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Sunday, May 4, 2008

New policy enacted to make RTs perfect

Shoreline is not run by JCAHO as most hospitals are, but ISO. If you think JCAHO is incompetent and out of touch with reality, consider this new policy ISO pretty much forced the administration to put pressure on the RT bosses to crack down on random errors. The ultimate goal here is to make RTs perfect:

Date: April 28, 2007
To: RT Staff
From: RT bosses
Regarding: New Departmental Policy

To prevent any further wasting of our time trying to deal with pesky RTs and all their demands, we RT bosses have created the following list for the further good of our medical institution:

  1. An RT supervisor will be assigned the responsibility of double checking every single treatment and order to make sure all the i's are dotted and t's are crossed. If there is any mistake, a note will be given.

  2. No matter what the note is for, after every seven notes the RT will get a write up.

  3. All incentive spirometer instructs must be completed within an hour of the order or there will be a note given to the RT notifying him or her of the error. We demand thorough documentation as to why the IS was not done. Failure to document appropriately will result in a note

  4. EKGs, ABGs, Holter monitors, incentive spirometers, treatments are all equal priority therapies and must be completed in a timely manner regardless of how busy the RT is. If any of these are not completed in a timely manner, a note will be left for the RT.

  5. A SOB patient does not take priority over a patient who is not SOB. The excuse that such and such patient needed my services at that time more than the patient who has been here for three months and is still on treatments will no longer work at this facility. If an RT complains this is ridiculous, the RT will be called an idiot and sent home for the rest of the day. He will also be given a note.

  6. All EKGs must be done within 10 minutes of the original page. There will be no allowable excuses such as, "I was busy with a SOB patient," or, "I was at a code."

  7. All Q4 hour treatments must be done exactly every 4 hours. There will be no exceptions. If a Q4 treatment is done at 8:15, the next treatment should be done at exactly 12:15. We will no longer allow a 30 minute leeway on Q4. We will allow a leeway of 10 minutes and no more.

  8. All Q6 hour treatments must be done exactly every 6 hours. We will allow no more than a 30 minute leeway. Q6 hour treatments done 20 minutes late will result in a note.

  9. We will no longer tolerate complaints that therapy is not indicated. If the doctor ordered it, it is needed. Period.

  10. Regarding #11, this includes Q2 hour breathing treatments on a patient who is not having bronchospasm and is in no respiratory distress. If the doctor ordered it, then it must be done exactly as ordered.

  11. If you can't get a treatment done when it is due, you must not ever chart "unable to do," even if this may truly be the reason. It does not matter if you had a code. It does not matter that you had a pt. who was laboring. If a treatment was due, and you truly can't get to it, you must call in help.

  12. You must call in help if unable to do a treatment even if the treatment is not indicated, and even though we know it takes most help 45 minutes to arrive and the treatment must be completed no later than 30 minutes late. When charts are reviewed the following day, a note will be left if the treatment is more than 30 minutes late.

  13. Call in help will not receive time and a half for coming in and helping unless the RT is over the 40 hour mark, even if they would be going above and beyond the call of duty by coming in and helping out the business.

  14. All overtime pay must be pre-approved. It doesn't matter if it is on a weekend or late at night, it must be pre-approved regardless of the reason.

  15. RT Bosses are not to be called after 5 p.m. or on weekends.

  16. If a patient is SOB or appears to have the look of impending doom, your responsibility as an RT is to stay with that patient until he is stabilized. This only makes sense.

  17. There will be no excuses for late therapies. Late therapies will result in a note.

  18. Q4PRN treatments must be assessed and charted every four hours. If you forget to chart why treatment not given, you will receive a note.

  19. For every seven notes, you will receive a written warning.

  20. All notes have the same priority, whether they were because you forgot to chart a med or whether you forgot to chart that a prn treatment was not given.

  21. If you complain about notes you will be given a note.

  22. If you complain that you are burned out because of all the new demands set for you, you will be told that you have forgotten how to work and then you will be ignored for your stupid comment.

  23. If you go over the RT bosses head to complain about stupid useless treatments, you will be ignored.

  24. If you go over the RT bosses head to complain about all the stupid notes, you will be ignored.

  25. If you go over the RT bosses head to complain that all your notes were for silly things like forgetting to chart PRN treatments and it's stupid that you now have a write up, you will be laughed and mocked because we expect perfection.

  26. If you get home and remember you forgot to chart something, too bad: that note with your name on it is already on the bulletin board.

As you might have guessed, this new policy has created quite a bit of animosity in our department. When I got wind of this policy a few months ago I warned the RT bosses this would back-fire on them, and I was right.

I'll let you guys consider the above, and then I'll discuss this in more detail in the coming days. In the mean time, I have a question for my fellow RTs: are your RT bosses cracking down like this, or is it just here at Shoreline?


keepbreathing said...

The RT bosses here have been cracking down, too. We have a policy where all missed treatments...every single one... must be logged in the computer, on a tracking form, and by calling the charge RT. We're being asked to document more and more, we're working more with fewer RTs, and the bosses just keep raining more demands down on our heads and then wondering why morale is lower than a snake's belly in death valley.

It didn't used to be like this. What happened to RT world?

Anonymous said...

I am an RT boss (canada) and I was sure this was a joke!! RT's should document but they should spend most of their time with patients not paper. This seems bizzare to me

Freadom said...

It wasn't really put in writing like this, so I did it for them. This is honest to God what's going on in our department right now.

I'm just curious to know if this is a national trend, or if it's just us.

Asthmagirl said...

I'm kinda stunned. I'm not an RT, but isn't there any common sense applied in hospital administration?I would rather have an RT that is attending to someone SOB than one who is treating everyone equal so they don't get a note.
That probably didn't come out right... but hopefully you know what I meant!

Freadom said...

No, this came out right. And your shock at how stupid this sounds is exactly why the morale in our department is right now.

However, I think the administration is well intentioned, and somewhere in the process there was a lack of communication. In my next post I'll explain.