full assessments vs. monitor vitals

NeoNurseTX, RN · Aug 3, 2009

I don't care when the previous shift did their last set of vitals/assessment..I do mine right when I get there.

Sweeper933 · Aug 3, 2009

Most of our babies get hands on vitals every 6 hours. Either 8-2, 9-, or 10-4 depending on what their q3 eating schedule is. When they're unstable (on HFOV), they get hands on vitals every 4 hours. Once they're close to going home and eating every 4 hours, we do hands on vitals every 8 hours. Otherwise, we take numbers from the monitor every hour. If they're on any type of oxygen, we have to count their respirations every hour, and not just rely on what the monitor says.

A few of our chronics will end up only getting vitals q12 h - depending on what their schedule is and what they have going on. This way, they can sleep all night and not get bothered too much.

nicu4me · Aug 3, 2009

Yeah, I don't feel comfortable waiting and doing an assessment either. But in our unit they may say your baby is "due" at 10:00 when I come in at 7:00 and we aren't supposed to do anything with them, just chart any a/b's or sx'ing that we do and then if their full assessment was done at 7:00 am and the baby is on a q 6 hour vital signs then the baby is not supposed to have a full check until 1:00 - making it the full 6 hours.

Ex full check (assessment) at 7 am

Monitor vitals (aspirate/feed/diaper) at 10:00 if it's a gavage then diaper is optional they say. U just write the monitor numbers down

Full check at 1:00 (full assessment-lungs, bs, heart, etc.)

This is to limit the number of assessments on the babies and I understand that but I prefer to do a full one when I come in. If the baby is not due to eat (level 3 here still) three hours after I come in, I at least verify vent settings, assess color, iv/picc, fluids, o2, etc. So they end up getting 2 full assessments in a row. (I wont do the blood sugar except as it was ordered) however, in our unit if it is a q 6 hour blood sugar they could do it with their am labs at 4:30 in the am and then we don't do it until later in the afternoon which is still not q 6, it's more of when the full assessments are due. Hopefully, you all understand my scenario and I didn't confuse ya.

So the problem becomes if you have a q 3 hour feed with a q 6 hours full assessment. So either you have to do two full checks on your shift and one monitor vital or take and do a full check but not chart it the first time (all on paper) because it makes the assessment times off.

nicu4me · Aug 3, 2009

Most of our babies get hands on vitals every 6 hours. Either 8-2, 9-, or 10-4 depending on what their q3 eating schedule is. When they're unstable (on HFOV), they get hands on vitals every 4 hours. Once they're close to going home and eating every 4 hours, we do hands on vitals every 8 hours. Otherwise, we take numbers from the monitor every hour. If they're on any type of oxygen, we have to count their respirations every hour, and not just rely on what the monitor says.
A few of our chronics will end up only getting vitals q12 h - depending on what their schedule is and what they have going on. This way, they can sleep all night and not get bothered too much.

You actually worded it better than I did, our units are similar but the question remains then if you come into that HFOV baby and it's not due for four hours after u get there are you doing an assessment anyway when you come in? Usually with the HFOV we're sx, and have ROP guidlines that we are charting o2 anyway everyhour. So my question is we really are leaving the full assessment open for that long. We aren't supposed to pause the HFOV and check LS if they are monitors until the full 4 is up. I don't like it but I do it because my reasoning is that I can see a lot by looking and my monitors or labs are usually telling me something as to their status. I can usually tell when I am walking into a trainwreck but sometimes with those q 6hour you never know with the person who you are following.

neonatal_nurse · Aug 3, 2009

Always assess before doing (or not doing) any intervention. Just to be safe, than sorry. :)

Sweeper933 · Aug 3, 2009

You actually worded it better than I did, our units are similar but the question remains then if you come into that HFOV baby and it's not due for four hours after u get there are you doing an assessment anyway when you come in? Usually with the HFOV we're sx, and have ROP guidlines that we are charting o2 anyway everyhour. So my question is we really are leaving the full assessment open for that long. We aren't supposed to pause the HFOV and check LS if they are monitors until the full 4 is up. I don't like it but I do it because my reasoning is that I can see a lot by looking and my monitors or labs are usually telling me something as to their status. I can usually tell when I am walking into a trainwreck but sometimes with those q 6hour you never know with the person who you are following.

Well we never make q4 vitals due at 7-11-3... because then it would always be due during shift change - no matter if it were a 8 or 12 (or 4) hour shift.

Because of this - vitals are never more than 3 hours after you walk in the door (start shift at 7, first set of vitals are at 10). Obviously, if it appears that something is clinically changing with the baby, we don't wait until that 4 hour mark - assessing immediately.

