I was recently hospitalized for a lap chole. The procedure went very well and I am feeling great...I almost feel ready to go back to work. I have some concerns about things that happened after the procedure that I'm not sure if I should mention or not (they are going to call me today to do a patient satisfaction survey over the phone).
My blood pressure went up a lot during the procedure. Certainly no one's fault, but it did. Since my blood pressure went crazy, they had me on a cardiac monitor throughout my stay.
When they transferred me to my room (I had to stay overnight), they put me on a monitor that is apparently new and unfamiliar to most of the staff.
My rhythm seemed to be normal sinus initially, but then switched to what appeared to be atrial flutter a few minutes after they put the monitor (not just a portable telemetry box, but a huge bedside monitor) on. The nurse just stood there looking at the monitor and said, "I've never actually seen anyone in flutter before." I checked my radial pulse, which did not correlate with what the monitor showed. I asked if she needed to adjust lead placement and she said that she thought the leads were placed properly. I also asked about changing monitors and she said that she didn't think there was another monitor available.
The nurse did a 12-lead EKG, which showed a normal sinus rhythm and left the monitor showing what appeared to be flutter waves in place. The monitor alarmed every two minutes due to the flutter waves, so she showed me where the "silence alarms" button was and told me to feel free to push it.
After about four hours (and walking in the halls with an IV pole and a cardiac monitor) I took the monitor off myself and asked the nurse if she could please get it discontinued since it wasn't showing an accurate tracing anyway. They then brought in a portable telemetry box, which showed a normal sinus rhythm throughout my stay.
My question is...do I mention the cardiac monitor when they call today? There was no harm done, but it was really frustrating to have to either listen to the monitor alarming every two minutes. It is also pointless to have a monitor in place that for whatever reason isn't showing an accurate tracing.
Other concerns I have are...
The night shift said I had I/O ordered, the day shift said I did not. When I worked there, policy said anyone with an IV was automatically on I/O.
I only saw two nurses wash their hands.
I got coffee on my tray for every meal even though my surgeon (per my request) ordered no caffeine (including decaf coffee or tea).
Since I was on telemetry, they couldn't let me close my room door unless there was a nurse in the room with me. Even with ear plugs, I couldn't sleep because of all of the activity in the hall and the call lights going off all night. I didn't sleep much at all...maybe an hour or two.
The nurses were all very nice. I did get very kind and compassionate care. They did an awesome job of making sure my pain was managed and other than the things mentioned, I was very happy with my care. I just found some things to be very frustrating. I'll probably mention the cardiac monitor, but leave the rest alone.
I did mention the monitor...after four hours, I told the nurse I was taking it off since it didn't work anyway and asked her to get an order to d/c it.
As far as the rest of my concerns...I told her that being on telemetry was no reason not to close the door and that the lights and the activity in the hall were really distracting. She said that "policy" says to have the door open when someone is "critical" and being on telemetry made me "critical."
The dietary thing, I actually mentioned to the dietary person who brought my food. She shrugged. I left the coffee on my tray. The food was really good though...way better than I remember it being.
The I/O thing was mentioned to the nurse, the morning I was released. She didn't react.
And I did tell one of the nurses that she was only the second person that I saw wash her hands. I guess I was expecting some sort of a response like, "Oh...they must be sanitizing in the hall" or something like that.
Oh well...I guess it give me things to think about when I am at work. I don't want a patient to leave my care feeling like things were just forgotten.
I disagree completely regarding the priority of issues here - my area of clinical practice is ICU.
WASHING HANDS is the highest priority in this case.... I have personally experienced the death of family members due to nosocomial infections contracted in a hospital setting. Even though the technology attached to a patient may seem to be more important and handwashing is relegated to 'ho-hum' status, the likelihood of a problem for the patient is far greater from infection than from rhythm disturbances.
Hand washing is not a "little thing".
Having just been a patient myself , I accept the point you make ,lack of hand washing may have a greater impact upon health outcome . But as a patient my immediate concern is the constant interuptions to my rest , that damn alarm could drive you CRAZY !!,so although in my head I know that lack of handwashing can cause the problems you state , while being driven slowly crazy by that damned alarm beeping yet again would become the proirity .
