Today, as part of my rapid response rounding, I spent an hour at the bedside of a patient who was having respiratory issues secondary to TB and exacerbated by CHF. The whole time I was there, the patient's O2 sat never exceeded 89% despite his being on Hi Flo NC at 100% FIO2 and 30L/min. I had a lovely argument via telephone with the brand new intern who claimed that putting patient on NRB would violate the patient's wife's wishes that he be a partial code and basically disallowed everything except for pressors in the event of a code. (The patient and his wife had no idea that they had apparently signed away their rights to an O2 mask!).
In any case, the doc at one point said, "I just checked his chart, and he looks like he's doing okay.". HUH??? I walked to the nearest computer cart and opened the patient's chart. Sure enough someone had charted the patient's vital signs as O2 sat of 94% on 50% FIO2--ten minutes ago! Up and down the halls I roamed searching for the person who had charted these vitals. The hour I spent in that room, not one other person had come in to take vitals or assess the patient. Apparently it was the CNA. CNAs are responsible for getting vitals on the patients on our med-surg floors. Unfortunately this is not the first time I have found the charted vitals to be completely divorced from reality. Every med-surg patient has a respiratory rate of 18 or 20 for some reason, and nobody's O2 sat is ever below 90 unless the patient is busy for some other reason (diarrhea for instance) and the floor nurses want her/him transferred to a higher level of care. I have noticed that assessments and vitals are especially fictional if the patient, like this one, is on isolation precautions.
I could not find the CNA, but the RN for the patient assured me that the charting must have been a mistake. She thought that the CNA must have charted another patient's vital signs in this patient's chart. I decided not to make a stink about it so as to maintain good relations with the staff on that med-surg floor, but the more I think about it the more I feel that the CNA made up those vital signs just so he wouldn't have to enter the room; the values were much too similar to what the vitals had been 4 hours previously.
What do you think? What would you do? Find the CNA and question him (he pretty much disappeared after that!)? Fill out an incident report. Contact the manager for that floor? I did put a note in the chart stating that I had been at bedside during the time the vitals signs were alleged to have been taken and charted the actual O2 sats and FIO2 on top of the erroneous values.
Specializes in Care Coordination, MDS, med-surg, Peds.
At the hospital I worked, we called these "Air Vitals" because you grabbed the numbers out of the air!! Dangerous, unsafe, unethical and just plain old NOT RIGHT to do!
Specializes in Care Coordination, MDS, med-surg, Peds.
yep!! We caught aides/nurses doing it often enough that we named it! the staff were written up, fired or what ever was next in the disciplinary line up, but it seemes like someone would be caught wayyy to often!
Vitals are the basis of assessment. What's wrong with these people? Are they making up numbers to avoid calling the Dr for orders?! That's a lawsuit waiting to happen. Very disturbing for sure.
What do you mean you don't always count respirations? Are you saying you're guessing? Visualizing is not the same....
Tell me that you have never tried respirations count by visual after having done it so many times...I have done it many times and checked myself out of curiosity and it was always right.
I hope they aren't making them up. I give meds based on the vitals.
I don't take the chance..if my Bp and Ap are based on med adm then I take the VS myself everytime, in fact I almost always get my own, and if I can't I will ask another nurse as a favor...we work as teamplayers and help each other out
Tell me that you have never tried respirations count by visual after having done it so many times...I have done it many times and checked myself out of curiosity and it was always right.
I for one definitely can say I never JUST visually count my patient's resp's visually counting is never as reliable as checking them the correct way in my opinion--I would never guess (and thats what I feel one is doing when they only visually count the resp's) at any of the patient's VS to dangerous to me I refuse to put the patient at such a risk its not worth it no matter how a nurse or cna looks at it
I totally agree with "WDM08002" and "The Dreamer".....While working for agencies, I've unfortunately seen this happen frequently on various jobs, by RN's, LPN's, & CNA's. I've often wondered if it's b/c they are so stressed and swamped.
Specializes in Tele/med surg/step-down, Cardiology.
Personally I don't feel that the CNA should be charting O2 sats and O2 settings, that is the job of the RN or RT. I also will redo my vitals if they do not look right. The blood sugars are another thing. If they look to high/low I have then redone, but our machines are docked after using, so for the most part the CNA's do not need to manually put them in. Plus I can not imagine anyone making them up, that is just crazy to think about. I do Know that a staff member where I work was let go do to just making up his assessment, which blows my mnd because that is you license!! One must think, would you want this to happen to you or your family member??
I am a student nurse. I honestly have never seen an RR that is not 18 or 20 on med surg floors. Students are the only people who actually would go in and count it. One time I counted 14 or 16 and I charted it. Later I checked the chart, someone has changed my number to 20...
I have worked with a CNA before who was blatantly making up vs. This employee was terminated after an MD caught her making up BP reading on his mother who was in the hospital.
One worse, there was an RN who got pulled to a busy surgical unit - I was also pulled that day from my floor but had worked on this unit quite a bit before. The other RN was on lunch break and a post op pts IV was beeping. The charge nurse went in to hang a new bag and family wanted to know why no one had taken vs in a couple of hours on the pt. There were vs recorded, the last one which was entered just before the RN went to eat. The dinamapp was at the bedside, cuff not even on the patient's arm - machine unplugged -
silverbat
617 Posts
At the hospital I worked, we called these "Air Vitals" because you grabbed the numbers out of the air!! Dangerous, unsafe, unethical and just plain old NOT RIGHT to do!