short vtach after longer vtach

nurse2033, MSN, RN · Oct 3, 2011

Do you mean "runs" as beats? i.e. 4 runs = 4 beats of vtach? It sounds like your boss is freaking out and throwing you to the wolves without good reason. But, what is the policy on your unit? Why did you not hear the alarm? Had it been turned down? Are you unable to hear it from your work area?

As I understand it, a few beats of vtach is called a "run". If it was 4 QRS' I would call it a 4 beat run. If no harm occurred to the patient then negligence is hard to prove. I'm not a lawyer but you should consult one. This is a serious accusation. This is why you should have Liability Insurance, to protect your license against irresponsible nonsense. It is impossible to judge as we don't have all the facts. If what you say is accurate, you should get a lawyer. Yes that costs money, but this is your career we are talking about, what is that worth? 30 years of salary?

According to my text "Principles of Biomedical Ethics" (Beauchamp and Childress 2009) negligence is "unintentionally but carelessly imposing risks of harm" (pg. 154). This goes to standard of care, which relates to your unit policy. If you unit policy stated that you are to inform the MD under those circumstances you have violated the standard of care. I agree that you believe the patient was not as risk, but your clinical judgement is not the final word here. I think your boss should show some common sense but that is not a job requirement. You have to accept that there are hoops to jump through to do your job, and policy compliance is one of them.

Does it makes us better nurses? No. Does it improve health care? Maybe, but without following the rules, even if they don't fit the situation, keeps us employed. Best of luck.

iLOVEbees · Oct 3, 2011

The doctor is aware the patient has short runs of asymptomatic VT and is doesn't think it warrants intervention. I wouldn't have documented it further than puting a strip in the chart.

My opinion is that the supervisor is looking for a reason to get rid of you and had chosen this as the vehicle to that end.

Esme12, ASN, BSN, RN · Oct 3, 2011

:crying2:i missed to review the 3 arrhythmia alarm on my pt,i didn't hear the alarm sounds nor my other colleague who were also assigned in hourly basis to sit down in the station-no tech (the policy is not 100% being followed @ that time especially when busy). the alarm showed,3 runs,4 runs and 5 runs of v tach.the night before the same pt.had 17 runs and 8 runs of v tach which the doctor was aware and no intervention was done and pt.was fine and no complaint. he's electrolyte was normal.so this is not new to this pt.pt.'s has chf and in the icu for htn. my supervisor charged me with negligence in not documenting and not reporting it to the doctor.by the way she included the 4th alarm with 8 runs of v tach which happened 20 minutes after i gave report to the next rn..that rn reported it to the doctor.this pt.was transferred to the regular floor on the same day.there were no issues from the doctor and from the pt.
if you were to judge me,would you rather put me in verbal counseling first, and not reprimand for 1 year? i have a clean record and no other discipline.my proficiency record was high satisfactory.

i know you are upset and i'm sorry you are going through this......but i don't think you are going to like what i have to say.....

first .....how is your supervisor "reprimanding you for one year" second....v-tach is v-tach and i would bug the md until he gave an order stating to "ignore v-tach until x amount of beats or higher" and i would call the md until he gave an order to not treat until xyz or greater. i would also document my butt off because if, god forbid, something happened to the patient no one's going to blame me and say i should have called. not calling can get you sued.....calling the md just makes them mad.......boo hoo for him...write the order!!! trust me when i say that patients with chronic v-tach can and will code and trust me when i say the md can and will toss you under the bus if there is the slightest hint of trouble. that includes the hospital like the tossing of the nurse as calling it alarm fatigue when they they have eicu's.

http://articles.boston.com/2011-09-2...nurses-patient

the second patient death in four years involving “alarm fatigue’’ at umass memorial medical center has pushed the hospital to intensify efforts to prevent nurses from tuning out monitor warning alarms.

nurses exposed to a cacophony of beeps may no longer hear them or begin to ignore them, and that’s what appears to have happened in the latest case: a 60-year-old man died in an intensive care unit after alarms signaling a fast heart rate and potential breathing problems went unanswered for nearly an hour, according to state investigators who reviewed records at the hospital.

i agree with nurse2033 on this..

according to my text "principles of biomedical ethics" (beauchamp and childress 2009) negligence is "unintentionally but carelessly imposing risks of harm" (pg. 154). this goes to standard of care, which relates to your unit policy. if you unit policy stated that you are to inform the md under those circumstances you have violated the standard of care. i agree that you believe the patient was not as risk, but your clinical judgement is not the final word here. i think your boss should show some common sense but that is not a job requirement. you have to accept that there are hoops to jump through to do your job, and policy compliance is one of them.

"no one else called and he did it yesterday" will not absolve you if there is an untoward outcome. i am not sure why the supervisor was severe in her "corrective action" other than maybe she tried to explain to you that ignoring them wasn't a good idea and you answered with......"well, he had 17 beats yesterday and the md did nothing....what's the big deal?":rolleyes: instead of....."i'm sorry but i'm not sure what to document as it seems there is no treatment being changed and i'm frustrated":o. i do not know thw whole story but i know i would make sure you understood the gravity of the situation, or it's as others have said she's out to get you in trouble. not knowing both sides it's hard to tell. but always remember cya!!!! peace:redbeathe

judgeme · Oct 3, 2011

The doctor is aware the patient has short runs of asymptomatic VT and is doesn't think it warrants intervention. I wouldn't have documented it further than puting a strip in the chart.
My opinion is that the supervisor is looking for a reason to get rid of you and had chosen this as the vehicle to that end.