It is for the above reason I feel patient satisfaction surveys are a waste of time , they measure the priorities the patint sees not the clinical priorities .As you have answered in your comment I think we would both agree clinical priorities should have precedent , be measured accurately and sold to potential patients as to a reson to choose our facility for there care .
The constant beeping did drive me crazy. I don't like noise that much anyway and when every two minutes, I had to stop the noise, I was almost in tears. I couldn't rest with the alarm beeping half the day! I know they were busy and I know it didn't seem important to them since they knew I was not in a-flutter, but the noise was almost unbearable.
Hospitals are noisy...not a lot can change that. Hospitals are also not a good place to get rest...I am very aware of that. It just seems that doing something very simple (getting me a different monitor) could make a HUGE difference. Why monitor someone if the monitor isn't accurate?
As far as the rest of my concerns...I told her that being on telemetry was no reason not to close the door and that the lights and the activity in the hall were really distracting. She said that "policy" says to have the door open when someone is "critical" and being on telemetry made me "critical."
I would have countered with "Well if I'm so critical I need a monitor that works. Mmmkay?"
I certainly wasn't trying to be a difficult patient. I was a little concerned when she told me the monitor was showing atrial flutter...and I was annoyed when they simply left the monitor in place and went about their day. I would never just tell a patient to push the mute button to silence the alarms. There were enough alarms beeping without adding one more to the mix.
Excellent point about the handwashing. When I think about it, I don't wash my hands in the patient's room much either...LOL.
They should have NEVER told you to silence. What the heck is the point of the monitor if its not even showing the correct rhythm because of some malfunction and its on silence???? I would have made a stink about it thats for sure. I would probably mention a lot of the other stuff as it is a patient satisfaction survey
The constant beeping did drive me crazy. I don't like noise that much anyway and when every two minutes, I had to stop the noise, I was almost in tears. I couldn't rest with the alarm beeping half the day! I know they were busy and I know it didn't seem important to them since they knew I was not in a-flutter, but the noise was almost unbearable.
Hospitals are noisy...not a lot can change that. Hospitals are also not a good place to get rest...I am very aware of that. It just seems that doing something very simple (getting me a different monitor) could make a HUGE difference. Why monitor someone if the monitor isn't accurate?
In retrospect, a call to the shift supervisor and or charge nurse may have been in order.
In retrospect, I was still a bit fuzzy from the anesthesia and the pain meds. I knew enough to know that I was not in a-flutter and that it was ridiculous for me to be pushing the mute button every two minutes, but I wasn't quite there enough to think what to do about it.
I am far from perfect as a nurse, but I try to anticipate and take care of my patient's needs. I don't think they should have to say things like, "Can I please speak to a shift supervisor about my cardiac monitor?" As a nurse, I should be capable of troubleshooting and / or getting someone to do it if nothing I try works. I should be checking my patient's post op orders and ensuring they are on I/O if they are supposed to be on I/O. I should be an advocate for my patient and if they can't sleep with the door open, I should be talking to the charge nurse to get the OK to shut the door.
I don't agree with the whole "have it your way" concept in health care delivery, but I do think we need to grant reasonable requests to make the patient comfortable. I know the hospital isn't the Hilton and that there are going to be definite inconveniences, but I don't think that a patient should be left on a malfunctioning, beeping alarm for four hours. And I don't think the patient should be the one to point that out.
Why don't nurses troubleshoot alarming monitors , if you don't believe it at least try ot fix it . I have worked my way from patient to monitor trying to fix an attention seeking monitor,but if I've changed everything except for the patient I will tell the nurse whose patients monitor they have ignored that I have turned the alarm off ,giving them the choice at that point to attempt repair of monitor , replace it or leave the alarm off ( that wouldn't be my choice ) .
