It's 2:05 in the morning, and it's been another fine night. Since it's my fourth night in a row I decided I had better do something useful, so I finished a ventilator management protocol I've been working on.
Jane (fake name) is the therapist I replaced. She's been working here 20 years and is a veritable respiratory therapy encyclopedia. Yesterday I learned about the WOB patient # provided by the Servo i. I showed her what I learned.
"I knew that already," she said, fake blushing.
About 15 years ago she wrote protocols for everything, and they all got shot down but for a watered down version of her oxygen protocol.
So when she decided to write a ventilator protocol a few years back, the rest of us didn't say it, but we all thought she was wasting her time.
This time, however, she received the support of one of our Internists, who championed the protocol to the other doctors, and, lo and behold, we have ourselves a ventilator protocol.
Well, actually it's just a weaning protocol, but it's a giant leap.
Why is it we want protocols? Is it because we want the extra work or the extra responsibility? I'd have to say no to that. Is it because larger hospitals have them and sometimes we think we are ten years behind the times? Perhaps.
I'll tell you why I want protocols: because I have an education, I have ten years of experience to draw upon and, most important, I'm at the bedside and the doctor is not.
Some people I work with fear protocols.
"It's just gonna create more work," my co-worker Dave complained when I showed him the breathing treatment protocol I recently finished. "And the biggest offenders aren't going to follow it anyway."
Well, that attitude won't make this a better department. I thought since Dave is the biggest complainer of Q-forever breathing treatments, he'd be all for a protocol. I thought wrong.
There are another group of therapists of whom fear protocols. They are the one's comfortable with being a button pusher.
In all the protocols we have written, Jane and I have included an escape clause. In the "Call the doctor if" section, we added, "If you are unable to determine the appropriate therapy."
Likewise, for the doctors that might not like the idea of ceding authority, we added the clause, "If a doctor does not want to use this protocol, he or she can write an order for No RT Consult."
So there, everybody is happy. The protocols should pass with flying colors. Well, so far we have 2 protocols passed, an ER treatment protocol that's being championed by the ER Medical Director, and now 2 others waiting in line.
As for my Mechanical Ventilator Management protocol, the one where we'd get to change ventilator settings based on SpO2, EtCO2 and/ or ABGs:
"As much as I'd like to have this one," Jane said, "and as much as I think the patient would benefit, I think our doctors will take one look at it and laugh."
Either way, we have fun doing this stuff.