physician

ICU Physician Unveils New Self-Extubation Order Set

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AUGUSTA, ME – An ICU physician in Augusta, Maine is now using a self-extubation order set.  “It is a beautiful concept, really,” gushes ICU physician and order set creator Teresa Elder.  She elaborates, “I’m a firm believer in patient autonomy.  When a patient has failed a spontaneous breathing trial after spontaneous breathing trial, sometimes you just have to let the patient decide what is best for them.”

physicianBased on the initial data provided by Dr. Elder, the vast majority of patients decide they no longer wish to have their vocal cords ravaged by a large plastic tube.  She injected a new concept into her ICU in August of 2013 and hasn’t looked back since: the self-extubation order set.

Nurses are asked to discontinue sedation, loosen physical restraints, and minimize time spent at the bedside.  At this point, most patients choose to do what any normal human would do: they defend themselves against the evil machine attacking their face with compressed air.

“It is either a slam dunk extubation or not.  For those high-risk extubations, it just makes sense,” continued Elder.  “Why accept that medical-legal liability?  Technically, the documentation reflects that I’m not making the decision to extubate at all.”

Aside from rates of reintubation soaring light years above rates traditionally considered acceptable, the order set has been a big hit.  ICU length of stay times are down, for one reason or another, not excluding death.  Patient satisfaction scores are up, and Elder hopes to see a larger electronic medical record firm distribute her order set across the U.S.

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  • Avatar
    Ryan Madanick, MD

    T2 Believe it or not, I watched an anesthesiology prof self-intubate when I was a #medstudent #meded

  • Avatar
    Jo H Rina

    Yes!!!!

  • Avatar
    Caitlin Foxley Siler

    Raymond Broyles McCormick- no, I’m a physician actually. Hospitalist.

  • Avatar
    Raymond Broyles McCormick

    Or his….remember, men are nurses too!!! It is the nurses responsibility to talk to the doc not the RT anyway.

  • Avatar
    Raymond Broyles McCormick

    Or his….remember, men are nurses too!!! It is the nurses responsibility to talk to the doc not the RT anyway.

  • Avatar
    Raymond Broyles McCormick

    You are such a nurse!!!!

  • Avatar
    Raymond Broyles McCormick

    You are such a nurse!!!!

  • Avatar
    Raymond Broyles McCormick

    The willies don’t like it either

  • Avatar
    Raymond Broyles McCormick

    The willies don’t like it either

  • Avatar
    Raymond Broyles McCormick

    OUCH!

  • Avatar
    Raymond Broyles McCormick

    OUCH!

  • Avatar
    Kentner Scarborough

    Perfect for the U! Tony Defebio

  • Avatar
    Kentner Scarborough

    Wouldn’t do it as the RT just because I’m worried about the nurse getting blamed- it’s her patient- usually I’ll just talk directly to an attending if a resident gives me that kind of bs.

  • Avatar
    Cindy Little

    Grins

  • Avatar
    Tammy Novotne

    but we’re still billing for that sh*t

  • Avatar
    Helen Aanstoos

    The self-Foley cath removal really gives me the willies. Balloon, what’s that?

  • Avatar
    Anonymous

    That makes no sense!

  • Avatar
    Casey Overton

    Meredith Daugherty Burk

  • Avatar
    Suzanne Baldivieso

    Standing orders for O2 100 percent nrb bipap prn dc ogt swallow eval in am!

  • Avatar
    Courtney Parker Fischer

    Sarah Harris hahahahaha

  • Avatar
    Colleen Edgington

    ‘Not excluding death’

  • Avatar
    Siobhan Devlin Kocher

    Decreases length of stay for one reason or another lol.

  • Avatar
    Elizabeth Jane Welch

    Yes!

  • Avatar
    Janet Allen Myers

    Where can we sign up? I need to talk to someone ASAP!

  • Avatar
    Benjamin Tucker

    Janet Allen Myers

  • Avatar
    Chris Williams

    they say loosen restraints, if they are in them do they have mental capacity to risk extubation

  • Avatar
    Philip Moores

    Wow that’s brilliance. That’s how you be a patients advocate!

  • Avatar
    Melinda Cushing Riter

    Too good.

  • Avatar
    Craig Errigo

    Matthew Webster

  • Avatar
    Craig Errigo

    let’s do this asap

  • Avatar
    Debra Neal

    Patients do this every day WITHOUT an order.

