Hospital IGNORED my doc's PAP order!!!

[Pugsy]

Not taking sides here..one way or the other but it is possible that the protocol for OSA patients is that cpap machine is implemented if needed as shown by a drop in oxygen levels below a certain amount. That O2 sensor on the finger is worn all the time. When I had surgery I was told to bring the cpap machine (by anesthesiologist) and told that if there was a problem that the cpap machine would be used and that my O2 levels would be monitored continuously. It was not ever needed.

OSA is so very common now that I bet there is some sort of standard protocol behind the scenes.

[Sleep2Die4]

I didn't have an "attendant" to always be there.
If I had, they would have seen that I was having trouble breathing prior to me waking up. BTW, the O2 alarm was going off when I woke, so I was in some distress at the time.

In addition to OSA, I have severe COPD,

If you still think I'm over reacting

No Komodo, now that you have added some information to the story, I don't think you were overreacting.

All of my experiences, in two different hospitals, were very different from your experience.

If I had trouble breathing to the point that the O2 alarm was going off (not sure what point it is set to alarm) and there was no attendant present, I would also have been upset.

Did I suffer any long lasting harm? No I didn't.

I wasn't asking about longterm harm. What you experienced was harm, even if only shortterm, and it should not have happened. What kind of attitude does the hospital think you will have if you show up again for another surgery?

CPAP or not, I think an attendant should be present with you in the recovery room. During the recovery I would not trust the CPAP to do its usual job because the body and mind are in an unusual condition.

If I ever have to undergo another surgery I want to be sure to ask in advance about a personal recovery room attendant present and observant every minute.

[Komodo]

No Komodo, now that you have added some information to the story, I don't think you were overreacting.

No harm, no foul, no problem.

On a side note, after I was fully awake and had no problems breathing, just for "Fun" I took off the O2 sensor. The alarm goes off, and it took them 12 minutes (I timed it!) before someone came over to check it out!

[Pugsy]

just for "Fun" I took off the O2 sensor. The alarm goes off, and it took them 12 minutes (I timed it!) before someone came over to check it out!

Now that is typical unfortunately.
Sounds like something I would have done also. I like to test them too.

[BlackSpinner]

Perhaps your surgeries were more serious, or you were in a better hospital than I was in, but I didn't have an "attendant" to always be there.
If I had, they would have seen that I was having trouble breathing prior to me waking up. BTW, the O2 alarm was going off when I woke, so I was in some distress at the time.
.

Neither did I last time I was in. (But that was quite a few years ago) There was one person in the room who eventually came by after I had been awake for some time.

[Slinky]

I was just thinking .... even at one nurse per recovery patient, don't even try to tell me that if one of the patients "crashes" the other nurses do not leave their patient to assist in recovering the "crashing" patient! And if my nurse is one to rush to assist and I stop breathing .... ??? Would my PAP, if it were on, keep me going long enough for my distress to be noticed???

There are articles and abstracts verifying the benefit of CPAP, bi-level PAP, etc., in recovery after surgery.

[chunkyfrog]

Komodo: If you are so inclined, may I suggest a registered letter to the hospital administrator,
fully detailing your experience--especially all that you have shared with us.
I would also cc to the state hospital licensing board, your insurance carrier
(especially if it's Medicare), and, of course, your sleep doctor.

[ChicagoGranny]

On a side note, after I was fully awake and had no problems breathing, just for "Fun" I took off the O2 sensor. The alarm goes off, and it took them 12 minutes (I timed it!) before someone came over to check it out!

How low does O2 have to drop to set off the alarm on hospital machines?

[Slinky]

I'm guessing 88% because that is the level that had the nursing staff considering requesting an 02 order from the doctor during my last hospital stay. All I had to do was take a deep breath to take my sats up to well w/in acceptable range but just laying around my sats would drop on occasion.

And during one of my sleep tests I was told that there was an 02 concentrator just outside the door and that if my 02 sats dropped to 88% or below for any length of time I would be started on 02. The sleep study prior to that the nurse actually came in the room to check the 02 sensor fit on my finger and told me my sats had dropped to 88% and if it continued to do so she would need to call the doctor for an order to administer 02.

[BlackSpinner]

I'm guessing 88% because that is the level that had the nursing staff considering requesting an 02 order from the doctor during my last hospital stay. All I had to do was take a deep breath to take my sats up to well w/in acceptable range but just laying around my sats would drop on occasion.

