What part of pt care gets overlooked most often - page 3

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   veegeern
    Definitely oral care. Changing any tubing including feeding tubing runs a close 2nd. Usually gets done by certain nurses consistently, and not done by others consistently. Our assessment screen flags IV sites that are over 72 hours old (computerized charting). If you had to wait until after shift to finish charting, then this doesn't help, of course.
  2. by   kitty=^..^=cat
    What are the things about oral care put it so high on the list?

    I know that when I was doing ICU nursing years ago, having an adequate supply of GOOD oral care supplies was a problem sometimes.

    What else?
  3. by   pickledpepperRN
    Quote from kitty=^..^=cat
    What are the things about oral care put it so high on the list?

    I know that when I was doing ICU nursing years ago, having an adequate supply of GOOD oral care supplies was a problem sometimes.

    What else?
    Our patient care committee embarrassed management into providing sufficient numbers of the right supplies when we used the AACN Practice Alert to change our oral care policy. We had a class held just before and after each shift taught by a Clinical Nurse Specialist (CNS) from a sister hospital.

    I'm going to try to attach the alert.
    Last edit by pickledpepperRN on Dec 27, '06
  4. by   dorieabsLPN
    I see that range of motion is hugely missed on a lot of patients. oral care for sure is at the top. Actually cleaning the ears with qtips and for patients who are unable cleaning the noses. I work with brain injured people and so many have crusty noses inside. It would drive me crazy to not be able to blow my nose. Turning patients every two hours/
    Last edit by dorieabsLPN on Dec 24, '06
  5. by   AfloydRN
    Oral care and turning patients on time. Some times on a crazy day,we pass off dressings that we couldn't get to. I forget to change IV tubing and relabeling it.
  6. by   chadash
    Oral care is the one that I have seen overlooked so often in hospitals.
    There seems to be a lack of understanding that hospice or tube fed patient's mouths could be uncomfortably dry. I had a patient last week who literally opened her mouth when she say me coming. She had had no consistent oral care before I had her,and was craving the moisture. I have had three similar patients in the past few weeks, and the other aides just honestly dont seem to be aware of this need, and frankly dont have the time.
    Hospitals dont seem to be as intune with comfort measure or hygenic needs. It probably is not priority, but I think that it cannot be ignored.
  7. by   jo272wv
    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
    Excellent policy, wouldnt mind this on my unit..
  8. by   leslie :-D
    oral care, bowel regimen, dirty nails, stage 1-11 ulcers from tubing behind ears or in nares....
    my worst is catheter care.
    90% of the time, i will note dried feces on the (female) catheter and further exploration reveals dried feces on the vaginal area, inbetween labia.
    when i've asked techs about this, they shrug their shoulders: one said "we don't go near there"....
    so i do all cath care to ensure e coli isn't ascending up into their urethra.
    just another statistic for a uti.
    sigh.....

    leslie
  9. by   JBudd
    Quote from chadash
    Hospitals dont seem to be as intune with comfort measure or hygenic needs. It probably is not priority, but I think that it cannot be ignored.
    It was mostly basic hygeine that Nightengale used to cut death rates so dramatically in the Crimean War. She stressed controlling the environment as essential to nursing care. Technology is making us forget the very basics of the difference that good nursing practice can make. That, and paperwork that prevents us from getting in there to do it.
  10. by   EmerNurse
    Quote from Angie O'Plasty, RN
    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.
    On this note my other pet peeve for these folks is when they're on continuous O2 sat monitoring. Please please relocate the probe every shift - I've seen some pretty grody fingers under those probes. Looks like they've been soaking it in a bathtub for 2 weeks. The excoriation can be nasty and then the adhesive on them pulls painfully on the skin when you DO take them off to change sites!
  11. by   GrnHonu99
    Oral care esp for patients on vents! We are pretty good at changing our tubing, but I admit that on occasion I have forgotten to do c-line dressing changes!
  12. by   Lorie P.
    Everyone,
    Yeap oral care, foley care, and not changing IV tubings. But then again I do what I can when I can. Taking care of 6-9 total care patients on a med/surg floor can be quite overwhelming at times.
    But I have found that when I go into to my assessments, I take the time to do most of the above tasks. This way I am getting several things done at once, assessing my patient, looking out for any changes, and providing them with the basic care they need along with medical care.
    I attitude is the paper work can wait, but telling a patient that his/her dry crusty mouth can't wait is a big no no!
    I am only one nurse, I put all my effort into making sure my patients comfort levels are met to the best of my ability.
  13. by   Marie_LPN, RN
    From what we get, mouthcare is what we see that's not done.

    As in, we have to do mouthcare, get the gunk and crust out, because the mouth is so filled, that the MDA can't even begin to find the back of the throat, and can't even pass the ET tube through.

    Foleys with brown gunk all down the tube, dried BM either all over the skin, or in an obvious place that someone can see to clean. Pts. that look like they haven't had a bedbath in days.

    We started writing incident reports on all of these things after we noticed that pts. in this shape were mainly coming from one floor. Some of what we've seen, there's absolutely no excuse for it.

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