short vtach after longer vtach

[judgeme]

:crying2:I missed to review the 3 arrhythmia alarm on my pt,I didnt hear the alarm sounds nor my other colleage 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 vtach 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.

[judgeme]

Yes it was reported to our ADN and I was reprimanded for 1 year and it stays within the facility record. I filed a grievance with the union which still in the process.

[judgeme]

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?

There is no clear policy but we always do report it whenever there is a changed to pt.condition ..I already apologized for not reporting and not documenting ...but as I said she should have just talked to me and discussed what should have done so this thing wont happen again..

[locolorenzo22, BSN, RN]

Have you been talked to before about some other situation that you did not notify the doctor about? Do you have some other event with a patient on your record? I think the biggest thing to me is that regardless of if the patient is symptomatic or not, if it is a change, then you need to call. Vtach is a big deal. Even if you call for the first event on your shift, and then get no intervention, mention "doctor, do you want me to call if mr xxx is not symptomatic with his vtach runs?" that would cover you.

Why is there nobody near the alarms? somebody needs to be close enough to the monitors to note when events happen. Just because it's "busy", that will not be a good excuse. GL, but I think you are leaving something out to us.

[Esme12, ASN, BSN, RN]

Yes it was reported to our ADN and I was reprimanded for 1 year and it stays within the facility record. I filed a grievance with the union which still in the process.

Ahhh....you are union. The picture is suddenly crystal clear for me. So, you discipline remains within the facility. It wasn't reported to the State. Discipline within the union contract is pretty well set in the contract as well as your grievance process. I'm sure the supervisor appreciates your apology....or she may not. Whatever the case learn form this......document, document, document. I am sure there is more to this story as I know how it is to work at a union hospital as both a union member and administration.

I am sure there is a policy for documenting arrhythmias on your unit......another benefit for having a union is that policies and rules are very clear. You'll find out what the policy is during the grievance process, I'm sure. The negative about the union IS that us vs them mentality.....the union hates the "boss" and the "boss" resents the union....everyone comes to the table with lines drawn and NO ONE hears the other. I found in my experience that both sides will cut their noses off just to spite the other, it sets up an animosity between management and workers and nothing gets done.

For now...follow you grievance process. Does being on warning keep you from overtime or some other perk? Regardless..... LET IT GO....