daily weights in your unit?

[picurn10]

how does your unit handle weighing pts? Our standing policy is daily weights for all pts. We have about half our beds that actually have scales, for all the rest we have to put the pt in a sling scale. It can be painful for the pt and dangerous in my opinion. Occasionally I've refused to use the sling scale on a pt when I felt it was too dangerous. We routinely have pts come back from the OR on a non-weighing bed and are expected to get them into the sling scale.

What frustrates me is that we do strict I/O on every pt, and we DO NOT use the new daily weight to adjust drips. I've yet to get a straight answer on why we get weights if we aren't going to use them. When writing orders the md's use the admit weight only. Sure you can glance at the weight at see if there was a big gain or loss overnight, but you can do the exact same by looking at the I/O for the 24h, right? That seems more accurate to me than the weight anyway, because I don't believe that other nurses always pay attention to what the bed was zero'd with to begin with.

I know its a big source of frustration for staff because the lack of weighing beds/kids being forced to use the sling scale is upsetting to pts and families. We've had numerous unplanned extubations during weighing too.

What does your unit do? Do you use the weight to recalculate gtts or for new orders?

[SprightlySparrow, BSN, RN]

I forgot to say I was appalled when I read the original post about using sling scales! I am SO sorry you guys have to do that...it seems absurd to do that on a postop. Dangerous! Our kids are weighed/measured immediately prior to surgery and are not weighed again until they are stable. We rarely have an unplanned extubation bc of weighing a patient, but we don't use the sling scales...it definitely seems like your unit will benefit greatly from you looking into this more closely and trying to find a better way. I'm sure your colleagues will be forever grateful to you!

[picurn10]

babybluenurse, how do you lift a 50kg intubated pt w/ ct's, drains, on CRRT, or whatever the case may be? We have kids from 0-21yr and so other than a sling scale there isn't a way to lift them up. We have some pretty big kids too. I had a 85kg 9yr old a few weeks ago! What about a burn pt who is in terrrible pain, just w/ turning? I would never want to pick them up, even if I could do it.

Our hospital also does a weight just post op, but we're expected to get a weight on admit to the unit from PACU (just a few hours later) and then if they admitted during the day, sometime later that night they want the "daily weight" done.

[SprightlySparrow, BSN, RN]

I was not under the impression you were speaking about larger children. That is why I used the phrase "I may be missing something". Clearly I was...one would never expect the nurse to lift a patient that large in the manner I was speaking about.

Most of our patients are quite complex, and they are therefore small as there are repaired as early infants/neonates. These 2, 3, 4-kg kids are the ones I am referring to and thinking about when I suggested lifting them. I was not intending to offend you in any way. We do get the larger children as well, and they generally are weighed once they are extubated which typically is POD 0, 1, or 2. And a patient on CRRT?...not getting weighed. If our cardiac patient is on CRRT let's suffice it to say their weight is the last thing on our minds. That patient is usually quite ill.

[Bringonthenight]

I'm not in ICU but a cardiac floor where policy states it is the night shift nurses responsibility to weigh patients at 6am. Certain night shift nurses do not weigh the patients, they sometimes give a lame excuse in handover "this patient is fast asleep, so I haven't had a chance to weigh him yet" or worse yet no handover at all that the patient is a daily weight. Weights are subsequently getting missed, or are caught late making them ineffective. Doctors get understandably angry and it's the day shift nurses that get the heat.

Suggestions???

[picurn10]

Sorry if my post came across that I was offened, not at all! I was just explaining why we can't pick up many of the pts. The more feedback I'm reading here, the more I realize it is unreasonable to weight them every day.

[SprightlySparrow, BSN, RN]

I'm not in ICU but a cardiac floor where policy states it is the night shift nurses responsibility to weigh patients at 6am. Certain night shift nurses do not weigh the patients, they sometimes give a lame excuse in handover "this patient is fast asleep, so I haven't had a chance to weigh him yet" or worse yet no handover at all that the patient is a daily weight. Weights are subsequently getting missed, or are caught late making them ineffective. Doctors get understandably angry and it's the day shift nurses that get the heat.

Suggestions???

Our stepdown unit weighs every patient every night around 2000. (Actually, it's part of the nurse tech's responsibility, but the nurses assist when they are able). Though this makes the beginning of the night kind of busy, the parents are awake as well as the child, usually. The nurses are already in the room anyway bc of meds/vitals/feeds/assessments, etc. unlike at 0600 where you may have no need to go in there at all. I've not seen the whole 6am weighing thing work out well because A.) patients are usually asleep B.) parents are usually asleep C.) they are some nurses who habitually won't do it for whatever reason and D.) 0600 is a really busy time! Weights at 0600 are easily pushed aside because of any reason whatsoever...patient threw up, meds came late from pharmacy, someone needs a pain med, med student/resident/NP wants an update on your patients, someone pooped the bed...you get the picture.

