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Tuesday, July 1, 2008

You cannot schedule SOB time

It is a firm belief of mine that if a patient isn't having constant problems with bronchospasm, like an asthmatic or COPD patient, then Albuterol b10reathing treatments should never be ordered QID.

The reason I say this, is that bronchodilators should, technically speaking, only be given when a patient is having trouble breathing secondary to bronchospasm, and the only way you can tell if this is occurring is to be in the room assessing the patient.

In other words, it is not possible to know in advance when a patient will be short of breath. You cannot schedule SOB time. Therefore, Dr. should use all the recourse's that are available to them, which are their respiratory therapists. RTs can go into the room at scheduled times to assess the patient to determine if the treatment is needed.

This is why I am such a proponent of protocols. Or, at the least, I think all treatments should be ordered every four hours as needed (Q4prn) . We go into the room, assess the patient, and give the treatment only if there are signs of bronchospasm.

Thus, here is RT Cave Rule #20:

RT Cave Rule #20: You cannot schedule SOB time. You cannot know in advance that a patient will be short of breath every four hours. Therefore, unless the patient is chronically SOB due to asthma or COPD, treatments should not be ordered Q4, they should be ordered Q4 prn.

Why force your RT to wake a patient up in the middle of the night to give a treatment that is not indicated. Use your RT, have him assess the patient every four hours if you think that is necessary, and determine if a breathing treatment is really indicated.

And this brings us to RT Cave Rule #21:

RT Cave Rule #21: You cannot know in advance when a patient is going to be SOB, and SOB due to bronchospasm is the only indication for a bronchodilator.

That concludes today's class.


Anonymous said...

Two comments in one post here!
Firstly - surely nebulized inhaled corticosteroids are "breathing treatments" and I believe these should be scheduled - yes?no?

Secondly - is the patient not allowed to become SOB BETWEEN your four hourly visits??? Inconvenient certainly, but shouldn't these visits by an RT be "as required" by 'nursing' staff - under such circumstances scheduled (preventive) treatments may be better for the patient than waiting for your scheduled visit.

As a patient I have never had a nebulized breathing treatment, but I use a combined ics/LABA DPI on a scheduled basis (and would not be scared to take an extra dose if I was becoming unusually SOB!).

Chris Wigley

Freadom said...

Yes. Corticosteroids should be given on a schedule. And some patients do require scheduled bronchodilator treatments, and I made an exception for them in my post.

Also, some patients do require in between treatments, which was the whole point of my post. That's why I like assess and treat orders, RT protocols, etc., and prn treatments that allow us to give the therapy when needed, which may be Q4 or QID.