Checking visitor's vitals

[AJPV]

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?

[Guest219794]

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.)

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.

Negligence is actually pretty tough to prove, especially if you haven't done anything wrong. I would stand by my actions in front of any review. The chance of anybody proving Duty, Breech, Causation, and Damage because I put a COPDer on his home oO2 setting is minimal- I'll risk it. The funny thing is, he didn't even ask for help. He looked lousy. He had no acute problem other than his stupidity, which I suspect was chronic.

That being said, you are probably right. The correct thing to do is to send him to registration. If he really decompensates, I can just dump him in a bed and call registration. If he get's hypoxic enough. I'll have implied consent.

That would be the prudent, correct thing do. It is absolutely what I would instruct a new nurse. I have heard it said that even if the person is your patient, you are supposed to have an order for O2.

I am still putting him on my wall O2.

[wooh, BSN, RN]

For me though, it's not how tough it is to prove once it goes to court. It's how long it's going to take to convince the other side they can't prove it and to drop it. And all the worry and aggravation in the meantime. It's not worth it to me. If you feel bad, we'll have security bring a wheelchair and push you down to the ED where you can register and be looked at. Or you can walk down. Or you can go home.

The "can you do my BP too?" is like walking into a bank with your buddy, they make a withdrawal, and you ask the teller, "Since you're in the drawer anyway, how about giving me a $20 while you're at it." The teller isn't going to serve a random person just because they know how to hand someone $20 and do it all day. They might even work the church bake sale collecting money and making change and handing money to people all day long as a volunteer. But if you're not the bank's customer, doing the proper paperwork at the window, giving them the right forms and such, the teller isn't going to hand you $20, even though it would be "nice" and the person might really need the $20 and I'm sure customer service scores would go sky high if they gave everyone that asked a $20 bill. If you want that $20, you've got to go fill out the paperwork, get a loan or open an account at the other end of the bank. Just like the bank customer you walked in with did.

[Esme12, ASN, BSN, RN]

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!

It may be just a B/P.....until you get sued...

[Esme12, ASN, BSN, RN]

The wife of one of my pet 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.)

And if she seizures, aspirated, suffered brain damage in the parking lot and the family sued for delay of treatment because you took her sugar (a critical low) fed her, "gave her diabetic teaching" and because she felt better and she had been "treated by the nurse" she did not seek further medical care and follow up as she would have had you not intervened........What will you do then? How will you justify this in a court of law?

I realize that we all sometimes "do what we gotta do" but we also need to recognize that there can be ramifications to our actions, no matter how well intended, that are serious, life altering and career changing and we need to be very careful no matter how well intended we are......that and carry malpractice.

I've seen some very well intended nurses get the pants sued off and the facilities toss them under the bus because it "goes against policy" etc.....just take what can happen under advisement. :)

[Esme12, ASN, BSN, RN]

call the code team, and they are going to provide care, beyond cpr. like drugs, defibrillation, etc. yes they will 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. there is you just don't don't know what it is. in acute care and a patient codes you call a code and register them ad an ed patient "john doe" if necessary until further information can be obtained. all hospitals have to abide by certain laws and regulations the dictate behavior that your are unaware of......that doesn't mean that they don't exist.

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.
  
• preoccupied
  
• not very smart
  

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

that he was hypoxic, had a stroke, had a low glucose and therefore couldn't remember his o2. that you delayed medical treatment by giving a medicine (yes o2 is a medicine) without an order. that because you gave him the o2 you delayed the patient from seeking medical treatment and suffered irreversable effects....blah, blah, blah.....it's all very simple and common sense and no big deal...until you get sued.

i have been a nurse a long time and i have seen some very tragic results because nurses had a big heart and were kind. in this lawsuit happy society it is a sad but true reality that you need to be very careful or end up a victim yourself.

[Esme12, ASN, BSN, RN]

Negligence is actually pretty tough to prove, especially if you haven't done anything wrong. I would stand by my actions in front of any review. The chance of anybody proving Duty, Breech, Causation, and Damage because I put a COPDer on his home oO2 setting is minimal- I'll risk it. The funny thing is, he didn't even ask for help. He looked lousy. He had no acute problem other than his stupidity, which I suspect was chronic.

That being said, you are probably right. The correct thing to do is to send him to registration. If he really decompensates, I can just dump him in a bed and call registration. If he get's hypoxic enough. I'll have implied consent.

