Originally Posted by
mturner27
As far as outcomes go, we monitor our post op pulmonary complications at our facility and they actually went DOWN after discontinuing the automatic standing orders, which by the way was the change we made in our facility. Before the change, EVERY SINGLE POST OP had a standing order on a pre printed order sheet for IS q1 h w/a. Of course the most anyone received was IS QID, as per policy at the time. [To my knowledge, no one really believes this effects a temp but a very few] This included every toe, knuckle, knee, etc operated on. This also caused our dept to staff an additional 2.5 FTE for the only purpose of doing IS. I don't know about your facility, but we had to take a look at how we are doing things here and tighten our belt. (mandatory salary budget cuts) So we had to be better and effective at what we were doing. By your own statement, it is the "technique" not the ball of the IS that has any "effect" and that is what the study showed. IS is no better than deep breathing and coughing...SO why do them? In my experience it came down to two types of patients: One- the compliant pt that will do anything they are told to facilitate recovery, in which case proper instruction on the front end will suffice and IS is not needed and TWO the non-compliant patient, in which they will not do as instructed and all the IS and DB & C coaching in the world will not change that and of course IS will not help them either.
The policy change, which was approved by our medical director, simply stated that our dept will no longer do "standing order IS" that we WILL be available to treat any patient that the Dr or nurse has a concern about and that we will tx as indicated per our protocols. The exception (for now) are the CABG patients while they are still in the unit (but dc'd when they go to the floor, and Gastric bypass pts receive an initial instruct and are put on their own after surgery.
I agree with you that patients should receive an order for RT to assess and treat anyone there is a concern about. We have the ability here to order and treat patients with most of the medications we provide per our protocols. But I do not believe that includes an RT to go in and instruct every post op patient they should cough and DB q 1 h w/a. Change is difficult, but required if we are to succeed in our profession. Gone are the days when every patient that gets admitted receives all the standard EKG, chest-xrays, rainbow labs, etc...we have to be smarter with staffing and treatment which includes reducing length of stay as much as possible with as little cost as possible. If we don't, we will wind up like several other hospitals in our state and close the doors all together.