Occurrence report over changing FiO2 on Vent?

Published

Hello all, and let me preface this by saying this is a bit of a venting and asking for opinions thread.

So one night I had a pt on a vent (shocking for ICU right?) and the pt was sating around 96% on 70% FiO2. My view is that the sooner we can get a pts O2 down to baseline, and the closer we are to 90% (Hospital policy states between 95-90% for titration) the better. This prevents O2 toxicity, restores resp drive, ect.. So I went ahead and bumped the pt down to 65% FiO2 without changing the already 10 PEEP and RR. Well the pt shortly went below 90% SpO2 so I bumped the pt back up and made sure the pt was okay before leaving the room. The whole ordeal lasted less than 15 mins. In my opinion this served to tell me that the pt was not ready to wean, an assessment we are to do as RN's per shift.

Few hours later I mention this to the RT working that night, and she gives me huge attitude. On top of that I find out today that she put in an occurrence report against me.

I went back into the hospital policies and nowhere does it say RN's can't adjust vent settings, and the other O2 titration policies state that RN's and RT's are responsible to titrate SpO2 >90%. The verbiage is terrible in that it states "The RT is responsible for overseeing and managing the vent yada yada" but does not say RN's are excluded. I also found an interesting little tidbit that the night RT's aren't doing, spontaneous breathing trials (wake up and breathe trials) to be done at 5am and finished by 6am, right before their change of shift. This is instead done by the day RT's at 8-9am, after they've rounded and whatnot.

Not really sure I want to start a war against RT in my ICU but doesn't this seem a bit crazy to have an occurrence written for? My manager said nothing will come of it, but she still had to inform me. I say if she (the RT) wants to make an issue of it then I insist that we start doing the 5am/6am SBTs. Afterall, its in the policy. Thoughts?

+ Join the Discussion