The life or death squatty potty

[remotefuse]

So I just had to share this with people that would understand. Not a rant, just a quick story.

On my ICU floor, we have a stool like object that we use during CPR since or beds are pretty tall. I come into work to see the stool in a patients room. Apparently, she had been using it as a squatty potty. Maybe 10 minutes later, a different patient codes. While we're working on her. I tell the cna which room the stool is in for her to go get. She comes back and says that the patient wouldn't let her take it, even after she explained to the patient that we need it for a code, happening right now.

There are plenty of staff in the room (asking for the stool actually) so I run over and just grab the stool, all the while I can hear the patient making a big stink about me taking her squatty potty. I was just amazed by her selfishness. Stool should not have even been in her room.

She did complain to my charge nurse, but no one really cared.

[Wuzzie]

We used an OR "step-up". We had three and you could stack them for additional height.

As far as the entitled patient. I would have snatched it, probably said something extremely inappropriate, enjoyed pissing her off and then ratted myself out to my boss.

[JKL33]

I'm still trying to visualize how such a thing would be used in a code. Does the person doing compression's stand on it to get to the right height for the bed? That doesn't sound even remotely safe, why not just lower the bed to the correct height? I am of course assuming the bed has a CPR function to harden the mattress, if not the coding patient should be moved to the floor.

Step stools are used rather than moving the bed up and down because often enough there are at least a few other people working on the patient whose work would be disadvantaged by moving the bed low enough for shorter people to perform adequate compressions. And, on some of these beds the low position is impractical for providing care anyway, even or shorter people. Informal observation is that the height of the bed is usually a compromise of what works best for the majority of the people in the room, and the rest of us adjust. :) I will ask for the bed to be lowered a little if necessary for improved ease of compressions in real-time (while also using step stool); sometimes it's really jacked up there depending on the height of the person who intubated.

The step-stools were interesting at first - some people balked not wanting to look weak ("nah, I don't need that") but as we started paying attention to the actual quality of compressions being delivered, people got on board. One of the studies about this did show improved compression depths and comfort/ease for shorter people, but also a significant increase in incomplete chest recoil. This can be mitigated by "spotters" or, preferably, use of equipment that incorporates real-time feedback. I can't see a patient coding in the hospital being moved from a bed/stretcher to the floor. There are a lot of tools that allow us to avoid that.

[Emergent, RN]

In the ER where I work, there is a stool in each room. An ICU should be similarly prepared for an emergency. Maybe you can advocate for that.

[Chrispy11, ASN, RN]

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[klone, MSN, RN]

In OB we keep step stools in every room. It's considered emergency equipment for a shoulder dystocia.

[TriciaJ, RN]

On the surgical floor I used to work on, we had an IV pole with shelves, for attaching multiple pumps. I think we called it the Harley, but don't know if that was a brand name or if someone just named it that. Anyway, one FF (due to non-compliance) frequently had multiple pumps to start with and used that pole. After the pumps were gone and the IV saline-locked, he preferred to keep the pole as an ambulation aid. And people would let him do this.

Inevitably, someone else needed this pole for its intended purpose. A coworker came out of FF's room empty-handed "He won't give it up". Time for Nurse Ratched. I went in, politely told him I had to take the pole because someone needed it just as he had at one time and offered to get him a walker. He protested as I was wheeling it out of the room and I reminded him that this was hospital equipment and not subject to claims by any one patient.

At the next staff meeting I raised the issue that as soon as it is no longer needed by someone, the pole needs to be removed from the room and cleaned and ready for the next patient. We should not be in the position to have to "ask" for it back, then have to clean it in a hurry for the patient who needs it.

[jaderook01, BSN, RN]

Yeah- next time- tell anyone to just take the needed equipment without explaining. It doesn't belong to the patient, anyway. I've taken things I've needed for wall suction out of patient rooms before- only stopping to briefly apologize for bothering them. The equipment isn't theirs and is needed elsewhere. I don't owe them an explanation of any kind.

[LovingLife123]

I'm still trying to visualize how such a thing would be used in a code. Does the person doing compression's stand on it to get to the right height for the bed? That doesn't sound even remotely safe, why not just lower the bed to the correct height? I am of course assuming the bed has a CPR function to harden the mattress, if not the coding patient should be moved to the floor.

All of our code carts have step stools as well. I'm 5' nothing. I need one to adequately do compressions against the rest of the people doing compressions. You can't adjust the bed up and down all the for each new compressor.

[Daisy Joyce]

I was giving meds to a LOL who was quite demanding, when the call bell for the room catty corner to her went off. She could see the light over my shoulder out the door.

So she says, "Do you need to answer that?"

I say, "yes I do."

So LOL starts taking her pills even slower...

[kbrn2002, ADN, RN]

Yes, it's a step stool, basically, so shorties like me are able to be over the chest when doing compressions. I have never seen a patient in the hospital moved from the bed to the floor. Won't happen unless the bed is on fire or something. I have been at plenty of prehospital codes that started on the floor/ground, though.

I'm sure in the hospital setting moving a patient to a hard surface such as the floor wouldn't ever be a necessity, but I work in a LTC facility, all of our mattresses are somewhat soft so they're not ideal for compression's. I (knock on wood....loudly) haven't participated in a code in awhile, but the last one I was part of we moved the resident to the floor.

[Tenebrae, BSN, RN]

Some people really are selfish gits.

Polite be dammed in that situation. I would have taken the stool

[JBudd, MSN]

Most of our ER stretchers don't go low enough for short patients to sit on the sides easily, when getting into bed, let alone go low for CPR. We would never (!) put a patient on the floor! How on earth do you think it would be clean, or advantageous for intubating, or for decent compressions from kneeling staff, at that? I can just see the whole team on their knees (Davey DO? visual here). (Not to mention, my knees are a bit creaky for that, LOL)

I am 6 feet tall, and occasionally have problems reaching the patient, never mind my shorter colleagues. I have gotten up onto the bed with a knee; and even shown students how to straddle a patient (manikin) on the bed to get out of the way of other activies. Step stools are hard to find at times, but utterly necessary.