, RN]

Exactly.

I've never seen a RR team question the decision to call them in.

[kmoonshine, RN]

You definately did the right thing. The patient was in respiratory distress and needed an intervention FAST. You said that this patient ended up going to the ICU - therefore, the floor you work on was not an appropriate place for this patient (ICU has lower nurse-patient ratios, has more protocols, etc). You were right to call the rapid response team since your floor could not meet this patient's needs.

Nurses who call the rapid response team should never have to feel "bad" for utilizing this service - even if it was an "oops". This discourages nurses from calling the team for future situations, which could potentially lead to a disasterous outcome.

You knew what the patient needed: air. And you knew you couldn't "fix" this and needed to bring in a team which is designed to prevent a patient from deteoriating into a full-code. I'd suggest looking up your hospital's policy regarding the rapid response team, or contact one of the individuals who responded to your call and ask them if you acted appropriately, what could you have done different, etc. I think this would provide validity to your actions.

I'm sorry your coworkers were questioning your judgement. It is very unprofessional to criticize coworkers behind their back, and this behavior is very inappropriate, especially for the charge nurse! If this continues to bother you, maybe this should be brought up with management. If this charge nurse said this about you, you can be sure she's running her mouth about other nurses. This type of behavior creates a toxic environment and is very hurtful.

You did the right thing and you should be very proud of the decision you made. Someone is alive right now because of the excellent decision you made. Glad to hear this, since it would be devastating to read a thread enitled "my patient died...should I have called in the rapid response team?"

[Silverdragon102, BSN]

err.... did they want to patient to code surely better that the patient doesn't get that far. She had deteriated, you could not get in touch with RT therfore did the right thing and get RR

[Roy Fokker, BSN, RN]

Ok.

Assume you didn't call RR. Sats were 82% and not improving.

What if the patient bottomed out? Willing to take that chance?

Hind sight is 20/20. When you are Johnny-on-the-spot, you don't have the luxury of predicting events. You have no crystal ball.

You saw a patient in respiratory distress. You have minimal means of relieving distress on a regular gen-surg floor (meds, protocols etc.) - save for calling RT... which you already did but didn't get a timely response.

If I were you, I would have called RR.

In times of distress, better to over treat a patient than provide no treatment at all.

RR teams exist for a reason and your case as described is a textbook example of critical thinking and sound judgement for use of critical care teams.

cheers,

[lucky1RN]

You absolutely did the right thing. There's always someone who wasn't even there who likes to question events leading up to a crisis. I think if I were in your situation, I would write a memo for record outlining the objective facts of the situation (similar to what you wrote in your post) and give it to the charge nurse with a copy to the manager and let them both know that you won't tolerate the charge nurse's behavior. Questioning a nurse's judgment behind his/her back does nothing to help anyone...not the nurse, not the patient, not other staff members. It's just passive aggressive and unproductive.

[cheshirecat]

In my opinion, you did the right thing. I would question the Charge Nurses professional integrity for talking behind your back the way she did.

The patient was admitted to ICU. He obviously needed more intervention then is available on a med-surg floor. I am sure the patient will thank you for preventing deterioration in his condition.

[ohmeowzer RN, RN]

wow people came to your rapid response?? at my hospital no one comes or they come sauntering over like they are in the mall window shopping. you did the right thing your charge nurse is wrong. good job, give yourself a hug for me !! don't let them make you feel bad for doing the right thing.