Every 3 Hour Vitals and Lung Sounds

Published

Specializes in Rehab/Nurse Manager.

Lately, there's been a particular nurse who has been entering orders for every 3 hour vitals and lung sounds, including at night when the patients are sleeping.  

She states the orders are entered because these patients "need extra monitoring." Granted, she only enters them on patients who have shown a decline in medical status, but several patients have expressed displeasure about being woken up at 3AM for vitals and lung sound assessment.  They stated they can't get any sleep being woken up so often and are then too tired to work with therapy. 

It is unclear if these are actual orders from a doctor, but no one can ever find any written orders for every 3 hour vitals and she seems to be the only one who ever receives a "verbal " order for this. 

Any thoughts? Does this seem problematic to you or something to let slide? 

Up Vote Up Vote ×
Specializes in ER.

Maybe the other nurses will DC these orders...?

9
Up Vote Up Vote ×
Specializes in General Internal Medicine, ICU.
9 hours ago, Emergent said:

Maybe the other nurses will DC these orders...?

But the OP has explicitly forbidden staff from deleting orders without her consent….?

3
Up Vote Up Vote ×
Specializes in New Critical care NP, Critical care, Med-surg, LTC.

Perhaps this nurse speaks with the provider and recommends vitals monitoring be increased and when they agree she enters a verbal order. 

Patients should still have the right to refuse any interventions but if you have to wake them to refuse anyway they're still being awoken. If they require that much monitoring perhaps they also require a higher level of care. 

Lung sounds every three hours, is she concerned about fluid overload? Aspiration pneumonia? 

4
Up Vote Up Vote ×

     Are you certain that this wasn't written in the context of a nursing intervention (potential for fluid volume overload)?  If this wasn't the case and there is no actual LIP order, then I would let the patient's clinical picture and my experience dictate my clinical practice; I don't take orders from other nurses.

3
Up Vote Up Vote ×
Specializes in Psych, Addictions, SOL (Student of Life).
On 12/17/2021 at 9:13 PM, SilverBells said:

Lately, there's been a particular nurse who has been entering orders for every 3 hour vitals and lung sounds, including at night when the patients are sleeping.  

She states the orders are entered because these patients "need extra monitoring." Granted, she only enters them on patients who have shown a decline in medical status, but several patients have expressed displeasure about being woken up at 3AM for vitals and lung sound assessment.  They stated they can't get any sleep being woken up so often and are then too tired to work with therapy. 

It is unclear if these are actual orders from a doctor, but no one can ever find any written orders for every 3 hour vitals and she seems to be the only one who ever receives a "verbal " order for this. 

Any thoughts? Does this seem problematic to you or something to let slide? 

Why not just call the atending for these patient's and ask him/her? Problem solved.

Hppy

 

5
Up Vote Up Vote ×
Specializes in ER.

Has anyone here ever even heard of Q3 hr vitals? ?

 

7
Up Vote Up Vote ×
Specializes in Med-Surg.
43 minutes ago, Emergent said:

Has anyone here ever even heard of Q3 hr vitals? ?

 

Nope.  Q15 in PACU, q1h in ICU, q2h in progressive, and q4h on the floor.  Never q3h.  
 

Weird.

 

4
Up Vote Up Vote ×
Specializes in ER.
34 minutes ago, Tweety said:

Nope.  Q15 in PACU, q1h in ICU, q2h in progressive, and q4h on the floor.  Never q3h.  
 

Weird.

 

All I can say is 2 + 2 does not make 3. I present my evidence to the court.

1
Up Vote Up Vote ×
On 12/18/2021 at 12:13 AM, SilverBells said:

Lately, there's been a particular nurse who has been entering orders for every 3 hour vitals and lung sounds, including at night when the patients are sleeping.  

She states the orders are entered because these patients "need extra monitoring." Granted, she only enters them on patients who have shown a decline in medical status, but several patients have expressed displeasure about being woken up at 3AM for vitals and lung sound assessment.  They stated they can't get any sleep being woken up so often and are then too tired to work with therapy. 

It is unclear if these are actual orders from a doctor, but no one can ever find any written orders for every 3 hour vitals and she seems to be the only one who ever receives a "verbal " order for this. 

Any thoughts? Does this seem problematic to you or something to let slide? 

I have no idea what the context here, but I am pretty sure there are actual rules about who can write an order, and what the scope of that person is.  What does the policy say?  Who is the supervisor?

 

1
Up Vote Up Vote ×
Specializes in Critical Care.
On 12/18/2021 at 4:37 PM, MPKH said:

But the OP has explicitly forbidden staff from deleting orders without her consent….?

I missed that. LOL

Up Vote Up Vote ×
Specializes in Med-Surg.
8 hours ago, hherrn said:

I have no idea what the context here, but I am pretty sure there are actual rules about who can write an order, and what the scope of that person is.  What does the policy say?  Who is the supervisor?

 

Not always.  For example if my skin and general assessment says a person needs to be turned q2h, then I set in motion that that get turned q2h.  Maybe it's something similar there to do with taking vitals and lung assessments if the RN assessment deems that to be necessary for patient safety.

But still the MD should be made aware, for example if I'm turning because of a decubitus the MD might not be aware of, or if I'm assessing lung sounds more often because of a new onset of crackles that is no where on the patient's history the MD wrote. I need to tell them.  The MD might give and order for chest X-ray and lasix, and not specifically "do vitals and lung assessments q3h (still a strange # to me)", but I have the sense to do that.  

 

2
Up Vote Up Vote ×
+ Join the Discussion