Monitor: Yes, say something. They might not realize that nurses do not have the proper training in how to use them (or they don't listen to nurses who say they don't). Maybe a customer service oriented response will make them realize the need to provide more training. Plus the situation you describe could be dangerous under different circumstances.
I/O: don't bring it up. Maybe the policy has changed? We would only keep I/O on an A&O pt (in a telemetry unit) if they clearly weren't making enough urine. Otherwise, simply asking the pt "are you making enough urine?" or something similar should be enough.
Hand washing: Yes, mention it...a big deal (enough said!).
Caffeine: Don't bring it up. It is not the first nor the last mistake made by food service. Again, your A&O...just don't drink it. Saying something about it isn't going to prevent them from giving the wrong meal to a non-A&O person.
Door closing: Yes, mention it. Why can they not close your door? If the pt is not a fall risk, there is no good reason to leave the door open, especially if they are on a monitor already. On our telemetry unit we had a sign in each room that encouraged pt's to ask us to close the door to keep noise out if they couldn't sleep.
Nurses can offer alot a advice when crossing the patient/nurse border. You can bring back a variety of ways to increase patient safety, satisfaction, and fix what's broken.
I did talk to their director of nursing regarding all of my concerns. She seemed a bit surprised and told me she would like to investigate and get back to me. She called me back today.
She said that they have new cardiac monitors and many of the nurses are still uncomfortable with them. She also said that until around three o'clock, there were no cardiac rhythm strips in my chart. I was out of recovery and on the monitor that showed atrial flutter at around ten o'clock. I asked her if charges would be adjusted appropriately and she said she would look into it. I also talked to the director of nursing education and she said that cardiac monitor competency is going to be covered on their annual skills fair in June.
Regarding the I/O. According to my chart, I/O was recorded from the time I left the OR until the time I was discharged. After checking the time that my specipan was checked out of Pyxis, the DON had no explanation and said she would talk to the day shift nurse about it. I don't know (nor do I have the right to know) what came out of that conversation. She did state that all patients with an IV are on I/O whether doctor ordered or not.
The coffee being on my tray, she really had no explanation for. She did say that the "default" drink is coffee and if patients don't request something else, they automatically put coffee on the tray. Since juice wasn't offered on any menu since breakfast and since I don't drink anything but water anyway, I didn't request any beverages. She did say that the dietary department was aware and would pay more attention.
She had no explanation for the handwashing. She said they do not have sanitizer in the halls because the infection control coordination is still a "die hard soap and water fan." They have sanitizer at the nurses' station, but that people should have been washing their hands. Again, this will be covered in their skills fair (it always is).
And it is policy to leave the door open if the patient is "critical." All patients on telemetry are considered "critical." That is something that she says the Policy and Procedure committee debates frequently.
So…I don't know if my expressing my concerns had any benefit or not. I don't know very many nurses that work there any more, or I might ask…LOL
Specializes in Trauma, ER, ICU, CCU, PACU, GI, Cardiology, OR.
so…i don't know if my expressing my concerns had any benefit or not. i don't know very many nurses that work there any more, or i might ask…lol
unquestionably, you raise a doubt in their conscious, which leaves you with no regrets on the matter, therefore, you are left with a clear conscious that you did the right thing...just saying
on things.
flashpoint
1,327 Posts
I did mention the monitor...after four hours, I told the nurse I was taking it off since it didn't work anyway and asked her to get an order to d/c it.
As far as the rest of my concerns...I told her that being on telemetry was no reason not to close the door and that the lights and the activity in the hall were really distracting. She said that "policy" says to have the door open when someone is "critical" and being on telemetry made me "critical."
The dietary thing, I actually mentioned to the dietary person who brought my food. She shrugged. I left the coffee on my tray. The food was really good though...way better than I remember it being.
The I/O thing was mentioned to the nurse, the morning I was released. She didn't react.
And I did tell one of the nurses that she was only the second person that I saw wash her hands. I guess I was expecting some sort of a response like, "Oh...they must be sanitizing in the hall" or something like that.
Oh well...I guess it give me things to think about when I am at work. I don't want a patient to leave my care feeling like things were just forgotten.