Nurse adding water to humiderfier

[f11smith]

I was told that a new Federal Government rule as of this past January would not allow any hospital personell including respiratory therapists to add water to my wife's personal CPAP humidifier. Is this true? And where can I find that rule. They said that was my responsibility and I live 45 miles away. She only uses it at night, she has been hospitalized for three weeks and I have been there every night except for two. I would appreciate any information regarding this rule if it exist. This is the absolute truth, I had a confrontation with the daytime respiratory therapists yesterday when I checked the humidifier and it was dry as bone so I know none was added the night before. My wife was complaining about her nose being dry and bleeding. Actually the RT made a comment about "my president and new administration rules", she first said FDA before that. She told me they had one man without his CPAP, it was in Mississippi and the hosptial would not furnish one since this was a an acute rehab portion of the hospital, my wife had a hart attack three weeks with four blockages above 90%, they put three stints in, but could not put the fourth in. My wife was in an auto accident 28 years ago with a head and neck injury, she has high blodd pressure, is diabetic, spinal fluid building up where C5 and C7 were fractured. I know my wife's condition better than anyone else, some of the staff did not know she had heart problems or spinal problems.

[chunkyfrog]

That just sounds ridiculous!
I think somebody is shooting you a line of bull.
What other part of their job do they expect you to do?
I would definitely contact the hospital's main office and mention' lawyers' and 'malpractice'.

[Janknitz]

Oh for goodness sake! I've never heard such baloney. I'm sure the federal powers that be have more important things to do than make a rule that hospital personnel can't add water to a MEDICALLY NECESSARY piece of equipment owned by the patient.

Ask her doctor to write an order that distilled water is to be added to her machine up to the fill line once daily. If there's an order, they must comply. It should also be part of her care plan.

And if they continue to give you guff, take it up the chain of hospital administration and demand to see in black and white what exactly they are interpreting to mean that they can't make sure your wife has the treatment she NEEDS.

[archangle]

Tell them to put it in writing.

[rested gal]

she has been hospitalized for three weeks and I have been there every night except for two.
---
I had a confrontation with the daytime respiratory therapists yesterday when I checked the humidifier and it was dry as bone so I know none was added the night before. My wife was complaining about her nose being dry and bleeding.

I sure understand your concern and frustration with the answer the RT gave you. I'd check (very politely) with the hospital office to see if the RT was correct. It may very well be that that kind of action can't be done on their own initiative by hospital employees without a doctor's order.

Not to excuse the RT, but if you've been taking care of filling the humidifier every night for so many nights, I can also understand that the night nurses might not have been aware that "someone" needed to do that when you can't be there.

You said "confrontation" -- again, I can understand that you would have been upset to find the humidifier dry and your wife with a dry, bleeding nose. But if your initial words with the RT were something very confrontational, like "WHY DIDN'T YOU PEOPLE FILL MY WIFE'S HUMIDIFIER LAST NIGHT???!!!" I can imagine the RT's hackles going up and him/her firing from the hip with an answer that may (or may not) be right.

If you started out very politely, however, then it would have been more helpful if the RT had explained why they don't/can't do that, and added the very good, sensible suggestion Janknitz made:

Ask her doctor to write an order that distilled water is to be added to her machine up to the fill line once daily.

Unfortunately, neither OSA nor CPAP therapy seem to be very well understood (or taken very seriously) by medical professionals in general. With or without a Federal regulation applying to this situation, I really can understand how easily the oversight could happen, unfortunate as it was for your wife's comfort while using her CPAP. Nurses and even RTs are not used to thinking about all the things we already know about "CPAP" therapy. Or realizing how important heated humidification is for many CPAP users. If you were taking care of it on so many nights during three weeks, filling the humidifier wouldn't even occur to them. Even if they are allowed to do something like that.

I hope your wife is doing better. And hope you'll be able to work with them (with a doctor's order, for example) to fill the humidifier when you can't be there to do it.

[archangle]

Rested gal, I think you may be missing the crux of the issue. She said "personal" humidifier.

It's possible the hospital wants to rip the patient off for a hospital provided piece of medical equipment at exorbitant daily rates.

f11, did they seem to be concerned because it wasn't their own equipment?

[TooGroggy]

What kind of humidifier is it? Perhaps someone can suggest a hack to keep the reservoir filled. It shouldn't be that hard and it might be more expedient than fighting the hospital rule, Federal law or whatever is keeping the reservoir dry now.

[Otter]

If there is anything to this, I suspect it's not federal law but that someone gave hospital's legal risk management team some ridiculous FUD about the dangers of infection when using the humidifier. If this is the case, ask your doctor to inform the hospital of the risks if your wife does not use her humidifier, or if she stops using the CPAP because it's far too uncomfortable to run it dry.