When I was in ER recovery last year the alarm was turned off but the numbers turned red at 88% there too.

[FarmGirl]

OK.... I feel I must come to the defense of my fellow nursing professionals.

Unless you are a PACU RN, you don't know the monitoring alarms limits nor the policies which govern patient monitoring.

Generally, SpO2 alarms are set with 2 levels (if the monitoring system is capable) - a low level (well within norms) and a critical level (falling below norms). Just because you hear an alarm, it doesn't mean you are in crisis (or that it's even "your" alarm). I can also promise that you are never "left alone" to wake up on on your own. While you are still (basically) unconscious and under the influence of strong amnesiac drugs, you receive very nearly one-on-one attention until you are able to generally follow simple commands (cough, lift your head, take a deep breath). After that, you were likely observed from a slight distance.

I was just thinking .... even at one nurse per recovery patient, don't even try to tell me that if one of the patients "crashes" the other nurses do not leave their patient to assist in recovering the "crashing" patient!

Yes, I will tell you that when one patient "crashes" a FEW nurses leave their STABLE patients to assist. Other nurses also help to pick the temporary slack while the primary RN is away. You would be perfectly fine.

On a side note, after I was fully awake and had no problems breathing, just for "Fun" I took off the O2 sensor. The alarm goes off, and it took them 12 minutes (I timed it!) before someone came over to check it out!

Yes, the nurses already knew you were fully awake with no breathing difficulties and had purposefully taken the probe off. You had already to indicated (consciously or unconsciously) you were well awake, aware and in no distress (hence, all the monitoring wire attached to you). I wouldn't have come running at that moment either.

As to the OP..... take it as a lesson learned. The pulmonologist/sleep doctor had no "dog in that hunt." Why? Because the surgeon (the primary MD in the case) had not consulted him. The pulmonologist/sleep doctor could write every order conceivable on your chart, but until such time as he is consulted, the nurse cannot and will not follow those orders (s/he has no order from the primary MD to follow those orders).

How do you avoid this in the future? That's actually pretty simple. TALK, TALK, TALK, TALK, TALK..........
** Have an in-depth chat with the MD performing the procedure well before time about your specific needs regarding recovery.
** Ask the surgeon to call your pulmonologist/sleep doctor to discuss your needs (or even have the pulmonologist/sleep doctor send a letter detailing your needs and his recommendations).
** Discuss your medical/xPAP history in detail with the admitting RN and insist to have a note prominently placed on your chart that you are to have an order to use your xPAP machine in the PACU.
** Have another chat with your surgeon (preferably with a family member present, especially if you've been given mind-altering drugs) when he comes to see you in the pre-op area and remind him about your discussion and needs.
** Have an in-depth discussion with the anesthesiologist/CRNA (with a family member present) who comes to evaluate you in pre-op and make sure they are aware of your needs.

Just an anecdotal note..... When my hubby had outpatient shoulder surgery, he told the surgeon he used CPAP. The surgeon encouraged him to bring his machine, but made it a point to tell him he would have to be able to put it on himself (with extremely minimal assist) when he was awake enough to comprehend his need/want for it. That was their policy. In the admitting/pre-op area, we again told the RN about the CPAP and that doc wanted him to bring it and use it in PACU. She made a note, tagged the machine and put it on the bed on top of the sheets. When I was allow into the PACU (about an hour afterward), the RN was sitting immediately behind the head of his bed observing him and the monitors (as well as a patient about ready to leave). Hubby was already awake enough to don and doff his hybrid mask with little help. He later told me there was no issue about getting his machine and using it (he directed the nurse with set-up as he was not allowed out of bed).

Now.... I've said all of this to say....... Know who is able to write orders on your chart. Preferable have a copy of the CPAP usage orders from the primary MD in your hand before the day of the surgery and give a copy to the admitting/pre-op RN. Continue to remind the surgeon and anesthesiologist about your needs. Everyone here is quite vocal and independent about using/tracking their CPAP. It doesn't need to stop just because you're brushed off once, twice or even three time.

/steps off my soapbox/

[Slinky]

Thank you, FarmGirl. I am sure there are some minor variations of your unit's precedure and others but I am also pretty confident that they are somewhat similar and your advice should "work" for us w/them too.

[Bookbear]

I recently had surgery...

Hey Bookbear, sure hope your recovery is swift and complete!

Thanks! Further biopsies done next week, then the well-known 'waiting game'......