Should I stay or should I go ?

[time4meRN]

one of my other posts raised a question for me. our hospital is chest pain certified. one criteria is that a pt is "rolling" to cath lab within 20 min after dx of mi. and the cath is started with in 90 min. it's all fine and well on day shift when there are people around. on night shift we have one attending, one redident, one intern. nursing staff is half of day shift. to make a long story short last week i had a mi pt. we didn't start for the cath lab because the attending considered the pt to have high poten. for becoming unstable. he has the typical fire hat st's. we didn't move him until we heard that the cath team was actualy in the hospital. but we had integralin, nitg and hep going.(as well as some other stuff) he was pain free . otherwise we would take the pt over and stand there sweating beads until they arrived. i would have had to gone with an intern. the attending had a couple other unstable pt's in the ed , so he couldn't leave to attend if the pt coded. and we all know the intern wasn't going to run a code. so any way, i got all kinds of flack from admin for not "rolling in 20". to me the hospital may not be able to check off all their little boxes to look good on paper, but the pt. got good care. i know that the cath is what will make the pt better but, rolling in 20 would have ment that we would have been in unfamiliar teritory with a mi pt, intern and no nursing support staff. none the less we missed the time by 6 min. boy , did we ever catch it. does anyone else deal with these type situations? i feel the hospital would rather make sure they look good as opposed to the actual well being of the pt. (to tell you how comfie i would have been with the intern with me , he asked the attending if we should start the intrepid ! ha ha, yeah, he would do well by himself in a code situation. maybe we would have been better off starting the dodge truck }

[loricatus]

Truthfully, I think what you describe is pretty much the same all over. If you were to go somewhere else, it should be for other reasons. Of course, I could be wrong and somewhere out there is a place that understands that the priority is for patient(s) safety, which can't be quantified through a generic checklist.

[TazziRN, RN]

The "rolling within 20 minutes" is all well and good, but you need to have someone to roll the pt to. If there's no one on the receiving end ready to take the pt, it makes no sense to roll. When guidelines are not met, the reasons need to be checked out to make sure there is a legitimate reason, and in this case it sounds like there was a very legit reason.

[Kymmi]

I agree with TazziRN. Our hospital also has pretty much the same policy in place but I know that our patients do not leave the ER until the cath team arrives to accept the patient. I agree with you feeling uncomfortable being in a unit you are unfamiliar with and having the potential for a code. It would be devastating to you and the patient to be in a code situation with no back up and you not knowing where necessary things are at. Unfortunately in the eyes of the powers to be they will expect you to follow procedure until a bad outcome happens and then they will reevaluate and how much do you want to bet it will fall back on your shoulders (or whoever is in the situation at the time).

[Ginger35]

I have to agree with Tazzi on her statements. This is a bunch of crap that they are placing the blame on nursing staff for not getting this done in a timely manner. IN my eyes - Admin should have someone scheduled to be on in the facility or within say a 10 min response time. You did EVERYTHING RIGHT!!! I guess if they were still giving you and the rest of the staff a bunch of grief --- Did they offer any solutions to offer??? I'll bet they didn't

[Nightcrawler, BSN, RN]

The standard says that the ECG has to be done and interpreted within 10 minutes of presentation with chest pain and either fibrinolytics within 30 minutes or PCI with balloon inflated within 90 minutes. The WHOLE point of the facility saying that they have to be out of the ED in 20 is to give the cath lab staff enough time to find access, and get it done. If no one from the cath lab is in the building, then it doesn't matter if the patient is at the lab in 20 minutes or 2 hours, because the real benchmark, PCI in 90 isn't going to get met. The question is, did the cath lab staff get there in time? What was the time to balloon inflation?

I know that this sucks. It ends up being a big political game. We are known as a "heart center" that recently got spanked in the media for not meeting our times. The area hospital that met its time keeps its cath lab staffed with on site staff and docs 24/7, ours need to be called in. So now we have the cards guys blaming nursing staff for not having the patient ready, the nurses blaming the docs for not getting their b####s in on time, and the administration screaming that we allllllll need to get our acts in gear.

Garbage flows downhill, gravity is gravity, and it doesn't matter where you are, it is alllll the same

[gitterbug]

Agree with the other posters, YOUR night staff did everything right, so make like a duck and let the water roll off your back. Next staff meeting, ask why the cath lab staff was not ready to go in the time demanded. DO not expect a credible answer, but ask anyway to let higher ups know the ER staff really knows the truth.