Nurse changing vent mode

Specialties Private Duty

Published

There is a nurse that is changing the ventilator mode from volume (what the order is for) to pressure. Every time I come in, I have to change it back to what the order is for. I have a basic understanding of the two, but I'm wondering if any damage can be done with using a mode that the RT did not order. Also, changing the mode without an order is not in our scope of practice. I'm thinking of putting a sticky note on the vent simply stating that the order is for volume, maybe it's a misunderstanding? Or am I over-reacting?

When I find incorrect settings, I chart something like, "Corrected vent vol of 4 to correct vol of 5 per the plan of care. Patient with no distress etc." You could also add something like which family member you reported this to.

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I will def. use that in the future, but hopefully won't have to. I'm feeling kinda anxious now that I reported that to my boss... I know it's my duty, but in my situation there is only one person that could have reported it. (there are only 2 nurses on the case) and I know my patient wanted to handle it themselves, but I have to "CYA" right? *twiddles thumbs*

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Specializes in Complex pedi to LTC/SA & now a manager.

You had a moral and legal obligation to report. Hopefully you documented your findings upon arrival each time vent was reset so there is a paper trail

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You had a moral and legal obligation to report. Hopefully you documented your findings upon arrival each time vent was reset so there is a paper trail

I didn't......

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I noticed that the mode was changed quite often and attributed it to nurse hitting wrong button because they were documenting the right mode, but after awhile I realized that I was having to change it every shift after that nurse so I started paying closer attention and still whenever I came in after them it was on the wrong mode. I said something to the patient, made a sticky note, documented in communication log and now reported to boss.

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Specializes in Peds Homecare.

OP, you did the right thing, she is not an RT, and she has no right, or education to change the vent settings on her own. She should be fired. What she has been doing is a disaster/lawsuit waiting to happen. I just can't imagine what her thought process was to do that.

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Another nurse on a vent case showed me that she changed the high pressure alarm every time she worked because she couldn't stand it going off constantly. I diligently changed it back but didn't tell the supervisor at the time because of other circumstances going on.

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If it's going off constantly, there is a reason. Either the parameters need to be re-evalauted by the RT or pulmonologist, something is partially blocking the trach, illness or a bad sensor (or something else, since I am sure there several other possibilities) but just disabling an alarm because it's annoying is foolish and dangerous.

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Does an RT come to see this person at home? If you can, you should document each time you fixed it back to the original order and notify the RT each time it's wrong.

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

Wow, I can't even imagine WHY she would be doing this.... to what end???

Just goes to prove, you can't fix stupid...

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No the RT does not come here, but the supplier sets the settings according to the order and from what I understand we are to just record settings q2 hrs. and keep an eye on the pip and peep. My patient is upset that I talked to my boss about it instead of letting them talk to the nurse directly, but I told the patient multiple times about the incorrect settings. It's not the patients responsibility to do that and like someone said before I could get in trouble for withholding information. I explained that to the patient and they seemed to understand so all is good....for now. No news on if our boss has talked to the other nurse yet.

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Wow, I can't even imagine WHY she would be doing this.... to what end???

Just goes to prove, you can't fix stupid...

In the past, I changed it to the correct setting while the patient was on the vent and they asked what changed because it felt like they were getting more air before I changed it. Maybe the other nurse had this same experience and feels like pressure is better at delivering breathes? That is a wild guess though. I think maybe some education is needed here. Just because something feels better doesn't mean it is better.

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