fairone

/start vent This topic has recently become an issue in our unit and can relate to each and every problem posted in this topic. Management recently decided that we were to abolish our current visiting hours and have an open visitation policy after a family complained that our visiting hours were to strict. Previously we had no visitors during the morning Dr's round and a 3 hour block in the afternoon 1-4, other than that visitors were allowed around these times, which on the whole worked quite well and family were fairly compliant - of course there is always the exception with the palliative/dying patient, interstate visitors etc. etc. So a few months ago, without any input, discussion or suggestion to the ICU staff, management decided to change our visiting hours to open visitation. As you can imagine managements follow-up as to how the staff or the unit are feeling about this change is impeccable...NOT. Although when this change did come about, I did go in with an open mind, thinking that maybe it wouldn't make much difference, how naive I was! I must add we do try to mention to visitors and family to detract from visiting during the morning doctors round and shift changes, because of privacy issues, but you can without a doubt ensure that there will be visitors at the door despite. Issues I've found with open visitation -> * for some it's a social occasion coming into visit with family spending more time talking to staff or visitors, looking at the monitor, looking at other patients, etc. etc. 'what's the blue line for, what's the red one for, what's that drug' need I go on. * despite that, yes they maybe in bed all day, patients do get tired very quickly and easily, particularly after being seen by numerous doctors, physiotherapists, procedures being done etc.. I don't think visitors understand the scope of actually what patients go through sometimes and then they are expected to sit and entertain visitors for fours hours and they wonder why they are so tired! As far I can tell this can be detrimental to LOS. I found having even this 3 hours in the afternoon, patients actually appreciated the quiet time and had the opportunity to catch up on some very lost sleep...that is until visiting hours began again and there were visitors coming in going 'are you awake...?' despite telling them he was asleep. I could go on. Believe me. But these are probably the main issues that have seemed to escalate since changing visiting hours. There are always times we appreciate visitors/family being there and I do understand there need to be there and visit..and I don't have an issue with that at all, but as previously mentioned I think there needs to be boundaries set, and often by the time we realize this (usually after problems start occurring..) it's too late. I'm not sure if there is ever going to be a solution or a perfect answer to this issue...but it would be a start if management listened to the staff that work in the unit, who know the patients, family and place the best. /end vent :!

/start vent This topic has recently become an issue in our unit and can relate to each and every problem posted in this topic. Management recently decided that we were to abolish our current visiting hours and have an open visitation policy after a family complained that our visiting hours were to strict. Previously we had no visitors during the morning Dr's round and a 3 hour block in the afternoon 1-4, other than that visitors were allowed around these times, which on the whole worked quite well and family were fairly compliant - of course there is always the exception with the palliative/dying patient, interstate visitors etc. etc. So a few months ago, without any input, discussion or suggestion to the ICU staff, management decided to change our visiting hours to open visitation. As you can imagine managements follow-up as to how the staff or the unit are feeling about this change is impeccable...NOT. Although when this change did come about, I did go in with an open mind, thinking that maybe it wouldn't make much difference, how naive I was! I must add we do try to mention to visitors and family to detract from visiting during the morning doctors round and shift changes, because of privacy issues, but you can without a doubt ensure that there will be visitors at the door despite. Issues I've found with open visitation -> * for some it's a social occasion coming into visit with family spending more time talking to staff or visitors, looking at the monitor, looking at other patients, etc. etc. 'what's the blue line for, what's the red one for, what's that drug' need I go on. * despite that, yes they maybe in bed all day, patients do get tired very quickly and easily, particularly after being seen by numerous doctors, physiotherapists, procedures being done etc.. I don't think visitors understand the scope of actually what patients go through sometimes and then they are expected to sit and entertain visitors for fours hours and they wonder why they are so tired! As far I can tell this can be detrimental to LOS. I found having even this 3 hours in the afternoon, patients actually appreciated the quiet time and had the opportunity to catch up on some very lost sleep...that is until visiting hours began again and there were visitors coming in going 'are you awake...?' despite telling them he was asleep. I could go on. Believe me. But these are probably the main issues that have seemed to escalate since changing visiting hours. There are always times we appreciate visitors/family being there and I do understand there need to be there and visit..and I don't have an issue with that at all, but as previously mentioned I think there needs to be boundaries set, and often by the time we realize this (usually after problems start occurring..) it's too late. I'm not sure if there is ever going to be a solution or a perfect answer to this issue...but it would be a start if management listened to the staff that work in the unit, who know the patients, family and place the best. /end vent :!

Is this setting on a Siemens Servo vent? I'm not really familiar with it as we traded in our Servo's for Dragers a while back, but I found some info on 'automode' for the servo's - hope this helps. ------------- Servo (auto mode): The auto mode is suitable for patients who have a respiratory drive, are able to trigger breaths but require a backup rate, have changing ventilatory needs and still require additional monitoring. - Combines Volume Support and PRVC into a single mode. Switches between pressure support and pressure control, with pt effort determining whether the breath will be VS or PRVC. - If patient makes no effort, you get PRVC. - As pt begins to breathe spontaneously, switch to Volume Support. Auto-mode switching: Control to spontaneous mode will switch when the patient triggers two spontaneous breaths in a row. Spontaneous to control mode will switch when apnea intervals are achieved. -------------

I should be suprised, but I'm not. People try anything. I remember a mother once putting peas down her sons PEG tube....

6.9 on a diabetic ketoacidosis pt...survived. I've never seen a pa02 less then 30 - 40 - I remember taking one somewhere in that range and concluding it must have been venous. Repeat taken. Um....no.

Slope is the inspiratory rise time which basically controls the time it takes to reach the preset pressure or preset flow. (What I understand it as anyway..) A diagram shows it here: http://www.aic.cuhk.edu.hk/web8/mech%20vent%20intro.htm Hope that helps!