Who's on first???

Over the last month or so we’ve been talking with the pulmonology team about a modified sleep study for Porter to check his vent settings and potentially wean/maximize his progress on his vent while he’s sleeping.  We were told that this study would have to be done in the PICU vs the sleep study lab because there are no respiratory therapists in the lab.  Neither Steve nor I felt the PICU was a good environment for this.  Porter spent over 5 months there and we know how busy and crazy it is and didn’t see how on earth a respiratory therapist would be able to focus on Porter and his breathing all night long.  Well~ our thoughts were confirmed when Porter was admitted to the PICU last Thursday.  We arrived in the PICU late afternoon and the daytime RT gave report to the night RT around 6:30pm.  The night nurse came on staff and when I mentioned that we’re supposed to have a modified sleep study she didn’t know anything about it.  Red flag #1.  7:30 – no appearance from an RT.  8:30 – No RT.  9:00- I told the nurse Porter was getting tired and I still hadn’t seen the RT so I was going to put Porter on the vent.  The nurse said she would see if she could find the RT.  9:30- RT arrives, accesses the vent settings and says- “It sounds like Porter is going to have a sleep study soon”.  I said~ well as a matter of fact he is and it’s tonight… with you.   Red flag #2.  She didn’t know what she was supposed to do for the study.  I explained that it was a modified sleep study to monitor Porter on the vent and she said she wasn’t sure what she was supposed to do but would check with the attending. And another RED FLAG. By midnight she still hadn’t returned, no settings were changed on the vent and no one was monitoring Porter’s respiratory status except me.  I let the nurse know that I hadn’t seen the RT since 9:30 and wondered what was going on.  The nurse said she would attempt to get the fellow again.  Shortly thereafter he came down and apologized that no one had been around and said how busy the other end of the PICUwas.  I expressed my disappointment and also my knowledge of how busy the PICU is.  He said he would get the RT and they would start changing the rate on Porter’s vent.  If they are trying to do something like this in the PICU then they need to bring in a RT specifically for that purpose not one who is on the floor with the other patients.  They made a small change on the rate but nothing else and that is NOT what the pulmonologist wanted done.  She was quite disappointed. The good thing about is Porter got a good night sleep and was rested for his procedure the next day.   I packed up all his stuff, loaded it onto the stroller and walked with him down to the surgery center fully anticipating Porter to recover in their waiting room and NOT the PICU.   The tube procedure went well; the throat biopsy went well however they took him back to the PICU to recover and when I asked the resident why he was back in the PICU she said he needed to be because he was working very hard to breathe.  When I arrived in his room I immediately asked them how much oxygen they had him on and when they said 6 liters I almost jumped down their throat!  I explained he is never on more than 1 liter at home and demanded they turn it down.  As soon as they did he calmed down.  I was FURIOUS.  That’s just a tid bit of how the day went but we were very firm on making sure they knew that we planned to take Porter home that day.  As it is~ we shouldn’t even have been in the PICU at all.  We have contacted patient relations – had to leave a message- but we will be discussing this with them.  

Porter did come home that afternoon and has been doing well.  He had a little drainage out of his ears that night but none after that. 


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