short vtach after longer vtach

I missed to review the 3 arrhythmia alarm on my pt,I didnt hear the alarm sounds nor my other colleage who were also assigned in hourly basis to sit down in the station-no tech (the policy is not 100% being followed @ that time especially when busy). The alarm showed,3 runs,4 runs and 5 runs of v tach.The night before the same pt.had 17 runs and 8 runs of v tach which the Doctor was aware and no intervention was done and pt.was fine and no complaint. He's electrolyte was normal.So this is not new to this pt.Pt.'s has CHF and in the ICU for HTN. My Supervisor charged me with negligence in not documenting and not reporting it to the Doctor.By the way she included the 4th alarm with 8 runs of vtach which happened 20 minutes after I gave report to the next RN..That RN reported it to the Doctor.This pt.was transferred to the regular floor on the same day.There were no issues from the doctor and from the pt.

If you were to judge me,would you rather put me in verbal counseling first, and not reprimand for 1 year? I have a clean record and no other discipline.My proficiency record was high satisfactory. Last edit by judgeme on Oct 2, '11
Do you mean "runs" as beats? i.e. 4 runs = 4 beats of vtach? It sounds like your boss is freaking out and throwing you to the wolves without good reason. But, what is the policy on your unit? Why did you not hear the alarm? Had it been turned down? Are you unable to hear it from your work area? As I understand it, a few beats of vtach is called a "run". If it was 4 QRS' I would call it a 4 beat run. If no harm occurred to the patient then negligence is hard to prove. I'm not a lawyer but you should consult one. This is a serious accusation. This is why you should have liability insurance, to protect your license against irresponsible nonsense. It is impossible to judge as we don't have all the facts. If what you say is accurate, you should get a lawyer. Yes that costs money, but this is your career we are talking about, what is that worth? 30 years of salary? According to my text "Principles of Biomedical Ethics" (Beauchamp and Childress 2009) negligence is "unintentionally but carelessly imposing risks of harm" (pg. 154). This goes to standard of care, which relates to your unit policy. If you unit policy stated that you are to inform the MD under those circumstances you have violated the standard of care. I agree that you believe the patient was not as risk, but your clinical judgement is not the final word here. I think your boss should show some common sense but that is not a job requirement. You have to accept that there are hoops to jump through to do your job, and policy compliance is one of them.Does it makes us better nurses? No. Does it improve health care? Maybe, but without following the rules, even if they don't fit the situation, keeps us employed. Best of luck.

The doctor is aware the patient has short runs of asymptomatic VT and is doesn't think it warrants intervention. I wouldn't have documented it further than puting a strip in the chart.My opinion is that the supervisor is looking for a reason to get rid of you and had chosen this as the vehicle to that end.

Quote from judge mei missed to review the 3 arrhythmia alarm on my pt,i didn't hear the alarm sounds nor my other colleague who were also assigned in hourly basis to sit down in the station-no tech (the policy is not 100% being followed @ that time especially when busy). the alarm showed,3 runs,4 runs and 5 runs of v tach.the night before the same pt.had 17 runs and 8 runs of v tach which the doctor was aware and no intervention was done and pt.was fine and no complaint. he's electrolyte was normal.so this is not new to this pt.pt.'s has chf and in the icu for htn. my supervisor charged me with negligence in not documenting and not reporting it to the doctor.by the way she included the 4th alarm with 8 runs of v tach which happened 20 minutes after i gave report to the next rn..that rn reported it to the doctor.this pt.was transferred to the regular floor on the same day.there were no issues from the doctor and from the pt.if you were to judge me,would you rather put me in verbal counseling first, and not reprimand for 1 year? i have a clean record and no other discipline.my proficiency record was high satisfactory.

Quote from iLOVEbeesThe doctor is aware the patient has short runs of asymptomatic VT and is doesn't think it warrants intervention. I wouldn't have documented it further than puting a strip in the chart.My opinion is that the supervisor is looking for a reason to get rid of you and had chosen this as the vehicle to that end.

