What part of pt care gets overlooked most often

  1. 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 stuck between mattress and siderail and hanging off bed. I straightened her up and was putting her O2 back on her face when I noticed her mouth looked awful. After her sats went back up, I did oral care over and over and over to remove the gunk in her mouth. I pulled out this huge CHUNK of stuff that was like hard plastic approximately 5 cm in size! She had thick slime all over her gums and her lips were cracked. That gets overlooked at our hospital with about 95% patients.
    •  
  2. 59 Comments

  3. by   KIAN
    I've had this converstation with other nurses and we agree it is oral care. We can't tell you why for sure. Maybe the nurses thought the aids took care of it and the aids thought the nurses did?
  4. by   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
  5. by   clemmm78
    I agree, oral care and, to tell you the truth, I'm as guilty as the next person. I try my best to do it, but it isn't always something I give full attention to - and I should.
  6. by   cheshirecat
    Staff meal breaks - an alien concept for most of us. I agree, it is mostly oral hygiene that is neglected. Also washing between patients toes when bedbathing.
  7. by   nursey70
    Oral care! I used to work on a respitory unit with vent/trache patients and people on hospice care. It would infuriate me to find that my poor patients who were NPO had horrific looking tongues and mucous membranes. It is a pet peeve of mine to make sure that no matter how busy I am, I make it a priority to provide oral care. Imagine how the patients must feel. We can do better!
  8. by   4theBetterGetter
    Oral care is a biggie...I also think that most anything that has to do with spending time with the pt. at the bedside is greatly diminished for example...clean sheets, back rubs, comfort,reassurance...I could go on and on. We have to spend way too much time charting and re charting....ad infinitum
  9. by   Pepper The Cat
    Bowels! I took report on a pt coming from an acute care floor once. The nurse said pt had been nauseated, poor appetite for past 2 days, she didn't know why. Later in report, I questioned last bowel movement. She looked it up and said " Oh - 8 days ago. Maybe that's why he is nauseated"
    Ya think? And this was not the first time I'd gotten a pt from that floor who was FOS. And as we are a hospital that practises total pt care - no aides - they can't blame it on anyone else.
    Last edit by Pepper The Cat on Dec 22, '06 : Reason: because spelling is important!
  10. by   gitterbug
    Oral care vs bowel regieme run neck and neck here.
  11. by   Tweety
    When I saw your title before I clicked on I said "oral care".

    Also we're not good at changing IV tubing, changing IV sites, and changing central line dressings. Shameful.
  12. by   MarySunshine
    I'm in an ICU so we have more time for hygiene stuff. I would say we aren't able to give enough time to patient/family education. We're always just running in and out of rooms in a rush as we go over our "to do list."
  13. by   VivaLasViejas
    When I worked acute care, oral care and ambulation were the most neglected tasks on our unit. The nurses simply did not have the time to walk around the floor with patients, and the few aides usually had 12-15 pts. apiece, so folks were lucky to get vitals, baths and meals on time.

    I don't know what it will take to make American hospital administrators and CEOs understand that nurses are not machines, and that Press-Ganey scores are only a measure of how well we can kiss butts, not save them! There is only so much we can do when we have five or six heavy care patients with multiple issues (complex treatments, dementia, incontinence, dozens of meds, mobility problems etc.) and NO help. We shouldn't be expected to get a 300-pound hemiplegic out of bed and into a chair by ourselves. We shouldn't have to spend entire shifts getting a LOL knee-replacement patient in and out of the CPM every half hour for bathroom trips, doing Q-30-minute vitals on three fresh post-ops, feed two total-care patients, and dealing with families, doctors, 'suits', therapists, phones, and a continual barrage of new orders.

    But all of that, and more, IS expected, and nurses are often punished harshly when they can't perform miracles. This is one of the reasons I left hospital nursing; I couldn't do it all, and I didn't like carrying around a bunch of guilt because of that. I often wondered what my holier-than-thou manager would have done when two of her patients were circling the drain and another was climbing out of bed every five minutes---go brush someone's dentures? How much 'basic care' would she have had time to do if one of her patients was throwing up black blood and needing to go to the ICU two hours ago, another was on the call light every two minutes asking when she's going to be discharged, yet another was demanding to be transferred to a private room NOW because her roommate is chatting with a couple of friends and 'making too much noise', and still another had a blood sugar of 42 and there was no juice to be found on the unit?

    There are no easy answers, of course.........at least, none that the powers that be are willing to PAY for. But don't even get me started on that.........it wouldn't be pretty.
  14. by   TheCommuter
    In addition to the oral care, I think backrubs are badly neglected.

    Who, in all honestly, gives their patients the classic backrubs we all learned about in nursing fundamentals many moons ago? Patient care would be so much more pleasurable if we could all squeeze in the time for a good 'ole 3 minute backrub once per day.

close