Vital signs/Less interruptions for patients during night shift

Pangea Reunited, ASN, RN · Sep 26, 2015

We do 20:00, 00:00 and 04:00. At one place I worked, the nurse decided which patients needed 4AM vitals to be taken and everyone else got a pass.

As far as the complaining goes, I let them know that they can catch up on sleep when they get home ...and that if they were "normal" enough to be left alone all night, they wouldn't have been admitted to the hospital. They also have the right to refuse, of course. At least I know they're able to wake up when they say "no".

And for patients who are uncooperative and "scary" (stability wise), I let them know about a few times when patients have died overnight because they didn't want their sleep interrupted. It's happened!

meanmaryjean, DNP, RN · Sep 26, 2015

In Peds ICU- our standard is Q2H vitals. One of our intensivists (a very wise man) once said in response to this very question "The order says 'Vitals Q2' - it doesn't say WHICH vitals, now does it?" Unless there is a compelling clinical reason, we just take vitals off the monitors, and save the vitals that would disturb the patient for when they are awake.

loriangel14, RN · Sep 26, 2015

We do ours in the AM before meds and at HS before meds.

Karou · Sep 26, 2015

We do q4hr at 1900, 2300, 0300. Patients are q4hr for 24 hours after admission, post op patients, those on PCA's or anyone who is remotely unstable and/or with abnormal vital signs. Patients that are q8hr are just at 2300 for night shift.

Here.I.Stand, BSN, RN · Sep 26, 2015

Typically q 4 hr VS are done on the multiples-of-four hours --0000, 0400, 0800 etc.

I've had five babies, so speaking from personal experience in your type of unit, I only had an 0400 set done the first night. The need for rest is very real and should be protected when possible; Iwould think about how when I got home, it was going to be go time. My night nurse would come in sometime between 2300-0000 and check VS, I sent the baby back to the nursery so I could sleep hard w/o feeling like I had to keep my ears on for cries. Then whenever the baby got fussy she'd bring the baby back to nurse and check my VS at the same time. So in other words, cluster cares.

It's tough, though. I always feel bad for our aneurysm-related SAH's... a while back we had this one lady who developed hydrocephalus and eventually had to have a VP shunt placed because she couldn't tolerate having her EVD clamped. She had another issue that I can't remember offhand, and then of course there's the concern for vasospasms. She had q 1 hr neuro checks for more than 2 weeks. We gave the poor woman delirium. She got progressively confused and very depressed. Nursing staff had been asking neurosurg if we could do q 2 hr checks overnight (and we always check an ICP q 1 hr), but they wouldn't budge. The trouble was those frequent neuro exams were causing abnormal neuro exams. :no:

BSNbeauty, BSN, RN · Nov 2, 2015

Bump. Still looking for suggestions to decrease interruptions on night shift.

calivianya, BSN, RN · Nov 2, 2015

Bump. Still looking for suggestions to decrease interruptions on night shift.

If you have extra BP machines, leaving one hooked up to the patient who needs q4h VS and doesn't want to be disturbed might help. We take q1h vitals where I work unless condition warrants more frequent vitals, and people often sleep through an automatic cuff pumping on their arm just fine. It's us going in and saying, "Hi Mr. Smith, I'm here to get your vitals!" and grabbing their arms and putting the cuff on them that wakes them up, not the BP cuff itself.

~PedsRN~, BSN, RN · Nov 2, 2015

Depending on the diagnosis, we sometimes forego BP or temps. If they are on continuous monitoring, then we can get vitals easily. However, if they are sick enough to be in the hospital - then they are going to be monitored closely. I am not going to forego my hourly rounding for their sleep.

Karou · Nov 2, 2015

Care clustering. Time vital signs with scheduled medications. Be sure PCT and RN are on the same page about when to do things like take out trash, empty urinals, bed baths or turning, ect... Cluster if possible.

For rounding, I don't quite close the door completely so it doesn't bang open. I explain to patients at the start of shift that I check on them hourly during the night but if they are sleeping I won't wake them, if they are awake I will ask them if they need anything. I let them know anticipated times when they will be woken- antibiotic and vitals at midnight, lab draw at 0600, ect...

If they are having a particularly difficult time sleeping then I will explain that they can refuse hourly rounding. Make a note in my nurses notes about patients request for that, document "refused" under hourly rounding, and place a "do not disturb/see nurse before entering" sign on their door. I have had patients tell me at 2300 that they want to refuse their 0300 vitals. As long as their 2300 are WNL and they are stable, I make a note and document refused.