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Monday, October 15, 2007

I will never be content to be a button pusher

"What's the point of having a weaning protocol if nobody is ordering it," Dave argued during one of our department meetings about a year after our ventilator weaning protocol was initiated.

Dr. Marah, who championed the protocol to the doctors and is partially responsible for it becoming official, got wind of what Dave said. She said, I am told, "I will take care of this."

Now I've never had a problem with Dr. Marah, but I know a lot of nurses who can't stand her, especially if they have to call her. She's one of those Dr.s who will tell you what she thinks of you without a second thought. I'm sure every hospital has a doctor or two or three like that.

But when it comes to taking care of her patients, she's top notch. And, as part of the Keystone Committee at our hospital she is well aware of how highly the Keystone project recommends ventilator protocols. Studies have shown such protocols to greatly reduce bloodbourne infections and ventilator aquired pneumonia.

Not only that, but they get the patient off the ventilator quicker. I haven't seen any of the studies for our hospital yet, but since this protocol has been enacted patients don't seem to linger on vents for weeks on end.

The moment the patient is placed on the ventilator the weaning process should begin. The mouth should be cleaned out a minimun of every 2 hours, and inline suction should be used instead of the old lavage, suction and bag method our doctors used to demand.

The head of the bead up, cuff pressure at not less than 20 cmH20 like we used to be tought, but greater to maintain a good seal. Tidal Volumes should be low. Our protocol calls for a VT 6-10 cmH20/kg ideal body weight instead of 10-15. That's a change from just 10 years ago when I was in school.

Doing all this has proven to be of great benefit to improving patient care and outcomes, and Dr. Marah was not about to let this protocol drift into oblivion as so many other protocols have.

Dr. Pike must have been a little jealous, because when it came time to hire a Dr. to the job of championing the rapid response team, he was more than eager to take up the job. So now, not only do we have a ventilator protocol, we have a rapid response team as well.

Here's something interesting. For the past three months we've been extremely slow here at Shoreline Hospital. We aren't necessarily a small hospital, but we aren't a big hospital either. We are kind of right in the middle. So to be as slow as we have been is very abnormal.

I discussed this yesterday with my co-worker Jane. She said:

"I think we're so slow because we are doing all the right things. Especially since the enactment of the rapid response team, we are catching things early, and preventing patients from becoming critical care patients. Overall, we are educating patients better, treating them well in the emergency room, and sending them home."

"So you think this slow spell is going to last forever," I asked.

"It very well might."

I don't think so. I think a month from now we'll be running around ragged and people will be complaining about getting too much overtime. In the meantime, we've written more protocols we hope to find champions for.

I am confident this will no longer be a problem.

Either way, it is this hope that we will continue to become a better hospital that keeps me going. I will never be content to be a button pusher.

2 comments:

jesus_of_suburbia said...

"I think we're so slow because we are doing all the right things. Especially since the enactment of the rapid response team, we are catching things early, and preventing patients from becoming critical care patients. Overall, we are educating patients better, treating them well in the emergency room, and sending them home."

Madness! Madness I tell you! Patients recovering faster? Patients leaving the hospital with less ailments than when admitted? Educated professionals given the freedom to use their expertise to make decisions? The hospital... saving money?

What kind of zoo are you guys running over there?

just respiratory

Djanvk said...

Congrats on the Ventilator Protocol. We just got a Therapy Driven Protocol where I'm at to, but not for Vents just for treatments, we call it RCAT (respiratory care assess and treat). I work nights and it's really dropped my patient load at night (we only run 1 therapist at night) but Lots of QID's during the day. Great blog I'll be keeping a eye on it.