On the "off hours", we are still doing hands off assessments on all of our babies - no matter what their vital sign schedule is. This includes taking numbers from the monitor (and actually counting respirations if they're on O2), assessing IV sites, fluid totals, oxygen settings, and a few other random things that are a case by case situation (iNO, chest tube site assessments...)

labordude, BSN, RN · Aug 3, 2009

You actually worded it better than I did, our units are similar but the question remains then if you come into that HFOV baby and it's not due for four hours after u get there are you doing an assessment anyway when you come in? Usually with the HFOV we're sx, and have ROP guidlines that we are charting o2 anyway everyhour. So my question is we really are leaving the full assessment open for that long. We aren't supposed to pause the HFOV and check LS if they are monitors until the full 4 is up. I don't like it but I do it because my reasoning is that I can see a lot by looking and my monitors or labs are usually telling me something as to their status. I can usually tell when I am walking into a trainwreck but sometimes with those q 6hour you never know with the person who you are following.

You pause the HFOV every 4 hours? I've worked in multiple NICUs and never seen it that often before. It seems like too much stress on the baby forcing them to re-recruit alveoli so frequently, though I suppose it depends on why they are on the HOFV in the first place (micro-preemie vs sick big kiddo).

Always assess before doing (or not doing) any intervention. Just to be safe, than sorry. :)

I'm with you, I will always assess before any intervention. That way I have a leg to stand on should something happen.

BittyBabyGrower, MSN, RN · Aug 4, 2009

Our sickest kids will be every 6-8 hours hands on care. We do not bother them until it is time or they require intervention. We also never stop the oscillator or high frequency to check unless it is ordered...they can collapse in that interval of time and when you disconnect from the vent you are increasing your chance for a VAP.

As they get better and they are nippling more often we do their hands on vitals with their PO feeds, they have to get up anyways. NG kids, if they are well enough, we do hands on every other feed so that they can sleep.

Your unit should have a routine care protocol that sets the guidelines for how often a full assessment needs to be done.

nicu4me · Aug 8, 2009

If they are on an HFOV and you want to change positonions in an isolette you have to flip them from end to end in the bed. Sometimes it is not possible to have it out the end of the isolette due to location of the bed within the pod area. And you have to flip them side to side rotating their heads. Maybe our HFOV tubing is different. We also check to see if they are breathing on their own (spontaneous), and how are you supposed to check for bowel sounds with the HFOV going too? I also agree with not pausing the HFOV, I worry they won't vibe as well once you turn it back on after making a change in position. If they are in an isolette there is no bed scale so you have to take them out. I agree with all the posts. I get report from some people that work a 4 hour shift and have not touched the baby other than to hook up a gavage and changed the diaper (? sometimes) and haven't done any hands on care only to record the monitor numbers at that 3 hour mark. This could be a 31 weeker too, on a vent. It's a loose situation and I thank all for the replies, that's why I brought it up. One more point though is the older ones who are once a shift full vitals, they may have a kangaroo pump cont. gtt. and the person before you got them all snuggled in and their full assessment completed the last hour of their shift. Which may mean waiting to the end of your shift to look them over is what you are supposed to do per the once per shift requirement. I at least chart the obvious skin, picc, color, monitor vitals, but put sleeping because I couldn't do a neuro, resp, or cardiac assessment unless I use my stethoscope.

babyNP., APRN · Aug 10, 2009

We flip the HFOV kids once a shift (12 hours).

As far as assessment, if they're stable feeders, one full assessment every 6 hours, but we definitely do a full assessment when we walk in. The feeding schedule is 09, 12, 15, 18, etc and if they're NPO, it's 08, 12, 16, etc. If I'm on the off assessment, then I usually just change their diaper, listen to their breath/heart/GI sounds, and get a temp before feeding them.

nicu4me · Aug 12, 2009

We usually just have two babies each however, I was wondering how you could you possibly have set schedules on your babes? It would make all your babes due in your unit at the same time. It's bad enough if you get an easier assignment with a threesome and they are all nipplers and two are due at the same time or one due every hour! So really how does that get done on your unit? The other thing is too is that if you walk in the door at say 7 am and your regular feeder grower on a q 6 hour full assessment schedule or a once a shift schedule that is nippling all isn't due until 10 am there is nothing charted (long hand) about that baby other than you took over for the prior RN at 7 am. That makes me nervous as well. (There is a brain to our monitors), but don't you think that something should be charted? Even under behavioural? Or is it just me? Thank you!