Oxygen order changes

[Danztam]

Hi there

our hospital is recently changing its Oxygen policy. It will require us to get a new MD order every time we titrate oxygen in pediatrics. If we change from nasal cannula to venti mask we need a new order, if we titrate down from 1 liter to 0.5Liters we need an order. If we go up we need an order. We work nights and in pediatrics you can play with oxygen and equipment all night depending on how your kids sleep and their ages and if they roll over. It just seems excessive and doesn't allow our critical thinking. I'm wondering if this is the new norm out there??

thank you!

[perfectbluebuildings, BSN, RN]

That sounds absolutely ridiculous. Will it be the RT having to call the doctor all night about O2 changes, since that department came up with the policy? I am guessing not... I am guessing, somehow, that all of that responsibility will fall on the RN.

And seriously... like you say... O2 requirements can change hour to hour, even minute to minute for some of these kids!! Whoever came up with that policy has obviously never worked a night shift with pediatric respiratory patients. The order at my last place of employment was, titrate O2 to keep sats>90%, sometimes "up to [4L/8L/50% etc]." then notify the MD if higher concentration of O2 was needed. But it sounds like they want you to call every single time a patient falls asleep and desats, or needs extra O2 after trach suctioning, or has a rough CF night, or anything. I hope that policy does not last long for you all because that's absolutely ridiculous. Good luck.

[Crystal-Wings, LVN]

That's dumb. There should just be a standing order (for those already on O2 of course) with a range.

[PCnurse88]

My (adult) unit recently implemented this and it's going terribly. People are on oxygen for DAYS longer than they need to be because we can't titrate without a new O2 order, but the residents take a million years to put orders in. Night shift no longer touches the oxygen unless they need to go up for desatting purposes.

[HMartinho]

Protocols!! This is why I love protocols. Protocols just keep us from look like a complete idiot, and use our own brain.

Yes, oxygen is a drug, but, for real, are you telling me that I need to call a doctor every single minute, to titrate oxygen on my patient? Are you serious?

Most doctors who I work with (and most of them are really nice), will throw me under the bus, if that's the case. Obviously, if I feel that my patient need an high flow oxygen device, or he/she is getting unstable, I call the MD for sure.

In my 2 current jobs (ER, and prision), we have protocols for almost everything. Pain management (except opioids), chest pain, trauma, altered mental status/agression, asthma, possible anaphylaxys/angioedema, shock, Dyspnea, hypotension, fever, etc etc.

In my last job (nursing home), the doctor's staff had the iniciative to create some protocols as well, just to avoid calls for some "stupid" things: "Hey dr. XXX, it's nurse YYY, I apologyze to bother you so late, but I just check the temperature on Mr ZZZ, and he had 38.5 ºC. I just check your orders and I don't see any acetaminophen prescribed. I wonder if I may give some??"

Give me a break.

[RNperdiem, RN]

That "mother may I..." type of thing only works if you have doctors right there available 24/7. Does this needing an order include weaning too?

[xoemmylouox, ASN, RN]

Such a ridiculous policy! I doubt it will last long. This leaves little in terms of nursing judgement. How absurd. I have never heard of this. In my hospital we are allowed to initiate oxygen based on nursing judgement. Pretty much every MD has the standing order in their EMR care sets. Perhaps this would be a suggestion once this idea has ran its course?

The care set allows for us to titrate it up to 4 or 6 liters to maintain biox greater than 90-92% (based on MD preferences)

[Kayauhs]

I'm betting dollars to donuts that your doctors will put an quick end to this new policy on about day 3 of no sleep from all the calls they are receiving.

[Been there,done that, ASN, RN]

Protocols!! This is why I love protocols. Protocols just keep us from look like a complete idiot, and use our own brain.

Yes, oxygen is a drug, but, for real, are you telling me that I need to call a doctor every single minute, to titrate oxygen on my patient? Are you serious?

Most doctors who I work with (and most of them are really nice), will throw me under the bus, if that's the case. Obviously, if I feel that my patient need an high flow oxygen device, or he/she is getting unstable, I call the MD for sure.

In my 2 current jobs (ER, and prision), we have protocols for almost everything. Pain management (except opioids), chest pain, trauma, altered mental status/agression, asthma, possible anaphylaxys/angioedema, shock, Dyspnea, hypotension, fever, etc etc.

In my last job (nursing home), the doctor's staff had the iniciative to create some protocols as well, just to avoid calls for some "stupid" things: "Hey dr. XXX, it's nurse YYY, I apologyze to bother you so late, but I just check the temperature on Mr ZZZ, and he had 38.5 ºC. I just check your orders and I don't see any acetaminophen prescribed. I wonder if I may give some??"

Give me a break.

I will give you all the breaks you need, the lawyers, not so much.

Unless you have a standing order, you can not give Tylenol or change an oxygen order. It is called prescribing, nurses do not have a license to do that.

CY your A.