Djfrank70

Nah... she does this on every patient. These are ALF residents receiving home health services. These are a bunch of elderly rich folks, none of which are really critically ill. After many arguements and attempts at her trying to set parameters at LITERALLY 70% or 75%. . Finally did she bring it up to 85%. These are also resting o2 sats/pre-therapy. There is no "thought ptocess". She doesnt feel like a Pt should be responsible for vitals. Her rationale = "I set my parameters low enough, I will never have to be bothered with calling the md or intervening in any way." A copd patient on oxygen at 88% is ready for hospice... not physical therapy. :-) (criteria is literally less than 89% on room air for Copd dx)

Exactly. Thanks!

This just happened. Discussed with President of our region. She agreed with me 100%. Moving forward wit some backing... thanks for all of the replies.

Each discipline sets their own in their plan of care.

That is basically the plan, but she is off on vacation until next week...so it's kind of holding up progress and billing. :-/

I have tried the tactful "No" approach... she pitches a fit, and the higher managers are afraid to make waves. I have even tried to play the 'I will let her think it is her idea' approach by spoon feeding her reasons why the pt is high risk, and asking her if she wants to keep the parameter at 85%. All I get is "yes". Just being a jerk for the sake of being one. If it were up to me, I would have fired her weeks ago.

Thanks for the reply. The reason why basically is because she doesn't like to be told what to do. We had a case conference to let all clinicians know what the expectations were. (All vitals, including o2 sat via pulse ox every visit) It's a power struggle, because she is a princess, and a physical therapist who seems to resent having to answer to RNs. She doesn't want to be held accountable for actually calling and notifying the physician if o2 sat is below 89%. As for why the company won't do anything... it seems that all who are in charge are nurses, and do not have a strong grasp of where they stand in relation to the therapists as far as dictating standards of care. We have been unable to get any guidance from corporate policy, as the company has been bought out in the last year or two, and so much has changed, etc.

I am an RN, clinical manager for a home health company. I have to sign off on plans of care done by clinical staff as part of my job. The problem starts here... We have a physical therapist who has been very difficult to deal with in setting vital signs parameters for vital signs that would be reported to physician. She is pissed off that she has to get a complete set of vital signs, especially o2 sats. To buck the system, she has written her plans of care with o2 sat parameters as low as 70%!!! After lots of drama and nonsense that no professional adult should cause, she has starting writing as 80 or 85%. I am not very comfortable with setting a resting o2 sat parameter at 80 or 85% on any patient, let alone patients with extensive cardiac history, yet this individual thinks she has a right to set her POC parameters where she wants. My question is, since I have to sign off on her plan of care is where does my liability end? If something were to happen to this patient due to therapist not reporting an o2 sat below 89%, am I looking at potential for being sued and or/actions being taken against my license because I signed off on this plan of care? It is part of my job duty to audit OASIS and sign off... and so far, the company refuses to address this clinician. Please advise.