[DoriC]

When Mike was in the hospital I brought our own cpap which the Dr recommended. I had to sign some kind of form releasing the hospital from any liability and they put signs up everywhere stating "patient is using his own machine", the pressure being used, and giving RNs permission to assist with machine setup. I showed the 2 night nurses how to fill the HH, turn it on and how to adjust the mask if necessary and answered a few questions. These were not new nurses but they were acting as if they were! The next day the head nurse asked if I would demonstrate my "expertise" to a few of the other nurses on the day shift as many patients want to bring their own machines but if they're post-op or pretty ill, they can't give instructions themselves and their spouses or family members don't have a clue. He was in the hospital for 3 nights and all went well. Of course he only used the humidifier in passover mode so the water lasted almost the whole time and I checked it every day.

[Janknitz]

It is a lack of familiarity with the equipment that makes the nursing (and probably the RT staff) reluctant to do anything with the machine, but that's NO excuse as this is medically necessary and the OP's wife suffers the consequences if the machine runs dry--plus, it may cause the unit to overheat.

A doctor's order should solve the issue because then the nurses are REQUIRED to do it. If the OP will provide written instructions on how to fill the humidifier (in case it's not obvious) that would be helpful.

[lbw]

I am a nurse and have worked in hospitals> 20 years. In those years never did we have a patient in on CPAP. It is also not taught in schools. So I can understand the nurses not knowing how the machines work. The RT should be teaching the staff when they have a patient on CPAP. I do know with the SARS a few years back that humidity with oxygen has been stopped so I wonder if that has something to do with the hospitals stupid policies?? It makes no sense for hospitals to make these blanket policies that put patients at risk

[Guest]

Hello everyone. I'm a newbie and also an RN. IMHO it is incredibly stupid & lazy for floor nursing personnel and the RT to avoid this simple and necessary task. My experience is in the operating room at a very large teaching hospital. But the regulations and basic structures should be similar in small hospitals as well.

A little background. All hospitals that accept Medicare patients ( and therefore Medicare reimbursement), and this includes virtually ALL hospitals, must adhere to Joint Committee for Accreditation of Healthcare Organizations (JCAHO) standards of care. So... the majority of HOSPITAL based policy is designed with JCAHO standards in mind.

I'm guessing the RT in question is using the word FEDERAL because he/she believes JCAHO says no you can't do that. IMHO I doubt that is the case. Am guessing that most likely there is a poorly written HOSPITAL policy that essentially says "keep your hands off expensive patient owned equipment" (because we don't want to pay to replace it if we break it). A better hospital based policy appears to be the case as Dori has described. Sign a release so hospital isn't liable if humidifier is broken and help teach the staff about humidifiers & CPAP therapy in general. Kudos to the staff at Dori's hosp for their pro-active approach!

Here's how I would try to solve this very frustrating problem. Would start with head nurse on the unit/floor (and then move up the food chain). Also known as charge nurse/unit supervisor/nursing supervisor depending on which part of the country you're from. The unit secretary/ward clerk at the desk area on that particular floor can tell you which nurse is in charge on each shift. I'd have a pleasant chat w/ this person, using the SWEET approach described by Rested Gal. Would do it during the day shift 7am-3pm. I would GENTLY point out that you have many years of experience w/ CPAP, that quite often many folks are unfamiliar w/ the therapy, etc. Try to establish some credibility as a CPAP expert. Then GENTLY point out that no heated humidification is causing 2 BIG problems.

#1- Pain & Bleeding from the super dry tissue, this is a quality of care issue, easily solved with heated humidificaton. Problem #2- Potential for Infection- Gently point out that any body tissue that is normally moist needs to STAY moist. If it doesn't stay moist, then you (could be) facing nasty INFECTION possibilities. Explain & demonstrate how simple it is to fill humidifier, and tell 'em you will provide the distilled water.

If you get nowhere w/ charge nurse, then continue down the nursing path but choose a different direction. Politely but firmly tell floor supervisor RN that you wish to MEET w/ the Infection Control Nurse (they almost always work the day 7-3 shift- today. They will have one- JCAHO requires it. Tell them you aren't worried about infection FROM the humidifier, you are concerned about infection from the LACK OF HUMIDIFICATION. And the solution is quite simple- heated humidification.

If you are still getting nowhere, you could meet w/ Quality Control Nurse or a Nurse Educator/Patient Educator.

I'm not getting a good feeling about this particular RT, but you could talk to the RT supervisor.

And, at the top of the food chain, the Hospital Administrator on Call.

Have a notepad and make a point to write down who you talked to, when and what they said. You could say something like, "What is the name & phone number for your Infection Control nurse? Perhaps he/she can help us solve this problem" "Could you page them for me?".. The fact that you know they even HAVE an Infection Control Nurse will most likely convey the message that you're 'medical smart' and in problem solving mode.

And,yes, you can always get your MD to write the order. Would be best if MD writes exactly WHO fills the humidifier. Would hate to see nursing staff saying it is a RT function, & RT saying it is nursing function.

Hope this helps.

[archangle]

This does add to the evidence that hospitals are stupid about CPAP and really need to be educated about how important it is. Along with how bad it is to force patients to sleep on their backs.

Now, how do we do something about it?

[rested gal]

Excellent suggestions, "Guest."

[chunkyfrog]

We could all become CPAP advocates and coaches.