  • Avatar
    Sharon Apicella

    Hahaha its a slam dunk

  • Avatar
    Jason Johnson

    ‘sedation vacation’

  • Avatar
    Richard Ole Olson

    The insurance companies must love it!

  • Avatar
    Craig Errigo

    Sharon Apicella Mitch O’Shea

  • Avatar
    Raymond Broyles McCormick

    provide the research that it is ethical and provisional!

  • Avatar
    Raymond Broyles McCormick

    Sierra Mist suck…could be why

  • Avatar
    Raymond Broyles McCormick

    I have worked in States that RT intubates and some don’t….

  • Avatar
    Raymond Broyles McCormick

    which part?

  • Avatar
    David Hammond

    This has crossed my mind more than once, ha!

  • Avatar
    Caitlin Foxley Siler

    I only gave this article three stars, since the order set wasn’t included.

  • Avatar
    Renee Dittmar

    Too funny!

  • Avatar
    Raymond Broyles McCormick

    How can you teach nursing without working in the arena!?

  • Avatar
    Raymond Broyles McCormick

    Now, I am nursing professor…PhD. Oh, and after 40 years of nursing, I just stopped working in a hospital setting a month ago!!!!

  • Avatar
    Beth S Brock

    It would be dandy if they were all DNIs … But not !

  • Avatar
    Juliana Morawski

    But, Dr Elder completely ignored the requisite warm blanket, turkey sandwich and Sierra mist. Fail.

  • Avatar
    Raymond Broyles McCormick

    Oh, please don’t get me wrong…I had been a critical care nurse for 20 years at that point… lol

  • Avatar
    Raymond Broyles McCormick

    WOW, a forward thinker. I will admit, about 2 decades ago. I had a patient intubated and on the vent on CPAP….He had been on it for hours and hours. I called the resident to get the patient extubated…he stated, “I have to check with the Chief!” I said, NO, he is ready to be extubated. He frantically said…I will call you back. An hour later he did not call back. So, I deflated the balloon on the ET tube and told the patient, who was completely with it, “Pull the tube out quickly and in a straight line. He did…said, Thank you. I called the resident back and told him the patient extubated himself and is on nasal cannula at 2L. The patient went home the next day.

  • Avatar
    Nicole Jenkins

    Perhaps it should be reserved for pts who have, for behavioural reasons, failed traditional weaning attempts. There should then be a clause in the orders that it’s a one way extubation. A sink or swim if you will. That would fix the reintubation rates.

  • Avatar
    Nathan Lott

    Heheheheh! That’s a winner here on the west side !!!!!

  • Avatar
    Francisco Paz

    Easy: “q2 min ETT suctioning, chlorhexidine q15 min alternating with standard oral care, and haldol 0.005 mg q 12 hr PRN for goal rass +3 to +4.” Either the patient or the nurse will have the tube out in an hour or less

  • Avatar
    Rita Patel

    Truthfully, I DO need to practice intubating more ICU patients. Let’s do it.

  • Avatar
    Andrew Karl Terry

    Nathan, an idea for you…

  • Avatar
    Beth S Brock

    Yes. Pt stays are less. That’s all that matters!

  • Avatar
    Abby Barrows

    Lmao!!!! Hey if pt satisfaction scores are up, it must be ok.

  • Avatar
    Jody Goard

    Saad Khan

  • Avatar
    Andrea Sears Garr

    Lol Michael Garr Sara Gilliland Hale

  • Avatar
    Melissa Saxton

    Lmao

  • Avatar
    Jessica Lee Vera

    Lol

  • Avatar
    Eric Strayer

    Haha

  • Avatar
    Christine Michele

    lol!!!

  • Avatar
    Lesley Martinez

    Ibrahim Sammour when do we start!! :)

  • Avatar
    Ibrahim Sammour

    Jose Perez Rosenada Jose Antonio Bello Lesley Martinez Ana Cecilia Aguilar

  • Avatar
    Alfant Gomez

    Epic!! Sooo funny

  • Avatar
    Dawn Langley

    Lol

  • Avatar
    Luigi Zolio

    Ashleigh get on this

  • Avatar
    Tanya Saunders

    Aghck!!

  • Avatar
    Angie Florence

    Samantha Diaz is this in Epic?

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