Negligence?

[Mommy__RN]

I am in home hospice, former ED/trauma RN. Our agency branch manager just sent a message out to all RNs and LPNs that we are not to ever check O2 sats, even on patients who wear oxygen. Like, turn in your pulse ox. She said that we should treat the symptom, not a machine. That if a patient doesn't feel SOB, even if sats are 70%, we wouldn't assess saturation. I wholeheartedly and emphatically disagree with her. Oxygen is considered a medication, it is entdred into our med profiles, and you have to monitor the effectiveness of all medications. Why give Tylenol for a fever? Why check to see if a fever has come down after giving Tylenol? I think not even having the option to check O2 is negligent....and I am willing to resign this job to protect my license. Also, not all of our patient have a DNR or DNI. This is not a company policy, it is something that was decided today in preparation for the state audit next month. What do the nurses in here think?

[pmabraham, BSN, RN]

Good day:

I'm just transitioning to hospice coming from a jam-packed cardiac telemetry/medsurg unit on a 44-bed floor with varying levels of acuity. If the patient is not SOB and has no symptoms of perfusion issues, does it matter that you don't know the SPaO2 saturation %? What would you do if you did have a pulse ox and the stat was less than 90%? If they are COPD, it might be. If the patient denies symptoms and they are neurologically intact, and your assessment shows no signs of acute cyanosis (clubbing may be present for chronic COPD as some areas of cyanosis), what then (given you had a saturation %)?

Thank you.

[Kaisu]

I don't see any reason why a hospice patient should be subjected to regular assessment of O2 saturation. What possible good could you do with the information?

Is there another problem on your job and/or company management? Your response reminds of married people who fight over what appears to be insignificant things when the subject of the argument is a stand in for deep seated issues. That you would be willing to resign over this tells me there is more going on here.

[ap05]

I see no point in checking 02. What's the outcome you're looking for? If my pt looks sob, I treat them. If they look comfortable I leave them alone. I have families that obsess over vitals. I find the fewer values there are to be upset over the happier patient and family are. If your patient drops down to 70% what's the plan? Is it anything different than reposition, apply oxygen, and give morphine?

[Double-Helix, BSN, RN]

You mentioned that the purpose of checking O2 saturation would be to assess the effectiveness of the oxygen. However, in hospice, where the goal is comfort, your patient's symptoms are the best way to assess the effectiveness. Checking a sat really isn't necessary because, as others have said, you aren't going to intervene based on the saturation alone. This can be an extremely tough mindset shift for someone with ED/critical care experience where we tend to rely heavily on monitors.

I'll also say, though, that in the event of an investigation, you'll be held to the standards within your organizations policies and procedures. So until that policy gets updated, feel free to continue checking SpO2 per the current policy. It's certainly not causing harm just to check.

[caliotter3]

To record an O2 sat reading on documentation, it must be ordered on the care plan, the device must be per care plan. You can't use your personal finger monitor you bought at the local drug store. That is what my agencies have always said.

[caliotter3]

I see no point in checking 02. What's the outcome you're looking for? If my pt looks sob, I treat them. If they look comfortable I leave them alone. I have families that obsess over vitals. I find the fewer values there are to be upset over the happier patient and family are. If your patient drops down to 70% what's the plan? Is it anything different than reposition, apply oxygen, and give morphine?

This. For hospice.

[nursel56]

I agree with the others, Mommy RN. This is not negligence.

[cardiacfreak, ADN]

I understand treating symptoms and not numbers, but what about when you are evaluating a patient for hospice, or showing decline in the patient's respiratory status, for example patient O2 SATs 89% at rest, oxygen saturations 70% with ambulation of 25 feet with 4 minutes needed for recovery time.

We were told especially with our COPD patients, that we need to document oxygen saturations with activity and at rest to prove decline for recertification.

[Nascar nurse, ASN, RN]

Several years ago, when opening and doing the initial state survey for certification, the only thing we got cited for was checking O2 SAT without a physician's order and not on the careplan. Their rationale was just as stated above - subjecting patients to needless monitoring. At the time I thought it was beyond stupid. The more I grew into a hospice nurse, the more I thought all vitals are pretty much useless. Treat the patient - treat the symptoms.

[Gr8Gr8macaw]

I have just worked hospice 2 years after I retired. Someone was willing to teach the ropes to me. So many patients I visit need hospice not because they might die in 6 months but just because they are frail and need support of hospice. Family members trying to keep it together. Family members needing hospice more than the patients