Nurses doing nebs

SierraBravo · Feb 28, 2015

Nursing has always done nebs at my hospital. The only units where respiratory will do nebs are the ICU's because each ICU has a dedicated RT. I don't understand why RT would come to a unit to do a nebulizer. It's an extremely simple thing to do and takes less than 5 minutes. Plus, by nursing doing the neb you can assess the patient right away to determine if the neb was effective.

MatrixRn · Feb 28, 2015

At my facility nursing does the nebs unless the patient is in the unit.

If RT happens to be around and a neb is due, they will do it but often times the nurse does them.

proud nurse, BSN, RN · Feb 28, 2015

RT comes to do the neb tx. We have to call for a PRN tx, and usually they come promptly. I don't mind not having to do them at the hospital. Most of the time I'm really too busy, even though it's relatively simple. We used to have to do them at the nursing home.

RN403, BSN, RN · Feb 28, 2015

We do our own nebs. I don't mind especially when my pt needs a PRN neb...I don't have to wait around.

LessValuableNinja · Mar 1, 2015

...just treat it like any other medication that requires that you document results of treatment. Half the hospitals I've worked at, nurses did nebs, other half RTs.

Fiona59 · Mar 1, 2015

We discontinued routine nebs around five years ago. Patients are using inhalers and if necessary, chambers. Respiratory will come for the odd cold nebulizer use or if called for a rapid response.

We were told it had to do with the health and safety of staff and other patients. We are all exposed to the particles floating around from ill fitting masks, patients not finishing the treatment, etc.

sistrmoon, BSN, RN · Mar 1, 2015

We discontinued routine nebs around five years ago. Patients are using inhalers and if necessary, chambers. Respiratory will come for the odd cold nebulizer use or if called for a rapid response.
We were told it had to do with the health and safety of staff and other patients. We are all exposed to the particles floating around from ill fitting masks, patients not finishing the treatment, etc.

That's interesting. Did they say what effects of exposure they were concerned about?

sistrmoon, BSN, RN · Mar 1, 2015

Is there a pre-treatment heartrate at which you would hold a treatment since albuterol increases heartrate? The procedure rundown says it takes 8 minutes.

Yes, it's just another med to administer. And yes, you can assess the effectiveness.

But I'm okay with not having everything be done by me. I worked in a hospital with practically no support staff or services and awful ratios, and it wasn't fun or safe. They would have had us cleaning rooms and mixing our own meds if they could have. We had no CNAs. Sure, we could assess gait and skin easily and all our vitals were done by us so no second guessing. We truly had total care of the patient(I prefer working with a team to care for patients, not by myself) but there was never anyone to help walk or turn someone. We were all too flat out and burdened.

I'm sure it's no big deal if that's always been part of your job. I'm just hoping this hospital isn't starting the slow slide toward what I came from. I know the model very well of adding more and more onto the nurse to save money elsewhere.

LessValuableNinja · Mar 1, 2015

Re: HR question - is it albuterol only or a combimed?

GrannyRRT · Mar 2, 2015

The terminations probably came as a result of the hospital's decision to cut costs since CMS cut reimbursement for nebs. RTs are being laid off all over the country. This is not good since COPD is now part of the readmission hit list.

There also has to be some planning done for the transition to show education with competency. This is not an overnight decision.

RTS are also terminated for charting deemed as fraud by CMS. Each "neb" comes with very specific assessment charting and concurrent therapy is a big no-no. Nurses usually just claim their initial assessment and hang as many nebs as they can since they are not required to stay 15 minutes.

The infection control thing is an issue but does not mean it should be a blanket statement. RTS usually have assess and treat protocols. If there is an infection risk with a nebulizer or any therapy, modifications are made such as MDI, private or even isolation rooms. An extensive investigation was done in Canada following the rapid spread of SARS and it was connected with respiratory devices and nebulizers capable of propelling aerosolized particles. But, this is something RTS know. It is not uncommon to see RTS wearing a mask while giving treatments, MDI or neb, to patients.

Many hospital pharmacies prefer nebs over MDIs due to cost. MDIs are often used only once or twice and then the patient is discharged with no dispensing of the inhaler. Inhalers are also lout and several might be pulled from the med cart sending the cost into $1000s- for a short stay in just respiratory meds. Nursing staff argues for them due to ease and speed. Often the MDIS are left at bedside and it becomes the patient's responsibility.

Evaluation and assessment should determine therapy and the most appropriate delivery method should be provided.

The HR should be part of your policy. Usually the number is 130 for adults but clinical judgment must be utilized. High heart in the face of a respiratory event should be evaluated for benefit over risk. The uncontrolled a - fib or CHF pt with no relevant pulmonary history should not be just given a neb because "what can it hurt".

HouTx, BSN, MSN, EdD · Mar 2, 2015

Very interesting, particularly information provided by GrannyRRT. Thanks

Just wanted to add... I'll bet that the Powers that Be did not adjust workload expectations for the nurses who now must absorb tasks from RT. If my recollection is accurate, each Neb Tx is usually worth about 15 minutes of workload. But, like EKG, Phlebotomy, etc... just piled on nursing staff without any workload adjustment.

What happens to the revenue generated by Nebs? I'll bet that is still being routed to RT - after all, they are a 'revenue center', not simply a 'cost center' like nursing - LOL.