On the monitor or off???

  1. I work in a 12 bed Neuro ICU (we also take MICU overflow) and there is a debate on having to have the patient on or off of the monitor in 2 situations.

    Situation 1. Pt has transfer order to move to regular nonmonitored floor, AAT, VS Q shift, medlock, etc... The hospital doesn't have any available beds to move the pt to and the pt stays in our unit for a couple of days. My hospital policy states that we may go off of the MDs transfer orders at that point.

    Some RNs are keeping the pt on the monitor, stating that they are still in the ICU (although they are not charged for an ICU bed at this point). What does your hospital do? What do you do as the RN?

    Situation 2. Pt is DNR/DNI and is now made "comfort care only" or "pallative care". All labs, procedures and meds are cancelled with the exception of morphine, ativan and robinol. Consults have signed off. Pt is going to be extubated and is expected to pass quickly. Do you leave the pt hooked up to the monitor, bp cuff, pulse ox, pressure cables, etc.? Or do you try to eliminate as much as you can, making the pt seem more like themselves (for the family)? What do you do? Does your hospital actually have a policy addressing this?

    I would appreciate any insight.

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    About HezzRN

    Joined: Jan '07; Posts: 5; Likes: 1
    NSICU RN; from US
    Specialty: 2 year(s) of experience in MICU, NSICU


  3. by   SICUTOCRNA
    When we have pts with transfer orders we still monitor our pts--all of us (on our unit) feel they are still in the icu. some of our pt will go to q2h vs--but that is the least frequent time we will chart vitals--and typically i still cycle the bp q1h. Maybe it is just cya?--but we always monitor transfers.

    Comfort care is a different story. usually the pt's is monitored--but it is limited. we turn the monitor screen off in the room. we take off the pulse ox and bp cuff--but we usually take q4h vitals. ekg is usually monitored from outside the room--just so we know what is going on--sometimes if family members step out of the room for a little bit I like to have an idea what is going on so i can call them back to the bedside.
  4. by   schroeders_piano
    When I worked ICU, if we had med/surg orders without tele we took them off the monitor. We also would switch from the ICU charting to the Med/Surg charting(we still paper charted). If it was comfort measures we would leave them hooked up to tele, but would take everything else off.
  5. by   ello7
    When someone is being transferred, we generally leave everything on. There are times when patients are confused and pull everything off anyways, so if that happens, we just leave it off rather than constantly going in and out to put everything back on!

    As for comfort care, I personally leave them hooked up to the heart monitor and pulse ox, just so I can have an idea what's going on with them. Then every couple of hours, get a BP. And, just like Sicuto said, we'll also turn the monitor off in the patient's room, and monitor from the nurses' station.
  6. by   leesespieces
    When we have transfer patients we still leave them hooked up to the monitor. Depending on the patient I will continue to do assessments and VS as an ICU pt.

    With withdrawl of care situations I usually try to talk to the family before if I can to see what they want. Some families like to have the monitors on so they kind of know what's going on. Otherwise I turn the in room monitor off and just monitor from the nurse station so I know when they're really going.
  7. by   Janet Rawlinson
    I understand your frustration about being on or off the monitor once a patient has been changed to floor status.
    On the 32 bed Neuro ICU that I work on, many of the patient's are waiting for floor beds. Our standing written policy is that once the patient has written physician orders to go to the floor you can take the patient off the monitor and follow the protocol for vital signs/assessments that the floor nurses follow.
    Personally, I will take the patient off the monitor if they are very stable and they are getting up and down and ambulating in the hall and going to the private bathroom frequently. Many of our patients have just had surgery the day before ( crani) and are stable to transfer but sometimes it is nice just to keep an eye on them until they actually transfer. If the patients family is coming and getting me every five minutes to remind me what the patients blood pressure is etc. ( which is happening quite often now even though I am monitoring the patient) then I take them off the monitor. I have had families get upset that we are taking them off the monitor in the ICU.

    Comfort Care: We can take our patients off the monitor if they are comfort care. Most of the time we do not until they pass away. I always ask the family if they want the monitor on or off. Many times they want it left on. I have co-workers that get upset if we leave the monitor on ( we can turn the alarms off only in this situation). Sometimes leaving the monitor on for the family to watch is upsetting to them because they will ask often when do I think their loved one will pass away and I explain to them over and over that sometimes it is quickly and sometimes it takes days is very hard on them.
  8. by   FlyingScot
    Quote from SICUTOCRNA
    When we have pts with transfer orders we still monitor our pts--all of us (on our unit) feel they are still in the icu. some of our pt will go to q2h vs--but that is the least frequent time we will chart vitals--and typically i still cycle the bp q1h. Maybe it is just cya?--but we always monitor transfers.
    So is the patient still being charged for ICU level care then? I would think this could possibly get your facility into trouble from a regulatory standpoint if the only reason they are still in the unit is a lack of beds on the appropriate floor.
  9. by   Janet Rawlinson
    My facility does not charge the patient for ICU once they have floor orders written. This is monitored very closely and is inputed via our computerized bed board system. Sometimes the patient may have to stay in the ICU until discharge because the floor beds are full ( even though the facility I work at is very large).
    Thanks for asking. Janet
  10. by   FlyingScot
    Hope I didn't offend you with the question. Where I used to work if they were on a monitor we were required to charge them for it so it got sticky sometimes.
  11. by   Janet Rawlinson
    No offense taken.
    I just joined allnurses.com so I am enjoying reading everyone's posts.
    I joined because I needed some input about finding a nursing job in Minnesota.
    My family is there and I have been planning on moving there for over a year and now that I am ready there are no jobs there.

    I am looking forward to reading posts about all different areas of nursing and I am very glad for this website.
    Thanks for responding. Janet