Checking visitor's vitals

Nurses General Nursing

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What would you do in this scenario? A nurse is in a hospital room doing vital signs. The mother of the patient is visiting along with a couple other family members. The mother of the patient comments that she (the mother) isn't feeling great (feeling weak & a little light-headed) and asks the nurse if she can take her BP. She comments that she takes a BP medication. The nurse checks her vitals and everything is A-okay. The nurse tells her the vitals but adds that if she is still not feeling right she should go get checked out by an MD right away. The nurse mentions that the mother could go to the ER, but the mother and family downplay the need for this. The nurse doesn't push the issue further.

Questions... Did the nurse put herself or her hospital at legal risk by her actions? Did the fact that she did not institute an official healthcare agency response (ie, insisting that she go to the ER now, placing her in a wheelchair and escorting her to the ER, or getting the charge nurse or an MD who happens to be on the floor) fall short of what she should have done? Should the nurse have completed an incident report?

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I agree that it is prudent to look at the possible legal risks. That is the reality of our society. But I also think that is a very sad reality! Why is it that the same visitor can walk into Walmart and take their BP on the free automatic machine at the pharmacy and there are no "patient-provider" obligations that magically occur?

Because the machine at Walmart doesn't have a nursing degree and should know better.....:smokin:.

The sad reality is that everyone is looking for that quick buck and will pass the buck to whoever they can to obtain their goal. Patient provider provider obligations begin when there is an assumption of receiving care.....which the machine doesn't provide. It really is NO more Mr Nice guy or you take the chance of getting sued. Sad but true......:cool:

1 Votes
Specializes in PICU, Sedation/Radiology, PACU.

This situation actually happened to me a few weeks ago. My patient was an eight year old admitted in the middle of the night. I had him the following day. Parents had been up for well over 24 hours and mom hadn't eaten or drank much. About mid-morning, the mom told me she felt dizzy, lightheaded, and asked me to take her blood pressure. She also looked pale and shaky.

However, out hospital's policy states that we cannot perform any medical/nursing interventions on a person who is not out patient. Not even vitals. We have a system in place called a "Code 10" which is used in the event of an illness/injury to any vistor or staff member. If something like this happens, we are to call a Code 10 and a team of doctors from the ER comes to evaluate the person and they get front-lined to the ER.

So that's what happened here. I called a Code 10, about eight people came running a couple minutes later, took vitals (BP was low, but not seriously low) and took the mom to the ER where she got IV fluids and fell asleep for about 6 hours.

On the med/surg unit I worked on we were discouraged from even taking a person's vitals i.e. BP if they were not an admitted patient, for the specific reason that if we did take them and the results required some kind of intervention we were not authorized to perform any interventions because this was not an admitted pt. My advice to someone/usually a patient's family member, who visually did not look well was to tell them I could take them to the ER to be looked at if they felt that was necessary.

Specializes in OB, ER.

I get the legal mumbo jumbo but really it's a bp. You can get it done at Walmart, you can go to any firestation and they do it. (They are medical professionals with no other obligation to the pt). Nurses do it at churches as a curtesy thing. People check there own at home. IT'S JUST A BP.

On the other hand if someone looks like crap don't waste your time. Send them to the ER. If they are grey and sweaty who cares what the bp is because you can't do anything about it. Get them to the people that can manage it. If the person looks fine what will it hurt. You may find hypertension in a pt that never goes to the doctor and save a life. You may reassure someone who is exhausted that they just need a nap. It's an easy non invasive test. I've done it lots of times and will continue to.

I as much as I hate to say it. It is a huge customer satisfaction issue!

If you aren't my patient, I don't treat you or assess you or "just" take your BP. Not feeling well? What would you do at the store/bank/park if you didn't have me in the room with you? THAT's what you should do.

So-

If I am visiting a pt in your unit and code- Gonna call 911?

Went to assess an ER pt recently. Husband looked worse than the pt. Turns out he is o2 dependent, left his tank at home. I put him on 2l as at homr. He looked better.

Never checked the policy, don't care.

So- bad nurse?

So-

If I am visiting a pt in your unit and code- Gonna call 911?

Gonna call the code team (aka 911). And start CPR. Like I would if I was in a bank. Or at the grocery store. It's not "buy one get one free" on the hospital floors. If you want to get hospital treatment, go to the ED and get admitted like everyone else. I've already got a full load of patients, I'm not doubling up.

Went to assess an ER pt recently. Husband looked worse than the pt. Turns out he is o2 dependent, left his tank at home. I put him on 2l as at homr. He looked better.

My question? Why did an O2 dependent guy leave the house without his O2?

Never checked the policy, don't care.

So- bad nurse?

Not a bad nurse. One that could find themselves in some legal hot water though.

If you need your BP checked, do what you do when Uncle Carl isn't in the hospital.

