Treatment stacking

All RTs must understand the rules of treatment stacking. It's not ideal, but sometimes we RTs have no choice.

So, what is treatment stacking you ask? Let's make up a definition:

Treatment stacking: Giving breathing treatments to more than one patient in more than one patient room. You'll be leaving one patient unattended while treating another.

Part of being a good RT is staying in the patient room, doing a great assessment, and chatting with the patient. That's part of the fun of being an RT too: getting to know our patients.

Likewise, I hate leaving my patients unattended during a treatment. I hate it because when I was a kid I'd be alone in my room and I'd look forward to my RT visiting me. I hated RTs who left the room, or stayed in the room and paid me no attention. So I try my hardest not to do it.

So, ideally we should not stack. However, sometimes we have no choice.

Note: you must never stack treatments on any of the following patients:

1. Any patient in respiratory distress
2. Any patient with a compromised heart, or a heart you do not trust.
3. Any child who needs constant observation (any child)
4. Any unstable patient
5. Any patient that just doesn't look right

That said, you also should not stack unless you have a valid reason to do so. For example, where I work I'm the only RT on duty working nights. If I have several treatments due at 10:00 p.m. and ER has been paging me like crazy, I will stack as appropriate. Another good example is an RT working for a larger hospital who is given 50 patients all on treatments.

Another good example is if you have been at a code, or busy in the ER, and it is now 10:15 and you have several 10:00 treatments to do, and now you are way behind.

However, as a general rule of thumb, you must never leave the room of a patient you do not know. If you have been off for several days and don't know your patient, then it's a good idea not to leave the room. If you get a new admit, you should stay with that patient until you get to know him or her.

The following are patients you may consider stacking:

1. You have determined with relative certainty the treatment is not indicated (Lord knows there's plenty of these to go around)
2. You have a patient who is stable and takes treatments at home.
3. You have a patient who's comfortable taking treatments alone.
4. The patient is on a heart monitor and in the critical care unit (a place where the patient is being constantly monitored.

I also notice that some hospitals require no stacking, and also that the RT stay in the room for 10 minutes. If that's the case then you'll have to follow policy. However, there will come certain situations where you'll find yourself needing to stack, and now you know the proper way to do it.

Likewise, it is my humble experience that a treatment does not last 10 minutes. Ideally, a good assessment and treatment can be completed in less than five minutes tops. So if you're in a hurry, do the treatment right, but don't waste time in the room -- make every minute count.