I agree with esme12 you call that MD until you have an order to treat x beats of v tach or greater. It covers you and the patient. If the MD does not want to be bothered that is his problem. You are there for the patient

Quote from nurse2033Do you mean "runs" as beats? i.e. 4 runs = 4 beats of vtach? It sounds like your boss is freaking out and throwing you to the wolves without good reason. But, what is the policy on your unit? Why did you not hear the alarm? Had it been turned down? Are you unable to hear it from your work area? As I understand it, a few beats of vtach is called a "run". If it was 4 QRS' I would call it a 4 beat run. If no harm occurred to the patient then negligence is hard to prove. I'm not a lawyer but you should consult one. This is a serious accusation. This is why you should have liability insurance, to protect your license against irresponsible nonsense. It is impossible to judge as we don't have all the facts. If what you say is accurate, you should get a lawyer. Yes that costs money, but this is your career we are talking about, what is that worth? 30 years of salary? According to my text "Principles of Biomedical Ethics" (Beauchamp and Childress 2009) negligence is "unintentionally but carelessly imposing risks of harm" (pg. 154). This goes to standard of care, which relates to your unit policy. If you unit policy stated that you are to inform the MD under those circumstances you have violated the standard of care. I agree that you believe the patient was not as risk, but your clinical judgement is not the final word here. I think your boss should show some common sense but that is not a job requirement. You have to accept that there are hoops to jump through to do your job, and policy compliance is one of them.Does it makes us better nurses? No. Does it improve health care? Maybe, but without following the rules, even if they don't fit the situation, keeps us employed. Best of luck.

We don't know what the pt history is. My pt's have beats of vt all the time and you use your critical thinking to decide how many times you will call an MD for this. Sometimes we get stat bmp,mag level. Does his history include MI, does he have an ICD, what medications,is he 98 years old, etc. We do not know. If a Cardiologist is aware and wants no treatment then that is his choice. If this was a daily occurrence and is documented as such then maybe your boss is over reacting

Quote from judge me3 runs,3beats I call it the same..When I saw that runs of v tach @ the end of the shift I decided to myself not to bother the Doctors who are already having conference that morning,and I did not document it because I did not report it anyway...and since this is not new to this pt.and he was fine and no complaint and the next RN got the 8 runs of v tach that has more weight if there will be intervention ,which did not changed the minds of those Doctors.Pt.was still transferred to the floor that same day. I apologized to our Supervisor for not documenting and reporting it and said that I will be more careful next time but why did she still charged me with negligenceinstead of verbal counseling?I call it harassment and bullying...This is not the only things that happened in our unit,She makes small things big but we were all brave enough to get rid of her..Thanks to my fellow RN's that stand by me...:redpinkhe

You failed to follow facility protocol and in so doing likely VIOLATED the Nurse Practice Act for your state as most of them have a provision in them that nurses are to follow facility protocol/standard of care and not following protocol is a violation.

Runs and beats are NOT the same thing. Using the correct terminology is important when communicating with other members of the care team.The way the situation is described, it sounds like this is not new for the patient and that the physician is already aware of the arrhythmia. If this is the case, I wouldn't have called either, unless there was a change, such as an increase in frequency, duration, or the patient became symptomatic. Always call for a change in patient condition. I would, however, have posted the strips in the chart and documented the events.Of course, this would have been within protocol at my facility. If I worked in a unit where it was protocol to call for every episode of VT, I would call for every episode of VT.What is your facility's policy on this?

We had an LVAD patient in CVICU that was in shock resistant, Vtach for a week. He'd degenerate into Vfib, then go back and forth. We had the written order - do not call unless symptomatic! (no, he didn't do so well after that).

Yes it was reported to our ADN and I was reprimanded for 1 year and it stays within the facility record. I filed a grievance with the union which still in the process.