We were told to call for the ERT on visitors in the hospital. In LTC, I've called 911 for visitors (one poor guy had just been d/c'd from ICU, with prescriptions still in his pocket....looked like he died on the way over, but forgot to lie down). :eek:

I would not do random BP checks (like the machines at the drug store). If someone looked bad, I'd call for the appropriate help; I did not tell them one way or another what I thought- other than they needed someone besides me to check them out. :o

I agree that it is prudent to look at the possible legal risks. That is the reality of our society. But I also think that is a very sad reality! Why is it that the same visitor can walk into Wal Mart and take their BP on the free automatic machine at the pharmacy and there are no "patient-provider" obligations that magically occur?

The person assumes the responsibility for their own care with an inanimate object providing information. :) As soon as a HCP gets involved, there's someone with a greater knowledge base, and therefore a greater responsibility to offer suggestions for the next step (even if "see your MD").

The machine isn't offering advice- just giving information that the person decides to follow through on or not.

:)

1 Votes
gonna call the code team (aka 911). and start cpr. like i would if i was in a bank. or at the grocery store. it's not "buy one get one free" on the hospital floors. if you want to get hospital treatment, go to the ed and get admitted like everyone else. i've already got a full load of patients, i'm not doubling up.

my question? why did an o2 dependent guy leave the house without his o2?

not a bad nurse. one that could find themselves in some legal hot water though.

if you need your bp checked, do what you do when uncle carl isn't in the hospital.

call the code team, and they are going to provide care, beyond cpr. like drugs, defibrillation, etc. and the guy isn't even registered. maybe your place has a protocol for this. most don't. i suppose technically the move is to actually call 911, and get an ambulance in there, but i am hard pressed to imagine anybody doing that.

basically, it's a matter of degree. a family member of a patient you have known for a while needs a bandaid. wouldn't you just give them a bandaid?

my question? why did an o2 dependent guy leave the house without his o2?

i'd go with a combination of:

  • in a rush.
  • preocupied
  • not very smart

now- back to this legal problem. what possible negative outcome from putting a guy on his home o2 setting?

Specializes in ICU, Emergency Department.

what i believe management would recommend on my unit: either send family member to the ED, or if family member looks really bad (i.e. gray, very shallow respirations, looks like they are going to syncopize, etc.) call a rapid response. rapids can be called on anyone and i remember a nurse down the hall calling a rapid on two little girls who passed out when visiting their mom once.

what i would do: i would honestly probably take the BP if the family member looked a little crappy, and call a rapid only if necessary. i would not give medical advice other than to say the family member should follow up with ED/their PMD.

Call the code team, and they are going to provide care, beyond CPR. Like drugs, defibrillation, etc. And the guy isn't even registered.

They become registered when they're taken to the ED, just like any trauma patient coming into the ED. They're going to get a chart and a sheet with orders signed by the physician. You code, you become a patient, whether you like it or not.

Which is not what happens when I take a BP on a random person. They can either go to the ED like I suggest or they can sit there with a BP that I now know is dangerously high or low. And when I'm sitting on the stand, "Well why didn't you tell them to go the ED?" "I did." "Do you have any proof that you did? Any documentation?" Nope, I was just being nice. Or I get a perfectly ok BP. They stroke out over night. Well that nice nurse that took his BP said it was just fine! I've got a group of patients that I'm getting paid to take that liability on with. With facility P&Ps to back me up. I don't need to add a few random people onto that responsibility who aren't going to listen to my advice anyway (because if they were going to listen to me, they'd have already headed down to the ED where I told them to go when they wanted me to get a BP.)

Now- back to this legal problem. What possible negative outcome from putting a guy on his home o2 setting?

As has been said countless times in this thread already, you've now assumed care. What if the O2 isn't enough? And he refuses to get further treatment. Why didn't you force him to get more treatment. He was obviously hypoxic and not in his right mind and you let him leave without being further treated? And now he's dead.

If someone needs any kind of assessment or treatment in a hospital, they need to register. If they code, they get registered whether they want to be or not. Until they get on that gurney and go down to the ED though, they're a random person and you're playing fast and loose with your license, your states nurse practice act, and your hospital's policy and procedures for someone that's not your patient. You've opened yourself up to a whole world of liability.

Now most likely, nothing bad is going to happen. The idiot left his O2 at home, gets some O2 on and is fine. But if everything went like it should, we wouldn't spend 10 out of our 12 hours documenting our a$$es off. I don't care about the times it goes well, I care about the time it goes wrong. That one time you go and "be nice" because "what bad could happen?" and you end up spending your time worried about a lawsuit and being reported to the board of nursing instead of getting to go home after your shift and enjoying some free time on AN.

Specializes in Geriatrics, Hospice, Palliative Care.

The wife of one of my pts was "feeling funny", not diaphoretic, normal mentation...but was diabetic. She did not have a glucometer with her, and her daughters didn't want try ours, so I checked it...34. I work in a SNF, and raided our emergency stash of food since she was safe to swallow. Did a bit of diabetic teaching, as you might imagine. (The EMTs in our county can be a real treat with SNF nurses - had I called 911, they would have torn the facility to shreds for not treating, and that was something that would have been counterproductive to a family with a dying husband/dad. Sometime you gotta do what you gotta do.)

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