That would be the prudent, correct thing do. It is absolutely what I would instruct a new nurse. I have heard it said that even if the person is your patient, you are supposed to have an order for O2.

I am still putting him on my wall O2.

I hope you have malpractice. I am NOT being unkind. I am serious and concerned...protect yourself there are a lot of crazy people out there just waiting for the oportunity to make a buck. NO matter how well intentioned won't change the outcome....sad but true...Peace

[canoehead, BSN, RN]

If a visitor looks bad I tell them they really need to go to the ER and "educate" them about us not being able to treat/fix them without signing in as a patient.

If visitor doesn't look bad I'd recommend they go to the ER, their PCP, or Walmart for BP checks since we can't do it RT legal liability.

The only time I'take vitals on a visitor would be to prove I was right, they DO need to go to the ER immediately. Of course, if they are grey I'll commit an assault, shove them in the WC and drive them to triage. or code them where they sit, and deal with consequences later.

[canoehead, BSN, RN]

If someone relatively healthy has forgotten their oxygen I'll tell them they cannot hook into the hospital O2 without being a patient, but that I won't actually be looking for the next hour or so. If they look like crap I'll just give a flat "no" and offer directions to the ER. Don't want but one sick person per stretcher, thanks.

[Double-Helix, BSN, RN]

Think about it this way:

Here at Allnurses.com, if someone posts a question about their health or ther family member's health, we are not allowed to provide medical advice. This is part of the TOS and a rule that most users here agree with.

What's the harm in giving medical advice? The person is asking for help, we have experience in the field. Why can't we give advice?

Because we are medical professionals with a license, and a scope of practice to work within that license. As nurses, our advice is trusted. But on the internet, we don't know the person posting the question, what their PMH is, what meds they are taking, or what their doctor has told them. Giving advice on an online forum is potentially dangerous, even with the best intentions, if we don't know the whole picture. Furthermore, Many users state that they never give advice to family, friends, or acquaintances, but instead refer them to their doctor.

So, if it's not okay to give advice online or to an acquaintance, why would it be okay to assess and make recommendations (advice) to the family member of a pt? We don't know the PMH, home meds, potential problems, etc. It only takes one set of wrong circumstances to end a career.

[Esme12, ASN, BSN, RN]

Think about it this way:

Here allnurses.com, if someone posts a question about their health or their family member's health, we are not allowed to provide medical advice. This is part of the TOS and a rule that most users here agree with.

What's the harm in giving medical advice? The person is asking for help, we have experience in the field. Why can't we give advice?

Because we are medical professionals with a license, and a scope of practice to work within that license. As nurses, our advice is trusted. But on the internet, we don't know the person posting the question, what their PMH is, what meds they are taking, or what their doctor has told them. Giving advice on an online forum is potentially dangerous, even with the best intentions, if we don't know the whole picture. Furthermore, Many users state that they never give advice to family, friends, or acquaintances, but instead refer them to their doctor.

So, if it's not okay to give advice online or to an acquaintance, why would it be okay to assess and make recommendations (advice) to the family member of a pt? We don't know the PMH, home meds, potential problems, etc. It only takes one set of wrong circumstances to end a career.

:yeah:Smart girl! GREAT analogy!!!!

[cherrybreeze, ADN, RN]

Kind of crazy to get yelled at in this scenario. Much better to head off an issue then to have this man collapse in the middle of a patient's room and code. Also, I would think the liability would be high for a nurse to refuse taking some vitals.... if that patient did crash on his way home (etc), then I would think he could come back and sue the nurse for refusing to check.

How could he sue the nurse for refusing to check? It is not the nurse's responsibility to provide ANY type of care to a visitor/the general public. The person could have gone to the ER on their own, therefore establishing a relationship with a provider....until then, there's no liability anywhere.

5th possible outcome - you check their BP and is it WNL. They are happy. They go home. They have a massive stroke unrelated to BP. The family says "the nurse checked their BP and said is was OK so we went home instead of ER like we planned. It is all her fault." If she hadn't said the BP was OK we would have gone to ER.

You are sued. The hospital is sued.

Bingo. Exactly.

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?

Because they are doing it on their own. Someone can also buy an electronic blood pressure monitor and use it in their home. Then it is ALL on them to decide what to do about the numbers.

[Ruby Vee, BSN]

your supposed to take vitals on a non pt due to liability issues plus an employee is never

supposed to escort a non pt, but a volunteer can.

huh? why would you be "supposed to take vitals" on a non pt. what is a non pt anyway?