slideshow widget

Monday, December 16, 2013

Can an RT overrule a doctor?

Your question:  I am a nursing student.  My patient was a 2 year old boy, and he was on a non-rebreather mask.  The doctor came in and saw the the boy's SpO2 was 99%, so she turned the flow down to 2lpm on the mask, and wrote an order to keep it at 2lpm.  The respiratory therapist came into the room an hour later and turned it back up to 10lpm.  He said to me, "I like the idea of turning the patient's oxygen down, but if we're going to do it we better do it the right way.  He later placed the patient on 2lpm nasal cannula and the patient did just fine.  Who is right, the doctor or the RT in this situation? What do I do here?

My humble answer:  In this situation, the RT is right.  The flow to an NRB must be 10 or greater in order to blow off CO2 from inside the mask.  This was either an oversight on the part of the physician, or she simply doesn't understand oxygen therapy.  So long as the respiratory therapist is following hospital policy, it is fine to overrule a doctor's order in this case.  However, if the RT did not do so already, I'd make sure to contact the physician to let her know what the RT did and why he did it.

I would also like to add here that if the RT didn't explain what he was doing, then that is an error on his part.  If an RT finds an error like this, it is his responsibility to explain the error to the nurse and, of course, the physician.

Also, and I don't know about your hospital, but some hospitals have oxygen protocols that allow the RT to make changes regarding oxygenation without consulting a physician.  This is something else to consider.

RT Cave Facebook Page
Rick Frea's Facebook
RT Cave on Twitter
Print Friendly and PDF

1 comment:

Anonymous said...

I agree that the error should have been pointed out to the physician (otherwise the MD might do it again and not have someone fix it), but the physician must be approachable and receptive to feedback, and the facility you work in must have a culture that allows such conversations to take place. Otherwise you can't completely fault the RT for not speaking up to the MD.