Pet peeve, bad practice, or overly critical?

canigraduate · Dec 8, 2014

The OP is correct. It is absurd to make a chlorhexidine bath THE priority on an ICU admission instead of ensuring that the pt is hemodynamically stable.

I don't think anyone is saying to make it the priority. Just to make sure it gets done. If you have someone who is hemodynamically unstable to the point where you aren't able to roll them to remove the ER linens, then you can't do a CHG bath. I and others are just saying that if you are going to roll them anyway, why not do your CHG at the same time? It's less traumatic on the patient to do it only once.

ETA: I see you added some more to your post. I think we are essentially in agreement.

DogLover17 · Dec 8, 2014

We have nurses who do the same thing. However, our policy is that the patient must be assessed within 30 minutes of arrival to the unit. I assess, look over my orders and make sure there's nothing that has to be done immediately, and then bathe them. It's usually within the first 2 hours or less.

blackvans1234 · Dec 10, 2014

Im a new grad on a Cardiac Stepdown Unit.

My preceptor has told me- the two most important things when you get an admission (in no particular order)

1) Get their vitals

2) Get them on tele

dah doh, BSN, RN · Dec 10, 2014

So, here is my issue. When a new patient is admitted at night, we generally try to get our CHG bath knocked out within the first half hour. Our policy requires us to CHG bathe our patients within 12 hours of admission. Management has been getting on us pretty hard as of late, since our numbers are rarely 100%. The issue I have with this is that many nurses seem to focus on the bath as part of the admission over getting them onto the monitor. Patients are generally admitted to us because of a serious issue that will impact a vital sign...as such, my focus is on getting them on a monitor as soon as they are in the bed and developing a game plan for abnormal vitals as soon as possible. Are my priorities in order here or am I being overly dramatic? In my thinking, a patient can be absolutely stay dirty until I get a monitor on them. Why are these nurses okay with bathing the patient and getting the dirty sheets from transport out from under them while they are off the monitor? I feel like I must be missing something. Is this only happening on my unit or is this common elsewhere?

We are required to do the CHG bath ASAP upon admission and daily if the patient has a central line. We also have the "life saving MRSA nasal swab" upon admission to ICU & transfer out if length of stay > 96 hr in ICU.

If the patient is unstable, the CHG bath comes after stabilization; otherwise we just get it done when we roll the patient off the transfer sheets and lots of people are in the room to help out.

SubSippi · Dec 10, 2014

OP, I think the general consensus comes to two things:

1. Your coworkers have their priorities a little out of whack, and that you're right in getting patients hooked up to a monitor.

2. You can have the best of both worlds with some good old fashioned teamwork.

NPOaftermidnight, MSN, RN, NP · Dec 12, 2014

Bathing seems to be the first thing people jump to, and sometimes they get too focused on that when there are other (much more pressing) things to do. Especially the new grads/orientees. Some nurses will freak out if a CHG wipe touches the patient before they're on the monitor, which is a little ridiculous since there are typically 3-4 other nurses in the room and we are generally doing all of these things simultaneously. I was recently yelled at by fellow nurse for initiating a bath when the patient was not hooked up, even though there were TWO other RNs actively hooking the patient up to the monitor. That was a little overkill. Next time should I just stand there with the wipe in my hand while they finish?

I also am a little more lenient about it if it's a stable transfer that is awake, alert, and talking to us. But trying to bathe a fast-tracked trauma patient or an intubated/sedated/paralyzed patient direct from the OR before they're all hooked up? Obviously that's a bad idea.

Sugarcoma, RN · Dec 14, 2014

NO! You are not being overly dramatic. This is one of my biggest pet peeves. No patient of mine will be off the monitor. This includes during the bed transfer! I always tell the transferring RN's don't you dare pull your equipment off until I have mine on! The PCA is always chomping at the bit to get that bath started ASAP and they are not always happy with me when I tell them they have to wait until the monitors are on and I have assessed my patient! Then the aide and I will do the bath together so I can also do a thorough head to toe and skin assessment.

OP just to give you a few examples of things that I have witnessed:

PACU pt. brought in and monitor pulled off, they stand around waiting for the PCA and receiving RN to arrive to assist in the bed transfer, pt. transferred to bed, hooked to monitor.....V-fib. Coded for almost an hour, didn't make it.

Another patient who came from ER, very unstable per report, on multiple pressors etc. 3 Nurses and one aide performed bed bath, apparently no one performed pulse check during bath. Pt. was asystole when they finally got her hooked up.

Now obviously these were unstable patients and those few minutes off the monitor may not have made any difference in the outcome but I know that if my loved one went into v-fib I would not want it to take 5-10 minutes for anyone to notice!