Hospital CNA needs help with a LTC issue

CoffeemateCNA · Dec 20, 2010

At my facility I think it's technically the nurses' responsibility, but all of the CNAs are always dealing with O2 tanks and concentrators. If something goes wrong, by default it's usually the CNAs' "fault." I've never seen a nurse go check and make sure all of their residents' tanks and concentrators were on and set at the proper flow rate.

Just a thought, it may have been someone in the activities dept that turned off the concentrator in the first place (I only mention this because you said your parent was at an activity yesterday). More than a few times, I have seen an aide (or the director) from the activities dept walk into a resident room, mess with their O2 so that they can bring it with the resident to the activity. I've also seen them bring it back with the resident and just leave it there by the residents' W/Cs, unplugged and turned off. Somehow they don't understand that depriving someone of supplemental O2 can prove lethal, despite us telling them to stop messing with them.

Ytellu · Dec 20, 2010

Coffeemate that is what I initially thought that the activies person shut it off but I contacted her and she called to the floor at the time the activity was happening and a CNA went to the room to tell my parent its time. My parent walks with a walker that has a tank on it and just switches the nasal cannulas.

Someone needs to take responsibility. This was a serious matter. I worry that no one will be held accountable and this could happen again.

northernguy · Dec 21, 2010

Generally it would be the CNA who is responsible for making sure the people they are taking care of have supplemental o2 if they need it, at least where I work. Obviously some CNA at some point forgot to turn it on after transfering your parent. Im not sure why you believe it had been off 24 hours, dont they switch to the portable tank for meals or toileting? The last time your parent was out of bed was 24 hours prior?

Not sure what you are wanting to happen at this point. The mistake was already made, management has been made aware of the situation. I suppose they could write someone up, or more than one person if it really was 24 hours, not sure what else can be done. If this is part of a pattern of problems you can always find another LTC facility.

interceptinglight, CNA · Dec 21, 2010

The people in our LTC facility who are on supplemental oxygen get their O2 levels checked daily, or more often if there's a problem. Recently I came on shift and was given a report that Ms. V was sick and had been in bed all day with a low-grade fever, that was the entirety of the report. When I checked on her she had her oxygen on at 2 liters but I noticed her resps were very rapid and shallow.....44 per minute and her sats were hovering at 87-88 (anything below 90 is to be reported immediately to the nurse). She was literally panting, even with the oxygen on! I interrupted the nurse's report session and announced my findings on Ms. V. They all stared at me as if I was nuts (being newly certified they probably thought I didn't know how to take vitals)....however the nurse who'd just been in her room 20 minutes prior to that to give her something for the fever thanked me for my observations as he hadn't noticed the way she was breathing. He confirmed that she had pneumonia serious enough to require a transfer to the hospital.

One of the unfortunate problems with LTC is the volume of patients that the nurses and CNA's are required to take care of. The workload can be overwhelming and people like quiet little Ms. V who never complains can get overlooked, especially during shift change.

Dorali, BSN, LPN, RN · Dec 21, 2010

Where I work, it's the CNAs that handle the concentrators the most. The nurses might put it on if they are already in the room, but that's pretty much it. The rest of the day, it's the CNAs responsiblity. We know who is on O2 24/7.

To be honest, it was probably an oversight. I agree 100% that it shouldn't have happened, but there is so much for a CNA to do in a nursing home that it's unrealistic. That said, making sure someone has their oxygen on IS a priority.

I don't expect much will come of it. Someone may get wrote up IF they figure out who did it, but I doubt anyone will step up to take the blame. We're already crapped on enough as it is.

If I were you, I would get to know the CNAs that take care of your parent and make sure they understand that you are keeping an eye on them. You don't have to be mean or anything, but firm enough to make them take you seriously. They probably know by now anyway! :)

Please continue to go visit! If they know you are coming in regularly, they are more likely to stay on top of things.

systoly · Dec 22, 2010

Supplemental oxygen is considered a medication. Wherever I work, the O2 is my responsibility. I want all my CNAs to know where the O2 is stored, how to set it up and what types of delivery methods are available to us so that in an emergency I can say, go get a Q tank and a partial rebreather, but holding a CNA responsible for O2 is rubbish. If you're from another department and you mess with a resident's O2 without checking with me first, you will learn quickly not to do that again.

interceptinglight, CNA · Dec 22, 2010

Where I work, it's the CNAs that handle the concentrators the most. The nurses might put it on if they are already in the room, but that's pretty much it. The rest of the day, it's the CNAs responsiblity. We know who is on O2 24/7.
To be honest, it was probably an oversight. I agree 100% that it shouldn't have happened, but there is so much for a CNA to do in a nursing home that it's unrealistic. That said, making sure someone has their oxygen on IS a priority.
I don't expect much will come of it. Someone may get wrote up IF they figure out who did it, but I doubt anyone will step up to take the blame. We're already crapped on enough as it is.
If I were you, I would get to know the CNAs that take care of your parent and make sure they understand that you are keeping an eye on them. You don't have to be mean or anything, but firm enough to make them take you seriously. They probably know by now anyway! :)
Please continue to go visit! If they know you are coming in regularly, they are more likely to stay on top of things.

"...........already crapped on enough as it is." --Made me laugh!! :lol2: Don't I know it.

The suggestion about getting to know the CNA's who take care of your loved on is a great one. :yeah: You can give them particulars that will help them do their job better, and they might even want to put in a little extra effort just because they know how much you'll appreciate it, not to mention the fact that they know they'll be held accountable for anything that they do.

CanuckLPN73 · Dec 22, 2010

Supplemental oxygen is considered a medication. Wherever I work, the O2 is my responsibility. I want all my CNAs to know where the O2 is stored, how to set it up and what types of delivery methods are available to us so that in an emergency I can say, go get a Q tank and a partial rebreather, but holding a CNA responsible for O2 is rubbish. If you're from another department and you mess with a resident's O2 without checking with me first, you will learn quickly not to do that again.

Where I work its the RN's or LPN's that set the O2 (2 or 3)...however it is our job as an HCA/PCA/NA to make sure the res is hooked up to the O2. For example when we get them out of bed we switch over to the tank (its also our job to change the tank if empty). For everyperson who we washed up and toileted to have the RN or LPN run down to put the other O2 on the resident would have the RN and LPN running way behind their schedules as they have wound care, meds, baths, etc that they are working on (yes we also do baths, however the LPN tends to bath those with wound care). In the residents care plan if the 02 is at 3 we leave it there...we are constantly switching from the O2 that stays in their room to the O2 tank that they take down for meals.

I would be speaking to the manager and reporting that a res was not hooked up as I cannot possibly see that as a huge oversite in my opinion!

This also applies to nebulizers...if it is on the res careplan it is up to us to make sure the res gets it, as again it is given with personal care. The RNs and LPNs have enough on their plate with meds, assesments, paperwork, woundcare, etc.

LaterAlligator · Dec 22, 2010

The policies on who is in charge of the 02 have varied at different facilities I've worked at, but at all of them, in reality it was the aides that normally made sure the residents are hooked up to their 02 and keep an eye on them to ensure the tanks aren't empty. As far as whom to take to task for this mistake, it'd probably be the nurse on duty at the time. But I have to agree with previous posters that in terms of making sure it doesn't happen again, visiting often and getting to know the aides that routinely care for your parent is probably your best option. Being "written up" or warned about a mistake loses some of it's threat when one can be written up for very small mistakes (sorting garbage or linens incorrectly, for instance) whereas knowing that you might Really **** Off a Family Member Who Will Raise Hell is a good incentive to make triple-sure that your resident's are correctly getting their 02.