Q & A: Problem-Solving with Catherine
Just curious, what is the practice of your acute care facility when it comes to silencing/pausing monitors? Are SLPs permitted to silence or pause the alarms in your facility? Is there a policy on this in your facility? I am interested in all populations, but particularly interested in hearing from NICU therapists. I’ve done a lit search on this and have come up empty.
Answer: This is a complex question. As therapists in the NICU, we have the potential to cause harm, as the infant whom we are treating, by the nature of his need for intensive care, can indeed exhibit significant physiologic instability both during feeding readiness interventions and during attempts to coordinate sucking, swallowing and breathing. The neonatal nurse who is caring for/”assigned to” the infant you are treating is responsible for his medical stability. As therapists, we need to foster strong relationships with, and respect for, the bedside RN. She is your partner in care and there to both guide you, inform you, and intervene to support the infant with whom you are interacting. Your conversations with her should include how the infant has been doing, which will include his recent (~24 hour) and baseline physiologic stability and any concerns she may have about how fragile he might be, what conservative measures you might need to take during you treatment. That conversation should also include making a plan with her, should the infant show signs of impending or indeed acute instability. Be sure you know what those signs might be for that infant; if you are not sure, don’t hesitate to ask for her guidance and teaching. I learned long ago (YIKES! almost 30 years now) that asking questions or for guidance in the NICU is critical for learning about this unique environment and fragile population, as well as the complex (and ever changing!)medical information that impacts our care. We gain the respect of our neonatology and nursing colleagues by never hesitating to ask their input and guidance; if we don’t ask the questions or have the conversations we should, to build this partnership, we place the infant at undue risk, and we also risk respect that can be afforded to our profession. Each interaction with nursing prior to seeing the infant should be of the utmost importance. The nurse can clarify when to notify/call her, what objective parameters are ordered for that infant’s vital signs (HR, RR, saturations), what are the normal ranges for those parameters for him, what physiologic changes warrant her immediate notification so she can assess the infant. When the infant alarms, there is a reason; maybe it is an simple as the equipment is not picking up the signals, but most often it can reflect impending decompensation or indeed an acute event. The alarms, which “sound” often up to 15 seconds after vital signs actually have started changing, mean the infant requires immediate and accurate assessment and likely intervention. Your learning as an NICU team member and your conversation with that bedside nurse before that session should guide you. Never hesitate to ask for help when the infant alarms. Your understanding of why the infant alarmed, what to then assess, what to do, when to stop doing it and when, despite what the monitor says, the infant is not responding, are skills not quickly learned in the NICU. After all these years and so many wonderful nurses mentoring me and helping me hone my skills, many of the nurses trust me implicitly to support the infant. I still look to them to guide me, and respect their value from moment to moment, as the infant’s safety is at stake. With each and every nurse whose infant I work with on a given day, we have the conversations I described above, before I ever lay hands on that infant. The conversations reinforce our partnership, our mutual respect and regard, and offer me so many opportunities to learn and grow every day.
I hope this is helpful.
Catherine S Shaker, MS/CCC-SLP, BRS-S