The 2000 thing seems to work beautifully for our stepdown unit. Maybe you could pitch the idea and see what people think? If you meet resistance you may try suggesting a trial run? See if you can get the techs to assist with them, too. Having the nurse and tech work together makes things easier for everyone, obviously. Hope that helps!

[NotReady4PrimeTime, RN]

Our hospital also does a weight just post op, but we're expected to get a weight on admit to the unit from PACU (just a few hours later) and then if they admitted during the day, sometime later that night they want the "daily weight" done.

Okay, that's just ridiculous!! Daily weights are not necessary in the PICU EVER! Never mind within an hour or so of being weighed in PACU - which to my mind is also ridiculous. Do they not KNOW how much fluid was given in the OR? I'm pretty sure that the anaesthetist records all of that on the anaesthesia record. What, pray tell, is the rationale for weighing a patient immediately post-op, other than to make work?

Just an aside... we don't even have a sling scale. We have to borrow from the neighbours. Neither do we have a Hoyer lift. Or Maxislides. (We do have a couple of slider boards but they're not used much.) It's all us, baby!

[Bringonthenight]

Our stepdown unit weighs every patient every night around 2000. (Actually, it's part of the nurse tech's responsibility, but the nurses assist when they are able). Though this makes the beginning of the night kind of busy, the parents are awake as well as the child, usually. The nurses are already in the room anyway bc of meds/vitals/feeds/assessments, etc. unlike at 0600 where you may have no need to go in there at all. I've not seen the whole 6am weighing thing work out well because A.) patients are usually asleep B.) parents are usually asleep C.) they are some nurses who habitually won't do it for whatever reason and D.) 0600 is a really busy time! Weights at 0600 are easily pushed aside because of any reason whatsoever...patient threw up, meds came late from pharmacy, someone needs a pain med, med student/resident/NP wants an update on your patients, someone pooped the bed...you get the picture.

The 2000 thing seems to work beautifully for our stepdown unit. Maybe you could pitch the idea and see what people think? If you meet resistance you may try suggesting a trial run? See if you can get the techs to assist with them, too. Having the nurse and tech work together makes things easier for everyone, obviously. Hope that helps!

I'm in Australia, so no techs here. I understand how busy a time it can be and yes I do forgive them when their excuses are genuine but a lot of the time they just do not want to wake a patient. I like the idea of the 2000hr weight but isn't that too close to them eating and drinking to be accurate? At least I suppose the weights would all get done this way but still. I might pitch the idea. Also I think a lot of it might be education on the importance of weights. And maybe putting laminated reminder sheets in the charts for patients that require a daily weight so that the day nurse knows who needs to be weighed.

[SprightlySparrow, BSN, RN]

I'm not sure that it would matter much one way or another if the child was eating/drinking (unless you are thinking about it from the standpoint of interrupting the child's dinner, in that case, maybe that child could be done last in line). Otherwise, I think one could argue if the child was about to take a large poo, then THAT could affect their weight! Basically, in my humble opinion, I don't think it matters much being that it is dinner time. What matters the most is consistency (same scale, same time of day, etc.).

Our stepdown unit has a piece of paper taped to the end of the crib/bed that is filled out daily with the child's weight. There are several lines printed on it where you can easily write the weights down. It's an easy reference point when the RNs/techs are obtaining the weight ("oh, that weight seems way more/less than the one yesterday..."), and the parents seem to appreciate it, too. It may serve as a helpful reminder, too, that the child is a "daily weight".

[sapphire18]

Ok, so I don't work with peds, but in my adult ICU, all beds are zeroed with a set of specific things on them prior to the pt arriving in the bed. Fitted sheet, draw sheet and pad, flat sheet, blanket, and pillow. That is our policy so there's no confusion. We do weights daily and actually adjust our gtts re the new wt. New policy for that one.

[Sloan RN]

We get weekly weights on our patients (it's a medical PICU; the patients in the cardiac PICU might get daily weights, I don't know). Even then, if our patient is too unstable to be safely weighed, we can ask the physician for an order that says it's okay to not weigh them. Otherwise every patient in the unit gets weighed on the same day every week.

We used to get daily weights also, but our compliance was poor and our medical director analyzed some research and our policy and decided that for most patients a daily weight really isn't important, so we went to weekly weights instead. Some patients are daily weights, but it has to be specifically ordered that way by the doctor.

To solve the bed-zero'ing problem, we have a little form we tape to the bed that states what it was originally zero'ed with.

[Rookie12]

Usually the most we would weight a patient is 3Xweek. All our beds weigh and some of our cribs. For the beds people ususally zero the bed and attach a sticker at the bottom of the bed stating what the bed was zeroed with. Everyone tends to make their beds the same way but the sticker helps avoid confusion, although honestly if they're not a chronic or really sick kid who we expect to stay awhile we usually just stick with the admission weight