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!

[mrosette]

Looking for backup on four eyes skin assessment, anyone found any research that supports this practice? Any help appreciated!

[Karou]

I think that sounds like a great practice.

I do this sometimes. With my "total care" type patients I go in with the PCT or another RN and we turn the patient to get sheets out for under them, clean them, ect.. We are all checking skin and assessing the patient in a way. If it's a more alert/ambulatory patient then it's usually just me.

It can be hard to find two nurses to do this, but if it's feasible on your unit then it's a great idea.

[nanrn]

I'm also looking for any clinical research. Does anyone know of any?

[tayp1991]

My hospital rolled out "4 eyes in 4 hours," within the past 6 months. It requires two RNs to assess patient's skin, head to toe, within 4 hours of arrival to the floor. This includes new admissions as well as transfers. As you know, if a pressure ulcer is not documented within the first 24 hours of admission to the hospital (including ED time), the hospital owns it. The second RN must document a note in the progress notes section, not just as a comment in the flow sheets. Since we have started this practice, our 523 bed hospital has had zero hospital acquired pressure ulcers, so the practice is effective. However, having the time to do it is a challenge. On my telemetry floor, a tech usually helps me initially receive and settle the patient. I have to track down another nurse and then have to remind her to actually put the note in, if it is put in later than the 4 hours, then we get "dinged" as the protocol was not done correctly. I imagine that they will soon be rolling out a 4 eyes skin assessment at each shift change that must be documented as part of bedside report. We also have to have two RNs for catheter insertion. Same practice, the second RN has to document in the progress notes section that she was present for Foley insertion and sterile technique was intact. This was extreme as we went from techs (unlicensed personnel) inserting them without supervision to having to have 2 RNs! I have not heard a report on how this has affected our CAUTI rates. I feel that these are good ideas and may be effective, but until staffing improves the majority of us feel that we are pulled a hundred directions all day long and have so much extra documentation to do, on top of the copious amount we were already doing! Since I started with this hospital in May 2015 there have been 6 major practice changes...I fear that this is only going to keep coming!

[AceOfHearts<3]

We do this. 2 RNs are required to complete the skin assessment ASAP. We do this with new admits and transfers to make sure our unit isn't dinged for any preexisting skin issues. The assigned RN puts in the assessment and once that is done the 2nd RN signs off on it. It doesn't take long and everyone is always willing to pop in real quick to do it. We just say can someone help me with a skin check.