If a patient needs a treatment, give it to her

If a patient needs a breathing treatment, and the order is Q6 and Q1 prn (in English, that's every six hours or up to every 1 hour as needed). She was an end stage COPD patient, and benefited greatly from the therapy. So I gave her treatments every 2 hours.

At the end of my shift I said, "Now you make sure you call for treatments every time you need one."

"Oh, they work so well," she said, "I really appreciate you gave me one whenever I needed it. I never even needed to call you."

"You can have treatments whenever you want, so don't be afraid to push your nurses button when you need a treatment."

So the next day the night shift RT gave me report. She said, "I gave (said patient) treatments every four hours. She can't go much longer."

Based on this report, I suspected the patient was doing much better. However, when I entered the patient's room her smile grew quickly, and she said, "Rick! Boy am I glad to see you!"

I set up her treatment, and said, "So, did the night shift treat you well?"

"Oh, yeah. Everyone was such a doll. The night shift girl doing your job was great and all, but she told me I needed to start stretching my treatments out. She wanted me to go six hours, but I made her give me one at the four hour mark."

"You think you need them more often?" By looking at her I already knew she did.

"Yes."

"How far apart do you want treatments?"

"I find it hard to make it 2 hours without getting short of breath, so every 2 hours would be perfect."

"Then every 2 hours it is."

She smiled.

I don't understand what the deal is about giving a lady who actually needs Albuterol treatments a treatment when she wants. What's this about spreading them out? If the lady needs them every 2 hours, give them every 2 hours. If she wants them more often, give the treatment.

I don't know what this issue is of "spreading the treatments out." When she gets better then you can spread the treatment out, but not when she really needs it. Ventolin is a refined bronchodilator with basically no side effects, so take advantage of it!

When I had my last bad asthma attack 11 years ago, I gave myself treatments every hour, and when I was in the hospital I expected them that often too. If the RT would have told me I had to wait four hours I would have called the doctor myself.

We'll make this RT Cave #44:

RT Cave Rule #44: If a patient needs a treatment, and the doctor approves the frequency, give the patient the treatment when she needs it or wants it. It's that simple. Don't let a patient a sit there short of breath because you think you need to "spread the treatments out." Ventolin is a safe and effective medicine, so don't make the patient suffer due to some fallacy.