Rounding on patients at night - page 2

I round on my patients every 2 hours. I go the opposite hours that the CNAs go, that way my patients are being checked on every hour. Some people might think it's overkill, but it's just the way... Read More

  1. Visit  FlorenceFrightengale} profile page
    3
    At the beginning of the shift, I let the patient know I'm there until 730 and that although I'll physically peek in every hour, I don't wake him or her unless necessary. I'll give a little plan, "you have a heart monitor so I'll be needing to wake you around 4 AM for vital signs then at 6 AM for your Synthroid pill, otherwise I'll peek in but let me know if you need me if you don't see me. I'll make sure you have your call bell handy."

    When I round I check to make sure the bed alarm is on (if warranted), call bell and personal items are within reach and the patient is breathing evenly. If the patient is incontinent or a turn, I will obviously check him or her every two hours or more often.
    Soon2BNurse3, joanna73, and loriangel14 like this.
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  3. Visit  MInurse.st} profile page
    1
    I come in at 11 two nights a week so I often have to wake up my patients to introduce myself and do an assessment. I work on a surgical floor, so when I patient comes from PACU we do vitals q1 X4h. Otherwise q4 (midnight and 0400). For a post-op fresh off a PCA and on PO pain meds I ask them during my assessment if they want to be woken up for the pain meds.
    Fiona59 likes this.
  4. Visit  monkeybug} profile page
    1
    Quote from loriangel14
    Why would you wake a sleeping patient? We do rounds on my floor qh.I slip in, check for comfortable breathing and leave. If they are sleeping we assume they are not in pain. We would never wake a patient for a PRN med.

    If I was a patient I would be furious if my nurse woke me up to "see how I was doing". LOL I don't sleep well at the best of times and I would be up for the rest of the night once I was awake.
    Assuming that because they are asleep that they are not in pain would be an incorrect assumption to make in some cases. It is absolutely possible to sleep while in pain, even severe pain.
    proud nurse likes this.
  5. Visit  loriangel14} profile page
    0
    That's true.
  6. Visit  somenurse} profile page
    5
    I haven't read every reply, but the headline of this thread,
    reminded me of something i used to do if i had a patient i did NOT have to wake up, yet, did want to see. If i did not round with the CNA, sometimes i'd do this.

    I would take a large styrofoam cup, place it upside down, and stab a pencil or plastic knife into the base of cup (which is now at the top)
    and tape a peice of paper to the top of the pencil, which read something like, "HELLO! Please ring your bell if you wake up and see this! From- Your Night Nurse who wants to see how you are!"
    or something along those lines.

    then, i'd place this on their nighttable, where they'd be sure to see it.
    Worked everytime, and usually, the patients chuckled hugely over this, really got a kick out of it.

    That way, i DID get to see them during the night, and the patient got to choose when. (be sure you have collected all these "call me" cups at end of your shift!)
  7. Visit  brownbook} profile page
    3
    Do not document that a patient is asleep. I honestly am not at all paranoid about lawyers and law suits. However that is a big no no.

    Can't you just hear a lawyer asking you, "how did you know he was asleep and not in a coma?"

    Document the patient lying supine on bed, eyes closed, respiration's even and unlabored, skin warm and dry. If vitals had been taken with that assessment chart VSS.

    I am not the best at documenting and charting, there are probably better ways to word it.
  8. Visit  somenurse} profile page
    1
    Re: charting, i only charted what i observed. Depending on that facilities charting rules or format,
    i might chart "Eyes closed, Resp unlabored, skin pink, w&d, no s/s of distress" or, "turning self from back to side, eyes closed, resp unlabored, skin pink w&d" or "eyes closed, snoring loudly, skin pink W&d"

    sometimes i add in resp rate, too.

    I'd chart whatever i saw when i stood there, IF i did not 'have to' wake them up.
    joanna73 likes this.
  9. Visit  joanna73} profile page
    2
    Although the CNA's make rounds, I make my own rounds hourly. This way I know for certain what condition my residents are in. And if someone is sleeping comfortably, I'm not waking them up to inquire about pain. Rest is the best medicine, and I administer pain meds at bedtime and when they ring, or when they're up to the toilet.
    loriangel14 and Fiona59 like this.
  10. Visit  wanderlust99} profile page
    1
    I had a patient who I thought was sleeping all night and doing great, until I went in around 0630 before shift change and he started yelling at me, telling me I didn't do my job and he was in pain all night. I checked on him multiple times and his eyes were closed. Maybe I missed the times he was awake and in pain? I learned my lesson from that one. If I had told him the plan for the night and stated when I will wake him and how I want him to sleep and please use the call light, we could have avoided the horrible yelling and things he said to me.

    It's better to wake them up and have them complain that they didn't sleep all night versus complain that you neglected them.

    Glad I don't work nights anymore!
    proud nurse likes this.
  11. Visit  SionainnRN} profile page
    1
    Quote from getmethisnownurse
    I had a patient who I thought was sleeping all night and doing great, until I went in around 0630 before shift change and he started yelling at me, telling me I didn't do my job and he was in pain all night. I checked on him multiple times and his eyes were closed. Maybe I missed the times he was awake and in pain? I learned my lesson from that one. If I had told him the plan for the night and stated when I will wake him and how I want him to sleep and please use the call light, we could have avoided the horrible yelling and things he said to me.

    It's better to wake them up and have them complain that they didn't sleep all night versus complain that you neglected them.

    Glad I don't work nights anymore!
    To avoid that I would usually ask my pts at the beginning of the night if they wanted me to wake them up when they were due for pain meds, or if they were sleeping to let them sleep. Did you ask the pt if he was in pain why he didn't use his call light? We are not mind readers and if he didn't tell you he was in pain and wanted meds there is no way for you to know. I've had pts pull stunts like this, yell up and down how they can't sleep, need meds, etc and when I pull the meds and go in there they are sound asleep. They wake up later mad they didn't get their meds, well you were asleep, not gonna wake you up to give you your sleep meds!
    loriangel14 likes this.
  12. Visit  silverbat} profile page
    5
    I worked nights for 15 yrs in a hospital. I got good at going in rooms and not waking up patients.
    I always said that I could see quite well in the dark and must be part bat!! ahem.... ok...so I am "batty", but that's beside the point! I did have to laugh when a confused pt complained that "people were looking at her all night" and "my family thinks i am crazy because i said that"!!!! I explained to pt and family, that she was telling the truth, that people were coming into check her off and on all night!!!!!
    loriangel14, Intentional, joanna73, and 2 others like this.
  13. Visit  classicdame} profile page
    3
    sleep is beneficial to healing. Don't wake me up to ask me about pain. I will let you know.
    loriangel14, Libitina, and joanna73 like this.
  14. Visit  rdsxfnrn} profile page
    0
    Curious as to what all of you would do in this situation IF the pt was pretty much non verbal, hospice and cmo. Would you let the patient go for 10 hrs without any (prn) pain and anti anxiety meds?


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