Nurse vs Respiratory

[TheSixFootThree]

Hey everyone. Quick question

So just recently I had a patient with a neb treatment that was due at 2100. Hours later and it's now a quarter to 0100. The room is right next to the nurses station and I never saw the respiratory therapist go in to administer the treatment. It is now outstandingly late on the emar and has not been documented that it's been given or refused. The patient tells me that they're short of breath and claims they never got a breathing treatment. At this point it's 0100 and the patient had another treatment due at 0200 so rather then letting the patient suffer I gave the breathing treatment and it looks as if the patient got the 0200 dose early. 20 mins later the respiratory therapist comes in pissed because I gave it and tries to start an argument with me while I was carrying for another patient in another room. I tried to avoid the conversation at that time because it was very unprofessional to try to discuss one patient in front of another patient and also HIPAA. The respiratory therapist said "you don't give my neb treatments", then walks out of the room. The current patient I was with made a comment of that being rude which put a bad taste the patient's mouth about the professionalism of the hospital. After I finished what I was doing with that patient I Left the room to confront the respiratory therapist. She then tries to tell me that she already gave the 2100 neb treatment and that the patient got double dosed. Once again I remind you that the patient claim to never have got it. But I told her that you didn't documented anything and in this world when don't document it you didn't do it. Was I wrong?

[Wuzzie]

On 1/27/2020 at 9:23 AM, Anonymous666 said:

They normally grab all their nebs for the shift right at the beginning and carry them around with them (and leave the empties on the bed—bastards).

This practice should be stopped. The nebs should be pulled at the time they are ready to administer it. This causes a time stamp to be generated and allows others to verify if the medication was pulled. If it was then there is a higher likelihood it was also administered. Not to mention reducing the chance of a med error. I can't believe they are allowed to do it. Nurses certainly aren't.

On 1/27/2020 at 3:59 PM, nursex23 said:

Technically, any breathing meds, even albuterol, fell on the RT and more often than not, they would document towards the end of the shift.

I know everything has left a bad taste in your mouth but I would actually go back to that RT and apologize.

Administration of nebulized medication requires a documented before and after assessment. How can they do this accurately if they are waiting until the end of the shift to chart? Certainly as a nurse I want to know how they responded to the treatment. If the assessment isn't there how am I, as the nurse who is responsible for the patient, to know if the patient is getting worse or better? I cannot abdicate responsibility for one body system to another department.

No, she should not apologize for critically thinking, putting her patient first and trying to clarify.

On 1/27/2020 at 6:57 PM, EMT89 said:

Respiratory therapist going to nursing school here. Right now is flu season and RTs are often overloaded with treatments and often do not get to chart depending on system until after rounds. We can have anywhere 20-40 patients (not including the rest of the floor in the event a rapid response occurs). We carry 20-40 patients between November to April and often multiple floors.

This does not excuse you from doing what you should be doing. Everyone is busy. If you can't chart it you need to communicate to the nurse that it was done and how the patient responded and let them know you'll chart it ASAP.

On 1/29/2020 at 10:13 PM, hherrn said:

A patient was short of breath.

MAR indicated no TX had been given.

PT stated no TX had been given.

Nurse gave breathing treatment.

PT felt better.

Somebody got pissy.

Seems pretty straight forward.

This about a thousand times!

On 1/30/2020 at 4:40 AM, KeepGoingRN said:

Sorry, but if RT's are not documenting when meds are being given in real time then that needs to fixed STAT. If they are not held to the same standard as us nurses then that should change. In my hospital both RN's and RT's can give nebs. If they are not charting until they are about to finish their shift, how will I know that a treatment given by them could be a reason why my patient is tachy and having palpitations.

This also!

[LucidMonkeyCCRN, BSN]

They were unprofessional, yes.

However you should have paged the RT if the patient was truly in distress and asked courteously about the breathing treatment, healthcare is a joint effort and based on your story it sounds almost as if you feel like you swept in and saved the day, which is a mentality some nurses carry.

If the patient was in respiratory distress as you say, then either way RT should’ve been made aware... you know considering they are the RESPIRATORY therapist.

This doesn’t take away from the RT mistakes

-late documenting

-Unprofessional

But you’re the one here asking for our thoughts and so I will also tell you my opinions of your actions.

I think that an attempt to contact the RT would have prudent. ESP if they were in distress, I mean you didn’t even mention letting them know AFTER the fact either...

[AceOfHearts<3]

Quote

This is not true. I have never once administered a breathing treatment. The RT pulls the meds and administers. RNs do certain inhalers, where the pt inhales the powder from the split capsule. The RTs pull from the Pyxis.

That might be the way it is done at YOUR facility, but it does not mean that is how it is done at every facility. You never having administered a neb does not mean other nurses don’t or can’t.

At one hospital I’ve worked at just RT gave the nebs and any breathing treatment- including inhaled capsules like spiriva (a patient swallowed the capsule one time as they were confused). At another hosiptal the RT rounds on new admissions and every X amount of days or with new therapy being started, but the patient’s RN is responsible for administering 95% of the nebs/treatments. I’m in the ICU where RT does all the treatments and always need to remind myself to give the nebs when I’m pulled to the floors to help.

[bbyRN, BSN, RN]

What's there to discuss or feel bad about? The RT didn't document it, the pt said that they didn't recv it, the pt was SOB, then the RT interferes with you caring for another pt, violates HIPAA, destroys the patient's trust in her care, is a jerk, giving a neb is within your scope.

Sounds like the unit leadership is screwed up (no surprise), sounds like there's poor leadership in many places, not enough staff, hospital administrators too often suck as leaders and problem solvers. Healthcare 101.