What part of pt care gets overlooked most often - page 2

Ive noticed oral care. Last night I went in to check on a patient I heard moaning (not my patient, but was concerned). She was half in bed/half out, O2 off her face (sat 72), slumped in bed, leg... Read More

  1. by   kitty=^..^=cat
    Quote from PamUK
    Nutrition is also high on the list. Very often food is put by the patient and no-one comes to help them cut or chop the food or even feed! The next idiot comes along & takes the tray away, thinking that the patient doesn't want it. Or at mealtimes, they will get a visit from the doctor/physio whoever. By the time they are done, their food has been removed. We have implemneted a few measures to overcome these issues.

    1. Protected mealtimes. Everyone, visitors, doctors, the lot, are kicked out at mealtimes. No-one is allowed to enter re-enter the ward until it is over.

    2. Nursing staff cannot take their own mealbreaks at these times. This allows "all hands on deck"

    3. Patients who have difficulty with food are given red trays.... everyone else is yellow... so that they are easily identified

    4 A probably the most important one. LEADERSHIP. Someone is designated to take control of the whole process for all patients. They have a duty to ensure visitors have left and that everyone is fed & watered by delegating as necessasry

    These measures work really well for us
    Great post - you're obviously the kind of nurse that's the Quality Management Department's best buddy! I've done QRM for well over ten years, and I love it when people have ideas like that - bam, bam, bam...

    I agree that patient satisfaction scores are no real indication of quality of care. They serve a purpose, but too much emphasis has been placed on what is merely a small piece of the puzzle.

    I think that the "big players" in hospital care are finally getting the picture. Keep in mind that CEO types and bean counters like Press-Ganey and Gallup so much because charts and graphs and ratings and numbers are the things they know best - that's their comfort zone. Finally with Pay for Performance coming into the picture, there are some numbers on the table - outcome measures/core measures - that DO reflect clinical care and has $$ attached to it.

    The Institute for Healthcare Improvement has rolled out a whole new set of initiatives for the next two years that have components like oral care. Yes, it means that a lot of measuring has to be done - data collection and chart abstraction - and additional paperwork for folks (like me), but it really is worth it when you consider that this is the chance to really overcome the impact of patient satisfaction scores with ones that are really meaningful in measuring how good (or not) patient care and outcomes are. This way when scores look bad, it's evident when lack of resources/lack of staff is an issue...

    Check out Institute for Healthcare Improvement: Home -

    =^..^=
  2. by   meownsmile
    Ha,, i agree, if i were to mention a backrub for someone (while most of the staff are sitting at the desk) they would look at me like i was from Mars. Oral care is another biggie i agree with that. I get so angry when i got into a patients room that has been NPO and is unable to do anything for themselves. I get called in because they look like they are choking or their sats are dropping and low and behold i can usually pull out some of the biggest chunks of gunk off the back of their throats or roofs of their mouths that would make the toughest iron stomach wretch.
    I also have a problem with people thinking they dont have to take the TED hose off when they give a bath...can they say dander? OMG,, its horrible sometimes and just a little skin care with the bath would take care of it.
  3. by   SillyLilly
    When I was a nurses aid, I had like 1 day of orientation It was technically a nurse extern position. When I made morning rounds, I washed people like I did in clinicals, with the instructors around. So full body wash down, head to toe, with oral care.

    Over time, I wouldnt really wash the hair, but I still did face to feet, including behind the ears and oral care with every patient. And if they could do it themselves I made sure they did it.

    It wasnt until about a 6months into the job, I realized the reason why I was still doing rounds at 2pm, while everyone else was sitting at the nures station, was because I did all of that washing.

    At my job as a nurse now, no one does oral care-that I know of. Grosses me out. But they are so unorganized there, and the CNAs are soo set in their ways, you cannnot tell them what to do.

    Also, we had a vent pt, and I asked how to do oral care (read how it is a preventitive measure for pneumonia). No one knew how to clean the pts mouth. Except for a plain oral swab, which no one really used...
  4. by   Zizka
    The elderly probably use nursing services the most and in the healthcare setting they mainly reside within nursing homes.

    I would have to say that PT/OT rehab and activities are the most over looked part of care.

