4 Eyes Assessment

[Turtle in scrubs]

Hello Everyone,

Is anyone out there practicing the "4 Eyes Assessment" on their inpatient units? This is where 2 nurses (or other staff members) go in together once a patient is admitted to the unit and do a thorough skin assessment together while getting any extra sheets out from under the patient and repositioning them.

We plan to implement this on our unit but I'm trying to find some data to support its efficacy. After a quick peer review I came up short but will have another go here in a bit. Just curious if anyone out there has any data to support or experience they can share with doing this.

Thanks!

[Palliative Care, DNP]

I'm thinking in a perfect world this might work. In the real world 2 nurses are not always available...

[Turtle in scrubs]

True. We have a small unit and are therefore thinking of including techs as the second person. Our techs are pretty good, and it may help them become better at assessing skin and reporting early findings as well. Most of our techs are in nursing school.

We really need to do something on our unit as our rate of hospital acquired pressure ulcers is less than desirable.

[lisajtrn]

We actually do this all the time without really thinking about it.

[HouTx, BSN, MSN, EdD]

I really like this concept but don't like the title..... maybe it's due to my age, but "four eyes" has a negative connotation to me. Back in the old days, it was used as an insult for less-than-manly men.

It's a well-known fact that we can all suffer from 'inattentional blindness' (Inattentional blindness - Scholarpedia ) when we're so busy multitasking that even glaring errors or visual cues just escape us. These days, missing some minor detail like pre-existing skin problems, can have serious consequences for reimbursement as well as patient outcomes. With another set of eyes, it is far more likely that everything will be noticed.

True story - during a Monday morning bath on an ICU patient that had been admitted on Saturday, I noticed an additional gunshot wound on the lower back... that had been completely missed in ED. It set off a furious cascade of events, including criminal charges for the 'passers by' that had called 911 in the first place. ED staff had been so focused on head/facial trauma & abd stab wound that the additional wound had just been missed.

[FineAgain]

It's part of our charting and we get a "ding" if they see it has not been done (during chart audits). It's fairly new (within the last 6 months or so) and has not proved to be a big deal. Everyone knows we have to do it, so when you ask for a second, there is always someone who will do it with you. We have found many pressure ulcers that may have been blamed on a hospital stay when they were, in fact, preadmission.

[applewhitern, BSN, RN]

We usually have 2 nurses to do this, simply because we have to get the patient off the stretcher, undress them, etc. It isn't required for us to have 4 eyes, however. We are very, very careful about admission skin assessments. If anything is found later, we do a repeat skin assessment, and of course, one is done at discharge.

[BrandonLPN, LPN]

Maybe I'm just being snobbish, but the idea of the second person signing off on the assessment being an unlicensed tech doesn't sit well with me. In an unofficial capacity, yes, of course the tech could help with the assessment. But making it an official part of the admission assessment that a tech do a "second assessment"? I don't know....

I'll admit, my judgement may be clouded by the fact that I have an axe to grind with the increased role of techs. Im told all I do is "gather data" and techs get folded into the assessment process like its nothing? (Keeping in mind I was a hospital tech for 4 years)

[FineAgain]

Ours have to be done with a 2nd RN, no exceptions.

[xoemmylouox, ASN, RN]

I think this is an excellent idea. However as usual staffing needs to be adequate especially on the units with constant admissions/discharges.

[Jtyrrell1]

I work in a Cvicu and I can tell u this is so challenging. Often we need more than 2 people to accomplish this. However we found 7 ulcers on 1 patient by doing this.

[calivianya, BSN, RN]

We don't officially do it... but on weekday nights it's not uncommon for at least four nurses to be in the room helping out when a patient gets admitted. Whenever I work the weekend and I admit, it's not uncommon for it to be just me unless the patient is truly unstable, at which point all of the otherwise solitary adrenaline junkie coworkers will at least stick their head in once to see if I'm okay, and still usually won't help. Gotta love teamwork.