Seasoned nurses- your thoughts please

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Specializes in ER.

Have a question for y'all- had a patient today, swallowed pills fine. Sats 97-100% on room air. Meal tray ordered for patient-regular diet. I give the patient the meal tray. He eats fine. Other nurse says that the patient aspirates, but no Xray to prove it, but there is still food left in his mouth, and its my fault. Regular diet was ordered for the patient by MD. Sats did not dip below 97% at all on room air.

Who is in the wrong here? I am beating myself up even though I followed MD orders.

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Specializes in Cardiac Telemetry, Emergency, SAFE.

You followed the MD order, but the MDs usually arent there for meals. An evaluation should have been made by you and it sounds like it WAS. So, im not sure what you are being blamed for.

The patient pockets food, but is he really aspirating? You say the CXR is clear? Is he coughing or having difficulty swallowing or showing other signs of aspiration?

Is Speech on? Suggest an evaluation and a Video barium swallow study. Until then, consider an order for chopped, nectar thick diet (some facilities may have you keep them NPO until an eval, check yours.) Have him be a 1:1 feed, or at least meals with assistance and check to make sure he doesnt pocket.

Just suggestions. :p

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Specializes in ER.
So, the patient pockets food, but is he really aspirating? You say the CXR is clear? Is he coughing or having difficulty swallowing or showing other signs of aspiration?

Is Speech on? Suggest an evaluation and a Video barium swallow study. Until then, consider an order for chopped, nectar thick diet (some facilities may have you keep them NPO until an eval, check yours.) Have him be a 1:1 feed, or at least meals with assistance and check to make sure he doesnt pocket.

Just suggestions. :p

Well here's the thing...there was no Xray ordered after the "aspiration". I had the patient in the ER, no coughing, sats greater than 97% on room air. When the patient hits the floor, the nurse says I let the patient aspirate. I checked, and there as no CXR ordered by the floor to see if this really was aspiration. The nurse was just guessing that is what it was instead of pocketing (which I think thats what happened). Either way, I feel horrible and am beating myself up over this.

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If I understand the situation correctly, you have a patient with no history of aspiration that was ordered a regular diet. You witnessed the patient eating with no difficulty and swallowing pills with no s/s of respiratory distress. Another nurse at some other point in time finds food in the patient's mouth and assumes that the s/s of respiratory distress now present could be related to aspiration. Under this scenario, you are not "wrong" in the way that you administered care. Patient conditions can and do change during the course of hospitalizations. It is also reasonable that the other nurse should be concerned if she finds food in a patient's mouth but, since we don't know exactly where/when the food got there, it would be impossible assign blame. Try to focus on the care you gave and the steps you took to keep the patient safe. If you identify ways that you can improve, then learn from the experience. If you are 100% sure that you did everything possible, then be proud of the depth of care you delievered.

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Specializes in ER.

If there is no evidence of aspiration there isn't any...IMHO. His sats are OK, no chest xray (so I'm assuming no signs of pneumonia or respiratory distress). Does the patient feel unwell? Some people pocket food- totally different problem and interventions vrs aspiration. What is the other nurse basing her conclusions on? And just between you and me, don't let someone else's conclusion influence your own when they have no evidence to back it up.

I would be annoyed, not ashamed, if I was in your shoes. But maybe you can add more to the story?

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Specializes in ER.
If there is no evidence of aspiration there isn't any...IMHO. His sats are OK, no chest xray (so I'm assuming no signs of pneumonia or respiratory distress). Does the patient feel unwell? Some people pocket food- totally different problem and interventions vrs aspiration. What is the other nurse basing her conclusions on? And just between you and me, don't let someone else's conclusion influence your own when they have no evidence to back it up.

I would be annoyed, not ashamed, if I was in your shoes. But maybe you can add more to the story?

Really there isn't anything else to the story but this. I have no idea how this nurse could say I let the patient aspirate without a CXR to prove it. I am mad because this nurse wrote me up and I feel like I didn't do anything wrong. If the patient was choking on his pills no way I would have given him a meal tray, which WAS ordered by the MD who saw him.

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OP, from what you write, it sounds like this might be the 'ol teflon double-cross. :smokin:

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Specializes in LTC Rehab Med/Surg.

From what I read on your post, I can't see that there was anything wrong with your patient. What "other nurse" are you talking about? Was it the next shift? The next day? I've had pts choke and gag when taking pills for me, but swallow without a problem for the next shift. All you can do is assess your pt in the time that you are responsible for their care. Stand by your assessment.

You saw no evidence of aspiration. Do I live in la la land, or do nurses really write each other up for stuff like that?

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Specializes in ER.
From what I read on your post, I can't see that there was anything wrong with your patient. What "other nurse" are you talking about? Was it the next shift? The next day? I've had pts choke and gag when taking pills for me, but swallow without a problem for the next shift. All you can do is assess your pt in the time that you are responsible for their care. Stand by your assessment.

You saw no evidence of aspiration. Do I live in la la land, or do nurses really write each other up for stuff like that?

The other nurse is the floor nurse...I'm an ER nurse. I saw no s/s of aspiration when the patient was under my care. I honestly believe the patient was pocketing food.

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go with what you think happened, pt swallowing pills ok, no signs of aspiration.

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if the floor nurse is that concerned, s/he'll get a swallow eval.

otherwise, you used YOUR assessment skills and acted accordingly...

so tell her to stick it.

leslie

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The floor nurse can go and pound sand.

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