You said it right,Everyone else in my colleages said that the punishment is too harsh.and makes no sense.

lawandaluxnurse, ADN, BSN · Oct 3, 2011

I agree with esme12 you call that MD until you have an order to treat x beats of v tach or greater. It covers you and the patient. If the MD does not want to be bothered that is his problem. You are there for the patient

judgeme · Oct 3, 2011

Do you mean "runs" as beats? i.e. 4 runs = 4 beats of vtach? It sounds like your boss is freaking out and throwing you to the wolves without good reason. But, what is the policy on your unit? Why did you not hear the alarm? Had it been turned down? Are you unable to hear it from your work area?
As I understand it, a few beats of vtach is called a "run". If it was 4 QRS' I would call it a 4 beat run. If no harm occurred to the patient then negligence is hard to prove. I'm not a lawyer but you should consult one. This is a serious accusation. This is why you should have liability insurance, to protect your license against irresponsible nonsense. It is impossible to judge as we don't have all the facts. If what you say is accurate, you should get a lawyer. Yes that costs money, but this is your career we are talking about, what is that worth? 30 years of salary?
According to my text "Principles of Biomedical Ethics" (Beauchamp and Childress 2009) negligence is "unintentionally but carelessly imposing risks of harm" (pg. 154). This goes to standard of care, which relates to your unit policy. If you unit policy stated that you are to inform the MD under those circumstances you have violated the standard of care. I agree that you believe the patient was not as risk, but your clinical judgement is not the final word here. I think your boss should show some common sense but that is not a job requirement. You have to accept that there are hoops to jump through to do your job, and policy compliance is one of them.
Does it makes us better nurses? No. Does it improve health care? Maybe, but without following the rules, even if they don't fit the situation, keeps us employed. Best of luck.

3 runs,3beats I call it the same..When I saw that runs of vtach @ the end of the shift I decided to myself not to bother the Doctors who are already having conference that morning,and I did not document it because I did not report it anyway...and since this is not new to this pt.and he was fine and no complaint and the next RN got the 8 runs of vtach that has more weight if there will be intervention ,which didnt changed the minds of those Doctors.Pt.was still transferred to the floor that same day. I apologized to our Supervisor for not documenting and reporting it and said that I will be more carefull next time but why did she still charged me with negligence

instead of verbal counseling?I call it harassment and bulliying...This is not the only things that happened in our unit,She makes small things big but we were all brave enough to get rid of her..Thanks to my fellow RN's that stand by me...:redpinkhe

nyrn5125 · Oct 3, 2011

We don't know what the pt history is. My pt's have beats of vt all the time and you use your critical thinking to decide how many times you will call an MD for this.

Sometimes we get stat bmp,mag level. Does his history include MI, does he have an ICD, what medications,is he 98 years old, etc. We do not know. If a Cardiologist is aware and wants no treatment then that is his choice. If this was a daily occurrence and is documented as such then maybe your boss is over reacting

Esme12, ASN, BSN, RN · Oct 3, 2011

3 runs,3beats I call it the same..When I saw that runs of v tach @ the end of the shift I decided to myself not to bother the Doctors who are already having conference that morning,and I did not document it because I did not report it anyway...and since this is not new to this pt.and he was fine and no complaint and the next RN got the 8 runs of v tach that has more weight if there will be intervention ,which did not changed the minds of those Doctors.Pt.was still transferred to the floor that same day. I apologized to our Supervisor for not documenting and reporting it and said that I will be more careful next time but why did she still charged me with negligence
instead of verbal counseling?I call it harassment and bullying...This is not the only things that happened in our unit,She makes small things big but we were all brave enough to get rid of her..Thanks to my fellow RN's that stand by me...:redpinkhe

There is nothing in that statement you feel might not be the best decision? Can you tell a court of law......"Yes I saw the V-tach and I decide to not tell them because they had a meeting that morning and because I didn't tell them I just threw the strips away......besides he's done it before and the nurse who followed me had an 8 beat run and she did nothing.....so why am I in trouble...?" If you can honestly feel you can then, so be it.

What do you mean "charged you" with negligence. Did she formally report you to the board? of did she just write you up? Are you on probation for a year as you mentioned a year's action. Is that with the hospital or the state boards. Do you have malpractice? Check with them if you feel you have been wrongly accused it should provide a lawyer and advice and if you have been officially "charged" you insurance needs to know. I'm glsad you told her you are sorry....:)

AgentBeast, MSN, RN · Oct 3, 2011

You failed to follow facility protocol and in so doing likely VIOLATED the Nurse Practice Act for your state as most of them have a provision in them that nurses are to follow facility protocol/standard of care and not following protocol is a violation.

Anna Flaxis, BSN, RN · Oct 3, 2011

Runs and beats are NOT the same thing. Using the correct terminology is important when communicating with other members of the care team.

The way the situation is described, it sounds like this is not new for the patient and that the physician is already aware of the arrhythmia. If this is the case, I wouldn't have called either, unless there was a change, such as an increase in frequency, duration, or the patient became symptomatic. Always call for a change in patient condition.

I would, however, have posted the strips in the chart and documented the events.

Of course, this would have been within protocol at my facility. If I worked in a unit where it was protocol to call for every episode of VT, I would call for every episode of VT.

What is your facility's policy on this?

Biffbradford · Oct 3, 2011

We had an LVAD patient in CVICU that was in shock resistant, Vtach for a week. He'd degenerate into Vfib, then go back and forth. We had the written order - do not call unless symptomatic! (no, he didn't do so well after that).