I work on a Progressive Care Unit and recently we had a cardiologist perform a cardioversion on an 80 y/o man who is a DNR. The patient came in with NSTEMI, and due to his age and other diagnosis of Cancer (I wasn't his nurse so I am not sure where primary source is but has mets to brain) a heart cath was declined by family.
The patient went into atrial fibrillation, but rate was controlled with a beta-blocker, the cardiologist on day 3 decided to do a cardioversion and family agreed. The nurse taking care of him told me that when she asked the doc what sedation he wanted so she could send to pharmacy for the drug, the doctor said that the patient didn't need any because the nurse had just given the patient Dilaudid 1mg IV a half an hour prior and he was concerned with giving the patient anything else. The cardioversion was performed successfully at 50j and the nurse said that the pt moaned prior, during, and after the procedure.
I am appalled that the doctor performed this procedure, because the patient was due to be evaluated by a LTC facility the next day and, the plan of care was for hospice at the LTC facility. I am completely irate that only Dilaudid was used to perform the procedure. And, finally, I am upset that the nurse wasn't being an advocate for the patient whether he could speak or not, especially since he couldn't communicate!
So, anyway, my question is...am I the only one who thinks this is wrong on all levels?
Just a side note, the pt went back into a-fib that night.
I live in fear of a doctor like this. We need nurse advocates but we also need a nursing administration that supports them. Nurses are expected to advocate on the patient's behalf but are often in danger of recriminations. In this economic climate losing your job can be a deterrent to speaking up. This patient was put through a painful, unnecessary procedure without benefit. That is wrong.
It sounds as if this patient was a poor candidate for deep sedation, and perhaps for anticoagulant therapy as well. Maybe the thought process was that the temporary discomfort of an electrical cardioversion would be preferable to this patient having a stroke.
Just a thought.
I agree that on the surface this sounds bad, but I'd encourage you to dig a little deeper.
It sounds as if this patient was a poor candidate for deep sedation, and perhaps for anticoagulant therapy as well. Maybe the thought process was that the temporary discomfort of an electrical cardioversion would be preferable to this patient having a stroke.
Just a thought.
I agree that on the surface this sounds bad, but I'd encourage you to dig a little deeper.
I assume he was, I am not certain because he was not my patient. I only assume he was because that would be common practice for afib without contraindications for anticoags
Had a similar situation - really old lady came in for respiratory distress. DNR DNI, so the most we could do was bipap, which she was on. She was admitted to MICU but still in ED because there were no beds. She suddenly went into very rapid A-fib at a rate of 170's and higher and wasn't breaking after several minutes. Her 2 grandsons were at the bedside, one a pediatric ED attending, and one a pediatric cardiologist. I called the the MICU team, they said they were coming down but several minutes passed and they didn't, so I grabbed the ED attending who in the past I've found to be pretty close to useless but what alternative did I have? We tried cardizem with no results, other than making her hypotensive. The attending recommended cardioversion to family - BOTH DOCTORS and they agreed. We pre-medicated with fentanyl and when She was shocked her entire body jumped and she started moaning. I seriously felt like crying. I felt so terrible. Meanwhile the grandson leaned over the rail and says "sorry grandma, but I authorized that and I'm a doctor" I felt like smacking him. She converted back to rapid a-fib within a few minutes and they did it twice more. Ugh I thought I was gonna throw up. The image of that tiny little helpless lady on the bipap and her whole body jerking will prob never leave me.
Hold up! I was at home in bed when this happened. This was told to me by another nurse. I plan on taking this to the ethics committee.
So this is a he said she said? I would learn all the facts before going before an ethics committee and if this doctor is popular or highly ranked, prepare for some backfire.
So this is a he said she said? I would learn all the facts before going before an ethics committee and if this doctor is popular or highly ranked, prepare for some backfire.
I can file for an investigation, it will be documented what medication was given prior to, during, and post procedure. I can file anonymously. I am not sure how I can investigate the situation and not violate HIPPA.
So this is a he said she said? I would learn all the facts before going before an ethics committee and if this doctor is popular or highly ranked, prepare for some backfire.
When reporting to the Ethics Committee, the reporter can remain anonymous.
Had a patient a couple weeks ago who'd been on the wrong end of a pedestrian vs. auto accident. Lots of brain hemorrhaging, etc. Plan was to terminally extubate. Heart rate was tachy, and I asked the surgeon for some pain meds (she had no prn's).
Surgeon's comment, "I wouldn't worry about it!" Huh?? Excuse me, but I think if I'd just been hit by a car that I MIGHT need something for pain!! Took everything in me not to haul off and smack him !
I can file for an investigation, it will be documented what medication was given prior to, during, and post procedure. I can file anonymously. I am not sure how I can investigate the situation and not violate HIPPA.
YOU don't investigate anything. To do so would indeed be a HIPAA (HIPAAHIPAAHIPAA) violation and could leave you open to all sorts of unpleasant questioning. Make your report anonymously, the risk mgmt people will look up the med sheets and see what the patient got, and they can take it from there.
YOU don't investigate anything. To do so would indeed be a HIPAA (HIPAAHIPAAHIPAA) violation and could leave you open to all sorts of unpleasant questioning. Make your report anonymously, the risk mgmt people will look up the med sheets and see what the patient got, and they can take it from there.
Oops, my fingers must have gotten carried away, I know it's HIPAA. It was slight sarcasm about me investigating.
!
cherryames1949
347 Posts
I live in fear of a doctor like this. We need nurse advocates but we also need a nursing administration that supports them. Nurses are expected to advocate on the patient's behalf but are often in danger of recriminations. In this economic climate losing your job can be a deterrent to speaking up. This patient was put through a painful, unnecessary procedure without benefit. That is wrong.