Neb treatments

TheCommuter, BSN, RN · Jul 21, 2012

I assume you work in a LTC facility or subacute rehab center.

In a nutshell, this policy is unrealistic and ridiculous. I'm assured that you have multiple residents who receive regularly scheduled or PRN nebulizer updrafts and/or other respiratory treatments, some of them at the same time. You cannot be in five rooms at one time, and you cannot sit with each resident for 10 to 15 minutes while they receive their updraft.

In addition, how are you going to administer medications to the other 20+ residents on time? It sounds as if the facility needs to hire a full-time respiratory therapist if they expect someone to sit through each and every breathing treatment that is given in the building.

animal1953 · Jul 21, 2012

As an asthmatic, that sounds absurd. I learned at the age of 8 to do my own tx. My question is, are some of the pt unable to do this on their own or follow instructions? Has a pulmonary doctor spoken with them about the tx? I agree with The Commuter, they need to hire a respiratory therapist to handle the care.

wooh, BSN, RN · Jul 21, 2012

[sarcasm] Well it sounds like you'll just need to manage your time better, it's ONLY 5 minutes per patient. :rolleyes:

Of course, I assume they took away a task that takes the same amount of time when they added this to the workload, correct? :lol2: [/sarcasm]

CoffeeRTC, BSN, RN · Jul 21, 2012

bwhahahahah. Some shifts I might have 5-8 residents with qid neb tx (and some prn). you do the math and add on the 20 other residents. I do have to say that I am OCD about checking breath sounds before and after (not always with the chronic copders that are stable) and I like to have them all going at the same time, LOL.yeah it is noisy.

We were told that in order to get credit for the nebs that the nurse needs to be in the room too. As far as the self med rational...easy way around it. Get an order for "res may administer neb tx", get an pt ed form, go over it with the resident and then care plan it all. Bingo! We also have a page in the MAR for the breath sounds before and after, rr and time it takes for the tx.

wooh, BSN, RN · Jul 21, 2012

We were told that in order to get credit for the nebs that the nurse needs to be in the room too.

Well if you're getting paid to have a nurse in the room, then the facility should have money to pay for a nurse to be in the room, while another nurse is doing everything else right? Or I guess it can go to a CEO bonus instead, as that would be a much better allocation of funds...

makes needs known · Jul 21, 2012

Of course not, in fact more documenatation to prove that said breathing tx was effective with VS and sats before and after. " oh wait a min dear pt, before you can have this tx that you are needing, I need to get your o2 sat level." And where the heck is that pulse oximeter?

Kittypower123, BSN, RN · Jul 21, 2012

We just had a pulmonary inservice. We have been told that we are to stay with the patient the whole time they are recieving their neb tx.

Ok, so I have 6 residents who all have nebs due at 3pm. The neb needs to run for 10-15 in addition to the before and after assessment. If the before and after assesment takes a total of 3-5 minutes, thats 13-20 minutes per resident. That's a total of 78- 90 minutes. Technically this would be do-able except that I also have two g-tubers with meds due at three, two more residents with inhalers due at 3pm, two more nebs due at 4pm (for another 26-40 minutes), and seven blood sugar checks that have to be done before dinner at 4:30. Technically, the 4pm nebs don't need to be completed until 5pm, but if dinner is at 4:30, I can't really administer a neb treatment while the resident is eating and if I wait until they are finished, well, then it's late and I have to report it as a medication incident.

Now, if I start at 2pm (never mind getting report and counting narcs), I'd be done with the 3pm nebs by 3:30. If I then stop to do my two g-tubers, I will be occupied until at least 4pm (assuming I'm really quick). If I then do the two 4pm nebs, that will take until at least 4:26pm. I still have not done the two inhalers or any blood sugar checks and dinner is in 4 minutes. I don't know about you, but I can't do 7 blood sugar checks with any insulin admin. required in 4 minutes (especially since it has to be done in the patients' rooms and they are all now in the dining room). Once they start eating, well great, now I'm stuck.

If, on the other hand, I do the blood sugar checks before the g-tubers and 4pm nebs, I will be occupied until at least 3:45pm (assuming no insulin admin. is needed and all the residents are waiting patiently in their rooms). Now, if don't get both tube feeders done in the next 15 minutes, they are late, but if I do them next, I won't get to the 4pm nebs until at least 4:15 (again, if I'm really quick with the tubers), but dinner starts at 4:30 and doing both nebs will take until at least until 4:36 making them late. That's not too terribly late, so I could probably get away with it, but I still have not done the two inhalers.

All this is without taking into consideration the time it takes to walk from one room to another and the multitude of interuptions (as we all know, shift change is when everyone decides they need something). Just yesterday it took me almost an hour to do one blood sugar check and the required insulin administration. Between start and finish I had to change a colostomy (and no, this one could not wait), answer two phone calls and talk to a doctor twice about a different resident. I'm sure there were more interuptions, but I honestly don't remember them all.

So how exactly is this "stay in the room the whole time" supposed to work?

NotFlo · Jul 21, 2012

My facility we do an assessment of the pts ability to maintain and tolerate the neb treatment without direct nurse supervision. It is very quick basically if they can hold the thing or tolerate the mask without pulling it off and are able to ring the bell if they have a problem with it they pass.

Many people already know how to use the machine and mask already anyway. If they don't, if they're capable (since this is rehab and they'll have to do it at home anyway) we'll teach them how to do it. We sign the form, the MD signs it and an order is written for the pt so self-admin the neb treatments.

All respiratory patients go to my floor so I have the majority of my pts doing nebs all scheduled for the same times. There is no way I could stay with each of them the entire time they did the treatment and get anything else at all done.

BrandonLPN, LPN · Jul 21, 2012

Yeah, right, and I crush and give each pill separately and flush with 10cc H2O inbetween each med when giving meds through a PEG....

wooh, BSN, RN · Jul 21, 2012

So how exactly is this "stay in the room the whole time" supposed to work?

Ummm, hello!!!! BETTER TIME MANAGEMENT!!! Work smarter, not harder! It only takes a few minutes to do it right.

:lol2:

Am I the only one that's noticed that inservices never feature being told that you can STOP doing something? There's never an inservice saying, "You no longer need to fill out the time consuming redundant form." They're always, "You need to start filling out this time consuming redundant form."

CapeCodMermaid, RN · Jul 22, 2012

G-tubers!?! That is a really disrespectful term. And in the 5 weeks I've been at my new facility, I've told the nurses to stop doing I and O's on new admits unless there is a reason and chart on residents once a day...not every shift. We don't all like useless, redundant paperwork.

We also have orders to crush the gtube meds and administer all at once. Never had a problem with survey.