Many times it goes like this:
DR: "Well, what did you give?"
DR: "Okay, I'll write the order."
I respect that. And if I thought the patient needed three treatments, then I'd go ahead and give the three, and the doctor would cover for me by writing the order.
Does the patient need an ABG and the doctor is not available? Well, by golly, do the ABG. The doctor will write the order.
In a way, we really have no need for a protocol when the system works as well as it does here. Except, some doctors get a little anal retentive.
Still, if someone needs a treatment, I will not allow that patient to suffer while waiting for the doctor. In my opinion, this is simple common sense.
If we had a protocol, I'd like it to be something like this:
- Do one treatment and assess. If pt breathing fine stop and reassess in 30 minutes
- If pt is still SOB due to bronchospasm, do a second treatment. If pt. breathing fine after, stop and reassess in 30 minutes.
- If pt is still SOB due to bronchospasm, do a third treatment. If pt. breathing fine after tx stop and reassess in 30 minutes.
Ideally, a patient should get up to 3 treatments if needed, and then the doctor should be informed if more treatments are needed.
No paperwork. No complex algorithm.
In short, if a pt. feels better after 3 treatments they should get discharged to home, and if not they'll probably need to be admitted. It's that simple. Quick and easy.
Of course you have to add common sense to the mix too.
How does your hospital deal with the ER rush?