I’ve
always suspected that some students come to class for certification only to
return to their place of employment to provide patient care that resembles nothing
that was taught in class. In many
instances these students are experienced clinicians who have good intensions
but intentions based on false reality.
Stay
with me…
In
many instances people think they provided appropriate care however the reality
is that the care rendered was less than ideal.
Regardless of the system, EMS, ER, Code Team, Surgery, Post Op; etc.… each
system is made up of motivated, genuinely caring, and highly educated
individuals that over time can lapse into routine and bad habits.
The issue isn’t the
failure of the system to meet the standard, but instead over time, substandard
becomes the norm. The distinction,
though, is important.
While ages vary, a
large majority of cardiac arrest patients involve the elderly, having multiple health
issues with other contributing factors.
During these incidents, the “code team” will arrive to attempt to
resuscitate the patient and in the case of an unsuccessful resuscitation,
everyone would simply consider it ‘the patient’s time.” I mean, he/she was elderly, had an extensive
medical history with other contributing risk factors. Had they failed to resuscitate him/her, that
would have been sad, and tragic, and…perfectly acceptable for all the same
reasons. *
* How Hospitals Kill Our Loved Ones And Conceal It, March 17, 2017
The disturbing
part is in the case of a successful resuscitation, the team will be
congratulating itself for saving his/her life while overlooking long pauses in
CPR, late medications, improper defibrillation, not switching chest compressors
every two minutes, or CPR that isn’t 30:2 as taught in class….
We haven’t even
discussed return of spontaneous circulation (ROSC), in some instances we make
things worse rather than better. The
patient just came back from the dead and we tend to want to administer fluid
(fluid overload) or slow a heart rate that is fast secondary to Epi
administration. We need to give the
patient time to normalize. I’m not
saying withhold treatment from a symptomatic patient. What I am saying is “the enemy of good is
better” especially in the ROSC state.
We have all been
on those resuscitations where everything went well, we were on top of our A
game and all things worked for the good of the patient. I would hope those arrest cases outweigh the
ones where northing we did reflected the standard taught in class.
It is reported
that medical errors are the third leading cause of death in the US. More alarming is that number does not reflect
the number of deaths caused by the deficiencies in the standard of care. Many times, patients die of what seems robbing
Peter to pay Paul, when and one complication leads to the next issue; when in
reality poor treatment was the cause of the decline in the patient’s
condition.
A standard of care
is simply that, a standard and over time with good intentions and poor habits
the standard can become substandard but considered the norm. In these instances, a bad outcome is an
expected reality, rather than the reality check it ought to be.
To be clear, sick
people will die even when care is appropriate. But when patients die due
to a substandard of care, the failings go unnoticed.
My challenge to
each of you is to question yourself and the system. Did you do everything possible to ensure a
successful resuscitation? Was CPR 30:2,
interruptions in CPR less than 10 seconds, were shocks and medications
appropriate and timely? Did the standard
of care regress to innumerable and unnecessary lapses in treatment? Did the patient survive despite our best
efforts to kill them?
Take
a look at the big picture, debrief after every resuscitation attempt have the
courage to discuss what went well and what can be improved upon. The standard of care is a veil over its own
potentially lethal inadequacies.
Clinicians
can unknowingly contribute to a patient’s death, despite hard work and good
intentions, and conceal it even from themselves. It hides in plain sight;
it is business as usual. It is up to all of us to self-reflect, is my
medicine as good as I think it is? Is
there something I can do or the system can do better during a
resuscitation? Cross the T’s, dot the I’s, be an advocate for both the patient and good medicine.
#practice #acls #pas #smallbusiness #cpr #aha
- Brian Davis
Heartland CPR, llc
405-603-6666
www.HeartlandCPR.com
