Thoughts on calling an RR?

[Butterflyxx0621]

I'll try to make this as brief as possible. I had a frequent flyer who was in with CHF exacerbation and a fib with RVR, who had just been discharged the day before for a GI bleed. Was taken off cardizem gtt because her BP couldn't tolerate it before she even came to the floor. Fast forward to day 2. HR sustaining in 130's, BP is 70/40's after receiving albumin twice, she had labored breathing due to large pleural effusions (was going to be tapped next shift) and was third spacing significantly. We lost IV access, which is no surprise not only due to the third spacing but also because she ends up needing a central line every admission. Many, many attempts to get an IV with no success. So I call her MD, gave updates, and requested someone to put in a central line. 2 doctors on call refused to come in to put in a line and didn't want to do anything for her. So myself/the charge nurse called an RR because no one would listen to us/address this issue! And then we were treated like the stupid ones! Myself and 3 other nurses, including the charge, do a manual BP to confirm because the patient was twitching so it was very difficult to get a BP on her. In the end the MD who put the line in also did nothing for BP/HR and put in their note that the BP readings were due to an improperly fitted BP cuff because the machine reading was 130's systolic,. Since when do we go by a dynamap over manual, especially when it had been taken that many times? Would you have called an RR in this situation? We felt like our hands were tied and everyone was blowing off the situation. Personally, If it was my family member she would be s DNR/DNI because she is at that point but they wanted all measures. I just got irritated that the doc tried to blame their laziness for not wanting to come in on a nurse error that wasn't even true.

[Karou]

Are you on an ICU or PCU type of unit? I can't imagine a physician refusing to put a central line in for a patient in her condition.

We always take manual for a-fib. If you had several nurses verify a manual then I absolutely would trust that over the automatic.

Who all responds to a RR? House supervisor comes to any at my hospital and should/would have backed us up in your scenario. Although I probably would have called the sup ahead of time to let them know what was going on, and see if they could talk to the physician prior to us calling a RR out of desperation. Most of the time when the supervisor gets involved, the physician gives in.

It sounds like you advocated for your patient and got the care that she needed. Those vitals themselves would warrant a RR in many facilities. Patient was a full code, unstable with multiple medical issues, she needed a line.

[nrsang97, BSN, RN]

Speaking as a rapid response nurse, YES! you can and should call a rapid response in this situation. Even if you feel something just isn't right call. Your patient met many of our parameters.

[Butterflyxx0621]

Are you on an ICU or PCU type of unit? I can't imagine a physician refusing to put a central line in for a patient in her condition.

We always take manual for a-fib. If you had several nurses verify a manual then I absolutely would trust that over the automatic.

Who all responds to a RR? House supervisor comes to any at my hospital and should/would have backed us up in your scenario. Although I probably would have called the sup ahead of time to let them know what was going on, and see if they could talk to the physician prior to us calling a RR out of desperation. Most of the time when the supervisor gets involved, the physician gives in.

It sounds like you advocated for your patient and got the care that she needed. Those vitals themselves would warrant a RR in many facilities. Patient was a full code, unstable with multiple medical issues, she needed a line.

Yes I work on PCU. We did call the supervisor to let her know, she was actually on the floor with us at that point. Mandatory staff to respond is the NS, hospitalist, ICU charge nurse, and respiratory.

Sometimes I think we as a facility underutilize the ability to call an RR, to be honest. The hospitalist said last night, sooo you called this for hypotension? I felt like saying, YES just the hypotension (let's forget everything else and the fact that we have way no way to quickly Medicate). He was not paying attention at all, he's like okay let's give her a 500 cc bolus. First off, no. At that point I swear the whole room said in unison for what felt like the 10th time, SHE HAS NO IV ACCESS!

At this point, the ICU charge nurse took control and called the MD and said were taking her to ICU so you're gonna have to come in for a line whether you want to or not. I was so glad she took control of the situation.

Some of the nurses on my floor who used to work in ICU said they have seen this happen before, but I have never experienced that.

Once the hospitalist listened to what I was saying, he said wow this is really sad and he is notoriously known for being the laziest doctor in the hospital... Though at least he did his job!