miniangel and Sun0408 -
I think this speaks to several larger issues. First, I recommend that you talk to your Nursing Practice Committee about looking into this issue. As reimbursements for hospital care is being increasingly tied into patient satisfaction, and multiple interruptions during the night has been identified an enormous pt. disatisfier, it's w[FONT="Trebuchet MS"]orth looking into by nursing and hospital management. There is evidence that improving sleep in the hospital not only increases the patients perception of satisfaction, but also that improved sleep decreases actual length of stay as well as pain scores and anxiety levels, and increases retention of education (possibly decreasing patients being “bounced back” into the hospital, another Medicare reimbursement issue). So, there are many compelling reasons that administration should look into your concerns and ideas for minimizing patient interuptions during the night and early morning. It may help, or you could also suggest, that pharmacy and patient advocates be involved in this discussion as well. At our facility, we tried to get the PPI times changed (currently 0700), but the GI docs threw a little fit and said it wasn’t appropriate to give it later.
If you are working in a hospital large enough to have a Trauma/Surgical ICU, I'm assuming it also has a robust nursing practice council, nurse researchers who would probably be thrilled to hear from bedside nursing about suggestions for policy change, a patient advocate position, and a medical librarian who can take your request for a research stream and give you evidence based articles about the issue you're interested in - for example, the effects of loss of sleep on patient outcomes. I work in a moderately sized hospital, and our librarian LOVES working with nurses to find things they are passionate about, and is in general a great person to know for just such reasons.[FONT="Trebuchet MS"]In my own practice, I will give it when the patient wakes naturally (to pee, or ask for pain meds or whatever), and we have the option under our electronic charting to specify WHY a med was given at a time different from that ordered; in this case, I’m able to indicate “patient request”, or “other”.
[FONT="Trebuchet MS"]Remember that patient outcomes improve when we practice up to the full extent of our education – in this case, that includes YOUR knowledge of administrating medications appropriately, assessing effect, and making informed suggestions for change when this is outside your scope of practice. Your practice also needs to be based on clinical evidence, and if you can support your position with good research, your manager SHOULD be interested in what you have identified as practice issues - if not, well, that's a pretty big problem, isn't it? Also, it is your ethical responsibility as an RN to advocate for your patients well being and to respect patient autonomy. You are well within your rights to ask your patient, after discussing with them why a PPI was ordered, if they are OK being woken for this, if they would prefer that it be retimed, and documenting that the pt. refused the med or requests times be changed, which IS THEIR RIGHT.
[FONT="Trebuchet MS"]It may seem like this a minor inconvenience, or a small work around, but it seems to me like this is reflecting a much larger issue inside your facility, and suggests an environment that is dismissive of the scope and knowledge of nursing. Don’t take it lying down – advocate for you patients as well as your profession!!!!