Oxygen

MunoRN, RN · Sep 20, 2017

If the patient is getting oxygen, at the ordered rate, and using the correct route then there is no med error, the source of the oxygen is a separate matter. To have both an oxygen concentrator and home oxygen tank fill system covered by insurers there needs to be physician's orders to establish the necessity for oxygen therapy using those systems, which is why an order exists specifying the oxygen sources the patient qualifies for.

I'm not really clear what your asking though, has the patient been using an empty oxygen bottle during the day?

Marija1 · Sep 20, 2017

The long and the short of it is that they want us to fill the portable tank on each shift even when it's not in use. On my night shift he gets the oxygen from his in room concentrator. So technically on my shift he is getting oxygen. The only error I can see is that I am only signing for the portable one. I have been accused and disciplined for said error. Kind of a thin line as far as I am concerned. By them telling me I am not filling the portable one makes it look like he isn't getting any on my shift. They said if he needs to leave the building in a hurry at night that the portable one would not be full yet this could happen in the day. We can't possibly check it every hour as it is a retirement home setting.

Marija1 · Sep 20, 2017

Also I am in Canada so I think is covered already and no insurance required. So in reality that's not even the issue.

Miss.LeoRN · Sep 20, 2017

Here is how it would work in my facility. First,if a portable tank was used during the day and a concentrated at night it would be night shifts responsiblity to assure the tank was full for the AM. It would be the responsibility of evening shift (when he is switched to concentrate) to ensure the tank is filled in case there is an emergency at night. Will night necessarily need to fill it? No. But the check by night shift to ensure it was full reduces the risk of error or ensures that it will be filled if evening shift missed it for whatever reason. Second, I am responsible for whatever I sign in the MAR. You knew the Mar was wrong and signed it anyway, or you were just blindly signing like I see so many others. If you knew it was wrong you should have fixed it or brought it to someone's attention. If you're a blind signer just know that you are held responsible for what you do. "Well,it was in the MAR that way" isn't an excuse.

MunoRN, RN · Sep 20, 2017

I'm guessing by signing for the portable tank you are saying that it's being filled. If the patient switches to the portable tank during the day then it seems like it would make more sense to be filled at night so it's ready in the morning, that may be the issue.

Marija1 · Sep 20, 2017

I did alert my supervisor that its technically the wrong order, but essentially I also said we need two separate orders to clear up thevissue

Marija1 · Sep 20, 2017

And not a blind signer as I knew it was wrong but the supervisor is not interested in what I have been trying to tell her so that's where my issue lies

Marija1 · Sep 20, 2017

And it's my thought that the evening nurse should be the one to fill it after their shift as it was used in the evening and likely empty due to that reason, 100% of the time it's not being used overnight

Marija1 · Sep 20, 2017

I kinda think it should be morning shift that goes

In to fill it to prepare for the day, same as when I start my evening shift I would fill it to prepare for the evening, that makes more sense to me, everyone responsible for use on their own shift

Castiela · Sep 20, 2017

I kinda think it should be morning shift that goes
In to fill it to prepare for the day, same as when I start my evening shift I would fill it to prepare for the evening, that makes more sense to me, everyone responsible for use on their own shift

I have no clue how one would go about filling an o2 tank. That being said, in this situation I would have changed the mar to indicate pt getting portable o2 during day and connected to room at night. I can see technically where your manager is coming from, you did sign for something that is the "wrong route". However, if the patient was getting the exact same prescription from the portable as the room o2 supply, it seems a bit of a non issue. Is there a difference between the two modes of o2?

I know at my hospital, nights is when you get stuff prepared for the day shift - checking Mars, orders etc, stocking the ward etc. I would be annoyed if night staff didn't do their "chores" as it leaves me scrambling. It's our ward culture to get certain things done in the evening. Did the patient not have full O2 tanks for the day? Were they found empty? Was the patient affected by this? I guess it comes down to the fact you didn't do something that was required of you. Its not saying day staff shouldn't check to make sure the tank is full, but if it's expected for you to do something and you didn't do it, thats kind of your fault

Marija1 · Sep 20, 2017

The order states "all shifts" . And yes the route is a bit different as one is concentrated I believe, not sure the exact difference but there is one. If then days is expected to fill it as well then that is the "non issue" I would be then thinking of. Yes evenings should have had it filled, and if not evenings then nights, if not nights then days. The point being if it's in use you fill it, that simple. At my place it is not a ward. And their are duties for the night shift but not to prepare things for day shift. We have our own separate duties.