    They need to be of high quailty and continous but how could we afford to do that as a society without taxing us even more and as we know there's already so much waste.
    Last edit by Zizka on Dec 23, '06
  5. by   noBS N
    Since oral care seems to be on the top of everyone's list, couldn't the Hospitals hire a few dental hygenists to give better oral care.
  6. by   nursesaideBen
    I have to a agree with oral care as well. It sounds awful but since I can have up to 20 pts as an aide and have to do all the baths, accuchecks, vitals, make sure they have water so the nurses can give meds, call lights, admissions, discharges, I simply don't have time to make sure that every patient has brushed his or her teeth. If they have a trach or are NPO then of course I make sure oral care gets done but as someone said previously we are NOT machines, and I don't know about you all but I don't walk on water.
  7. by   PamUK
    Quote from kitty=^..^=cat
    Great post - you're obviously the kind of nurse that's the Quality Management Department's best buddy! I've done QRM for well over ten years, and I love it when people have ideas like that - bam, bam, bam...

    =^..^=
    I wont surprise you that I am in Quality Managment then!!! I love it too. Helping clinical staff to overcome the problems that impact on the bigger picture is great.
  8. by   GardenDove
    Quote from gitterbug
    Oral care vs bowel regieme run neck and neck here.
    I think you might be correct on that. These used to be the basics, but get neglected these days due to other demands.
  9. by   wannabemw
    Without a doubt: oral care! I cannot tell you how many times that as a student I dx (dare I say it?) black hairy tongue

    And now that I was actually a patient this week (had surg on Monday) I still say oral care.

    I also agree that we cannot ever find enough time to do those ever-so-cherished back rubs. I have actually seen prevention of skin breakdown b/c of backrubs. Had 86y/o dementia pt benefit b/c of it.

    I SWEAR it's the TRUTH! (sad isn't it?)
    :smiletea2:
    ~MJ
  10. by   UM Review RN
    Ok, my pet peeve, in addition to oral care and greasy hair on the patients who can't get their hair washed when they're in the hospital for longer than a week, is tops of ears where the O2 line sits.

    I can't tell you how many times I've found skin breakdown in this area because no one ever looks. And it's so simple to prevent.
  11. by   UM Review RN
    Quote from wannabemw
    Without a doubt: oral care! I cannot tell you how many times that as a student I dx (dare I say it?) black hairy tongue

    And now that I was actually a patient this week (had surg on Monday) I still say oral care.

    I also agree that we cannot ever find enough time to do those ever-so-cherished back rubs. I have actually seen prevention of skin breakdown b/c of backrubs. Had 86y/o dementia pt benefit b/c of it.

    I SWEAR it's the TRUTH! (sad isn't it?)
    :smiletea2:
    ~MJ
    I know that massage definitely does a lot to kill my aches and pains, so yeah, I believe you.

    It's a shame we don't have the time to try and teach non-pharmaceutical interventions. They were always a huge part of what made nursing so unique to healthcare.
    Last edit by UM Review RN on Dec 23, '06
  12. by   chenoaspirit
    I can honestly say that 2 nights ago I gave one of my patients a back rub. She was in with a bowel obstruction and had a colectomy and had chronic back probs. Lying in the bed so long had made her back hurt, pain meds didnt touch the pain. I applied heat packs, which didnt help. I finally eased her up in the bed and gave her a back rub with baby lotion. The look on her face was priceless. And it did help.
    IV's are definitely one at our hospital too that gets overlooked, they do not get changed when they need to be. The previous nurse will say "I didnt because it looks good and has good blood return". Well, if they are a HARD stick, maybe. But not when they have veins that look like garden hoses. We are sooooo short-staffed and overworked, we honestly dont have time to do the things that need to get done. Last night, we had ONE assistant on the entire floor. How on earth was she supposed to be able to provide care to everyone. Its horrible. The ones who decide to short staff will be the ones in that bed one day and then they will see what these patients are going through. Its sad.
  13. by   talaxandra
    After a patient develpoed a septic IV site it's hospital-wide policy that all cannulae are changed every 72 hours, so that's not a problem here. But I have to agree with everyone else - mouth care closely followed by bowel regime. The latter is not helped by residents who write elderly patients up for a number of strong analgesics and no aperients, which I see over and over. Argh!

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