This pt had been on the unit for a few days. Had been on tinza and asa since admission to the unit.
Start of shift, first day with him. He was c/o mild chest pain and bit of sob. A bit diaphoretic too. His SpO2 were fine but I cranked up the O2 a bit anyway. Paged the resident.
Came in within 5 min and assessed the pt. Came out and told me he sounded crackly and that pt pain has subsided. Ordered 1 time dose of IV Lasix. NOTHING else. I was expecting maybe a nitro spray or chest xray or whatever.
I came in next day...found out pt had a full code late in the night shift and passed away. Code team notes stated probably PE attack.
I don't know...been almost a week and been thinking this death could have been avoided.
Know what your acute CP protocol is. Along with what the protocol is to accurately monitor the tinza. If the patient was on antithrombotics, then I am not sure how he died of a PE.....but this is not my area, just curious.
You can only go forward from here. The first time a patient c/o of CP, is when the protocol is instituted. Which includes all of the interventions as noted by PP. Plus, PT, PTT, PTINR, D-Dimer....all those thing that may or may not be part of anti-coagulation protocols.
And acute CP with everything you describe would have been a RR. And any anti-coagulation for PE intervention/prevention is closely monitored for effectiveness or lack thereof.
I would assume that you reported off to another nurse the CP events and interventions. 24 hour gig. But I would be clearer on advising the MD that you have started the CP protocol, the r/o PE protocol when you call them. That way, they can add to it as test results come back in.
I don't consider that useless as much as the mistake of an inexperienced doctor. I'm not blaming you, either, but in the future if you continue to have concerns you should consider escalating over the resident.
Yes....do not be intimidated by doctors. Advocate for your patient.
I always make suggestions that I feel are needed, like when I call the MD I will tell them about the pt and what's going on and then ask "Would you like to order a chest X-ray/Do you want to increase their Lasix?/Do you think we should DC "X" med d/t them being put on "X" med?
Just a few examples. I'm finally feeling more confident in my ability to advocate for my patients.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Yes, frequently. Most are simply inexperienced and lack confidence. The vast majority go on to become competent physicians. Mostly they are not too dangerous if they keep their ego in check and are willing to listen to their nurses and willing to ask for help from their staff and senior residents.
A minority are simply stupid people and don't comprehend when they are in trouble, or (even worse) have a personality that won't allow them to listen to you because you are a nurse and also won't allow them to call for help.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Yes....do not be intimidated by doctors. Advocate for your patient.
This is great advice. I take it a step further and set out to intimidate those doctors who have shown themselves to be dangerous to my patients.
One of the great things about working in one place for a while is the development of relationships between me and attending physicians. If you are a dangerous resident I will not hesitate to call your attending (who is probably a fishing buddy of mine) and get you straitened out. Residents know that when I call them and alert them to a problem with a patient that they had better address it effectively, or if over their heads, call their senior or attending for help. If they don't I will. They know that and it shows.
I don't expect them to know everything. I do expect them to do their best, listen to good advice from the nurses, and call for help when needed.
Thank you for posting this story. As a newish nurse I am sometimes afraid to push the providers when I feel they are not taking taking my concerns seriously. This story highlights the importance of our role as a patient advocate and seeking out expert advice from our colleagues when we don't know what to ask for.
This was a difficult lesson for me to learn. I started out as a fresh, wet-behind-the-ears nurse in July, the absolute WORST time to start in a teaching hospital, and the residents are brand spanking new as well. I was trying to make sure *I* didn't kill my patients, let alone the new residents.
On a trial by fire unit like mine, both new nurses and new residents learn really fast to rely on each other.
I've got a year under my belt, and many of the new interns I started with are now senior residents themselves. I've overheard them encouraging their interns to trust and talk to their nurses.
I've stopped some seriously bad orders from getting to the patient. Do I get frustrated? Hells yes, my day doesn't get any lighter when I'm guiding an intern through their discharge or prescribing screens, but if I treat them kindly, it fosters better trust and communication later on down the road AND protects the patient.
As for the odd intern or resident that doesn't respect a nurse warning them of a bad decision - not only do other nurses remain aloof to them, but the attendings will (privately of course) hand them their gluteus maximus for ignoring and or micturating-off the nurses.
I've stopped some seriously bad orders from getting to the patient. Do I get frustrated? Hells yes, my day doesn't get any lighter when I'm guiding an intern through their discharge or prescribing screens, but if I treat them kindly, it fosters better trust and communication later on down the road AND protects the patient.
And you NEVER know when you might need that good relationship later on in life. I went to work for a stand alone endo facility several years ago that is owned by a group of doctors from two large hospitals in my city. I started the same week as another nurse. I was hired there because one of the docs I used to work with back in the day saw me and gave me a very good verbal recommendation.
Well, the other nurse was apparently well known to about 6 of these docs back when they were residents. She had made their lives such hell that they used to call her "Crazy Cathy" in the residents' lounge. Back then, they had no power over her, and I guess she used hers to show them that they "weren't her boss."
After a few of them noticed her training in the recovery room, they went to the DON and said "ABSOLUTELY NOT is this nurse to work at this facility." The DON let her go, and she was crying in the break room because she "REALLY REALLY" needed this job. Well, you reap what you sow.
I never let the docs push me around either, but you really need to learn how to develop a good relationship with them such that they view you as a colleague and respected member of the team. For one, that's good for the patient, and two, it's just good business sense. They well may be your "boss" later on.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Well, the other nurse was apparently well known to about 6 of these docs back when they were residents. She had made their lives such hell that they used to call her "Crazy Cathy" in the residents' lounge. Back then, they had no power over her, and I guess she used hers to show them that they "weren't her boss."
After a few of them noticed her training in the recovery room, they went to the DON and said "ABSOLUTELY NOT is this nurse to work at this facility." The DON let her go, and she was crying in the break room because she "REALLY REALLY" needed this job. Well, you reap what you sow.
I would leave nursing before I ever worked at a place where my boss, or my boss's boss was a physician.
jadelpn, LPN, EMT-B
9 Articles; 4,800 Posts
Know what your acute CP protocol is. Along with what the protocol is to accurately monitor the tinza. If the patient was on antithrombotics, then I am not sure how he died of a PE.....but this is not my area, just curious.
You can only go forward from here. The first time a patient c/o of CP, is when the protocol is instituted. Which includes all of the interventions as noted by PP. Plus, PT, PTT, PTINR, D-Dimer....all those thing that may or may not be part of anti-coagulation protocols.
And acute CP with everything you describe would have been a RR. And any anti-coagulation for PE intervention/prevention is closely monitored for effectiveness or lack thereof.
I would assume that you reported off to another nurse the CP events and interventions. 24 hour gig. But I would be clearer on advising the MD that you have started the CP protocol, the r/o PE protocol when you call them. That way, they can add to it as test results come back in.
Again, you can only go forward from here.