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Showing posts with label breathing treatments. Show all posts
Showing posts with label breathing treatments. Show all posts

Will LABAS end useless breathing treatments?

For the past several years one doctor orders Pulmicort BID instead the patient use his Qvar QID.  We RTs have hated it, because it makesk treatments last longer.  Now I'm wondering if this is the wave of the future, and that it's for the best.

Hear me out, folks, because Pulmicort BID treatments may be good for us.

Last fall I gave my first Brovana breathing treatment.  I had no idea what this medicine was, so I did a Google search.  After doing this I realized I had heard of Brovana before: it's Foracort.  This is a LABA: a long acting broncho dilator.

Think of this:  Both Brovana and Pulmicort only need to be taken twice a day!


You heard it here first, folks.  Remember a few years back I wrote about a talk I had with a doctor (you can view it here).  I asked her why she orders Q4 Ventolin treatments when the patient is not short of breath.  She said, "Because we want to prevent bronchospasm."  I said, "Then why don't you prescribe Serevent?"  She gave me a wry expression, hissed, and left the room.

That was ten years ago.  Yesterday a homecare representative visited me in the RT Cave, and he told me most of his patients now get Brovana and Pulmicort.  He said it's great because it improves compliance.  "Think of how much easier it is for patients to only take two breathing treatments a day, with Ventolin only if needed?" he said.  "Our doctors are buying it."

He convinced me.  If doctors truly believe all these patients need a bronchodilator, and all these procedures are burning us RTs out, and doing nothing for the patient, then why not at least try BID Brovana and Pulmicort with prn Ventolin or Xopenex?

Surely we can have further debates, such as will this put us out of a job?  Yet we'll delve into that in a later post.  Or, better yet, I'll leave it to you guys.  I just wanted to bring this subject up and let you know it's a possibility for the future.

This may be the RT Revolution we need?
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22 tips to get treatments done on those busy days

So you're having a busy day. Doctors are writing orders left and right, ER is calling you every 15 minutes, and now you have ten breathing treatments due all at once.

Or perhaps you have time now, and you're expecting the worse to happen anytime.

Or perhaps you are the night shift RT and you are working by yourself.
Here are ten tips to help you get the job done fast and efficient:
  1. Get a good report. Know who really needs the treatments and who doesn't. If you need further tips regarding this, click here.
  2. Prioritize. Do Q2 treatments first. If a patient needs treatment, do it.
  3. Do Q4 treatments second.
  4. Do Q6 hour treatments third
  5. Know QID treatments can be done at your convenience unless the treatments are indicated. Unless indicated, don't worry about these. Get them done when you have time.
  6. Don't sweat about TID and BID treatments. If the patient was truly in need of treatments they wouldn't be scheduled this way.
  7. If you know someone doesn't need a treatment, don't try to talk him into it. Don't be afraid to chart that the patient refused.
  8. Know that Q4 hour treatments can be done 1/2 hour early or late. If you're just standing around, do them a half hour early.
  9. Know that Q6 hour treatments can be done 1 hour early or late. If you're just standing around, do them an hour early.
  10. I know you love to, but don't chit chat with your patients
  11. I know you love to, but don't ask the patient if there is anything I can get for you
  12. Don't wait until all the mist is gone. Studies show the medicine dissolves first, so once the medicine starts to sputter it's just water
  13. Don't be afraid or too proud to call for help.
  14. If you work nights, talk to your patients at beginning of your shift and ask them if they want to be awakened during the night.
  15. Assess the patient really good after you start the treatment in case you don't have time to re-assess afterwords
  16. If you get called away, ask the nurse to finish therapy (this should only be done when urgent). If you abuse this nurses will lose respect for you.
  17. Talk to doctor to see if you can get un-needed treatments discharged
  18. Take full advantage of protocols that allow you to discontinue non-indicated therapy
  19. Keep an amp of Ventolin in patient's room if the patient is really labored or is in serious need of on-time treatment. If necessary the nurse can give it.
  20. Don't wake pt that is sleeping comfortably. Follow step 14 if possible, otherwise chart refused. This is also why it's good to follow tip #1.
  21. At times you will be in the ER when treatment is due. Do not chart "RT not available." This looks bad in court of law. If you must, simply chart patient refused and do treatment as soon as possible. If you know patient must have treatment, follow tip 13 or 19
  22. Follow hospital policy as best you can, yet don't be afraid to use common sense.
The above tips are made by a person who worked night shift by himself for 14 years. I think the most important things to remember is to always keep the best interests of your patients in mind, know your patients, know who you're working with, and prioritize well.
Likewise, common sense prevails. Keep in mind these are tips only, they are not rules.
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