Does your unit have a policy that states when you should notify docs of changes in vitals? If you do does it give absolute figures for example HR < 50 or >100 or is it expressed as a percentage of the patients baseline eg 20% increase or decrease over baseline. Thaks for your help. :angel2:
Mar 18, '05
We don't have a cut-and-dried policy but we'll often ask individual docs for parameters with certain patients with certain conditions or medications--mostly drips and BP meds.
For instance, we'll ask for parameters on patients on a Cardizem drip--should we DC it if sustaining for how long at what HR or BP? Or the doc will cover himself by ordering a prn BP med for BP's over a certain number, and I've seen them ordered for BPs as low as 140 systolic or as high as 220 systolic.
For cardiac rhythms, the doc will usually write for it when he's been called more than 3 times with the same problem: "Call me if patient sustains VT for >2 minutes" or whatever. We figure that doc just wants a couple of hours of sleep.
Mar 18, '05
We don't really have a set policy either...For our open hearts, we have a lot of standing orders and can start all kinds of drips/volume etc without calling...Our orders usually read call for sbp<80, sbp >150, svo2 <40, or something but it really means only call if you have frist tried, x, y, & z and your pressure is still <80...of course, if you don't meet quite meet those parameters and have a bad feeling or have seen a big change from the previous VS or whatever, it is better to call just to cover yourself...
It kind of depends on the problem, what the patient is in for, and, of course if the patient is symptomatic. If I gave lopressor at 2100 to a person who's sbp is in the 100s anyway and now it is 200 am and they are sound asleep and their bp is in the 70s...I probably wouldn't call for that ...our docs expect us to use common sense and our clinical knowledge before we call (as I am sure your docs do...)
As Angie said, individual docs will write parameters with certain patients and depending on why the patient is there we also have standing orders for various things that we are expected to try first...
For rhythm changes, we don't usually call in the middle of the night unless it is a lethal rhythm or the patient is symptomatic (or could go symptomatic quickly) AGain we use our judgement based on current standards of care...
Last edit by zambezi on Mar 18, '05
Mar 19, '05
Most docs write an order on admission to the unit for when to be called using absolutes -- i.e. "call for UO < 60cc/2hrs" or "call HO for HR<60>130, T>101.0". Again, professional judgement comes into play. If my pt was cultured up for a high temp 24 hours ago, abx have been started, and I'm coming close to the next dose of Tylenol being due - I'm not calling for a temp of 101.5.