I've been doing this long enough that I would consider myself an RT expert at prioritizing my therapies. I do this by asking one simple question when I come on duty after a few days off, especially if I don't already know the patients:
"Do any of these patients actually need the treatments?"
I know by now which RTs I can trust in their assessment and which one's tell me that a patient needs treatments when in all reality they don't. Either way, on my first day back I pay extra attention to my assessments, and determine for myself which patients need treatment and which one's don't.
Then I circle the names of the patients who do need them.
Now, that in mind, of the 16 patients I currently have here tonight, I have circled three of the names. That means, if I get busy in ER, or with a code, or if OB has a bad baby or something, I don't have to stress out about 13 of the patients -- they don't need their treatments anyway.
That in mind, my coworker Dale must have been fed up with this, because when I came to work yesterday he handed me a piece of paper. On this piece of paper he had three new 'olins for me to add to my list.
Following is what was written on that piece of paper:
Toolateolin: Most effective treatment for hopeless conditions. Use should be initiated by RN only. Drug has demonstrated no untoward effect when used for pulmonating edema, pneumothorax, cardiac tamponade, severe chest trauma, upper airway obstruction, nor agonal breathing. Like Xoponex, this drug comes in varying doses for cardiopulmonary arrest, v-tach, prolonged apnea, multi system failure, end stage mets, pulmonary infarct, rigor mortis or any other condition threatening imminent mortality.
Tryagainolin: A version of Toolatolin (as described above). Used continuous for prolonged periods should result in relief for all involved,with exception of patient & RT.
Waytoolateolin: A version of Toolatolin (as described above). Used continuous for prolonged periods should result in relief for all involved, with exception of patient & RT.
Note: Repeated use on multiple patients of Toolatolin, Waytoolatolin or Tryagainolin may result in changes. Normally witty RTs may respond to reasonable treatment requests with caustic cynicism. Normally, cynical RTs may respond to idiot requests with unconcealed anger. Normally, angry Rts may become despondent and resort to tears after self mutilating their heads on the closest brick wall
Further precautions: Treatments with Toolatolin, Muchtoolatolin and Waytoolatolin must be carefully documented. Charted comments such as “this treatment was a worthless waste of time” or “patient remained apneic post treatment,” may prove to be uncomfortable for doctors, RNs and RT department supervisors resulting in further enhanced working conditions or threatened continued employment.
After working last night, and seeing for myself just how ridiculously and unnecessarily busy we are here, and getting irritated with all the unindicated breathing treatments, and actually getting so irritated that I wrote on many of the unindicated treatments comments like: "This treatment not indicated," or "no signs of bronchospasm," or, "This pt. not sob before tx, still not SOB after tx," or "treatment had no effect."
Also, after spending half the night in the emergency with a critically ill patient who did not need treatments but nonetheless I had to do several of them on her, I completely understand now what instigated Dale's creativity.
Thankfully this occured before the day shift went home. However, if Jane had already clocked out, I would not have left this critically ill patient to do other treatments that were not indicated. No person is entitled to that kind of stress.
And this, my valueable readers, is exactly why I am a major proponent of bronchodilator reform.