Parent turning down the FiO2 on ventilator

Gompers, BSN, RN · Jul 4, 2006

The father of one of our premies turned down the FiO2 on the ventilator. He did it when the RN caring for the pt. was not looking, but another nurse saw it. When the RN tried to explain why this behavior was a problem, he would hear none of it. It went up the line to Charge Nurse, Manager, and Neonatologist. It seems this father knew more than anyone. The reason I bring this up is because my way of dealing with these situations is total avoidance. This was not my patient and fortunatly I work nights so it rarely comes up. But when I sense difficult parents I make sure I avoid those patients. If I sense a problem at all, I get the Charge Nurse or Manager to deal with it, then make sure I never get that patient again. How do you deal with these situations?

We had that happen one time. The baby had transferred from another hospital where, according to the parents, they were encouraged to fiddle with the oxygen to keep the sats within range. :uhoh3:

We told them they weren't allowed to do that on our unit, and it took some getting used to. They grumbled about how their baby was going to be blind because we weren't weaning their oxygen the second their sats started increasing. We can't sit next to the vent 24/7, but we do our best!!!

It had already been decided that if these parents (or any other visitors) kept on fiddling with the vents (or IV pumps, etc.) after we'd given them a warning, that they'd be banned from the unit. PERIOD.

Home Health Columnist / Guide · Jul 4, 2006

Couldn't say no to caring for difficult families as only two RN's on nights in 12 bed unit telemtry /vent unit but we did rotate er "shared the wealth"

Consult with our Psych RN Educator helped a ton to develop these guidelines:

1. Document, Document, Document

2. Up the chain of command

3. EDUCATION and REDUCATION: document

4. Involve social services. Address father's concerns-often fear loss of control in hospital.---??? over involvment affect child once discharged endangering life if continues to change vent in hospital

5.. Contracting with family: they can participate in XYZ part of care, can not touch hospitals medical equipment. SET CLEAR LIMITS staff reinforces 24/7.

6. Push for legal recourse if endangering child's life

7. BANN from unit.

mcdonaldgirl · Jul 4, 2006

I hope that the parents sign a "contract" to that effect......

"Mac"

prmenrs, RN · Jul 4, 2006

It doesn't help that some kids can't make up their minds whether to be blind or stupid. Adjusting O2 can be a full time job w/those babes.

Has the doc talked to dad? I agree that it would be better for him to let us do the dialing, but waht he's doing isn't technically wrong. It just makes our job more difficult cuz we never know what the kid is on @ any given moment. And dad isn't going to document.

As far as avoiding problem parents, I think you're going to have to figure that one out--soon!

Gompers, BSN, RN · Jul 4, 2006

It doesn't help that some kids can't make up their minds whether to be blind or stupid. Adjusting O2 can be a full time job w/those babes.
Has the doc talked to dad? I agree that it would be better for him to let us do the dialing, but waht he's doing isn't technically wrong. It just makes our job more difficult cuz we never know what the kid is on @ any given moment. And dad isn't going to document.
As far as avoiding problem parents, I think you're going to have to figure that one out--soon!

First of all, I want to make a bumper sticker out of your first sentence!

But I disagree that what the dad is doing isn't technically wrong. To me, a visitor has no right to touch any of our machines, especially ventilators.

BittyBabyGrower, MSN, RN · Jul 4, 2006

We had a dad that did that and after repeatedly telling him not to he continued and we had him banned from the unit until the kid was off the vent.

I don't agree with what the dad is doing....for all we know, he could mess with something else on the vent and do some serious damage. And if he turns the 02 way down and the kid crumps, who is gonna be in trouble. Us. He could deny that he did anything and there would be no way to prove that he did it unless someone saw him do it.

Give the guy warning and tell him if he is caught doing it again, security will be called and he will be escorted from the unit. End of story. You have to be the baby's safety net.

As for dealing with difficult parents, you have to do it. If you have that patient and the parents get out of hand, call a more experienced nurse to jump in. But you can't avoid them forever. You'll grow a tougher hide in time.

Liddle Noodnik · Jul 4, 2006

The father of one of our premies turned down the FiO2 on the ventilator. He did it when the RN caring for the pt. was not looking, but another nurse saw it. When the RN tried to explain why this behavior was a problem, he would hear none of it. It went up the line to Charge Nurse, Manager, and Neonatologist. It seems this father knew more than anyone. The reason I bring this up is because my way of dealing with these situations is total avoidance. This was not my patient and fortunatly I work nights so it rarely comes up. But when I sense difficult parents I make sure I avoid those patients. If I sense a problem at all, I get the Charge Nurse or Manager to deal with it, then make sure I never get that patient again. How do you deal with these situations?

I assume he was doing this to try to HELP the baby? and that it was not an attempt to HARM the baby?

t2000JC · Jul 5, 2006

I usually try to explain to parents that there may be times when the sats are going off (and yes, sometimes for too long), but to keep bouncing the fio2 up and down is not beneficial for the baby either..it might even hurt b/c if we lower too much too soon then they go way down on O2 sat and we have to go way up on fio2! they should feel welcome to voice these concerns, but oxygen is a medication and should be left to the professionals.

really, i think all parents entering the nicu should have an inservice on how the nurses are professionials and should be treated as such! t.

In general too, I think with difficult parents if you can explain why we do what we are doing (i.e. not jumping to lower an fi02 setting; not waking babies every ten seconds because they need rest) from the beginning, they feel better. Of course, there are always those parents who won't listen, but it could be a coping issue as they are in a very stressful situation. I then try to be as professional as possible but don't back down on my clinical judgement. T.

Gompers, BSN, RN · Jul 5, 2006

I assume he was doing this to try to HELP the baby? and that it was not an attempt to HARM the baby?

Yes, but oxygen is a medication and should not be touched by anyone but the healthcare team. Plus fiddling with the oxygen means touching the ventilator, and no visitor has any business doing that! There are too many buttons, and who knows if they might bump something else. There is much liability involved with visitors touching things they are not supposed to.

KRVRN, BSN, RN · Jul 5, 2006

A very similar concern is parents silencing alarms.

wee one rn · Jul 6, 2006

We have had a couple of similar problems with parents adjusting FiO2. I agree with you Gompers, this is a medication that shouldn't be adjusted by anyone except the hospital staff trained to take care of these kiddos and not without checking with the particular kiddo's nurse, some of our kids are so chronic that we will only wean by a certian FiO2% each day or have different sat ranges that we are required to maintain.

We haven't had to ban any parents, as nurses we talk to the parents, then kick it up the chain of command, end up with a care conference involving all staff- nursing, drs, social work. We have also done things like put signs on the vent about not touching it and sign it 'thanks, baby name'. In one case, the parent simply wasn't allowed to sit on the side of the isolette that the vent was on, everyone working in the room was aware of the situation and it wasn't an issue any longer.

final thought- imho- helping the parents deal with having a baby in the nicu is another aspect of our job that can be just as important as taking care of the baby