full assessments vs. monitor vitals

Sweeper933 · 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!

Even when it's an "off" time (non feeding or vitals) we still chart a lot of stuff each hour - bed temps, hr, resp rate, O2, IV status.... And for the first hour of our shift, we always chart their position, color, and their behavior (awake, sleeping...). That way if we come in at 7, but they aren't vitaled until 10, we still have proof that we've looked at them when we walk in the door

babyNP., APRN · Aug 13, 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!

Nothing's exact, but if I had three kids like we occasionally used to, one eats at 1130, one at 1200, and one at 1230. That leaves me 10 minutes for an assessment and 20 minutes to feed. I usually write down the numbers (temp and girth) because I would forget those, but I chart everything else after that.

The NPO babies don't really care when they're assessed, so I would feed a baby over assessing a (stable) NPO kid first and/or depending on if a feeder is sleeping and another one is crying, etc.

Our babies get moved around a bit on the unit since we have private patient rooms, so there's no way we could have everyone have different feeding schedules--too confusing! The only ones that get to eat whenever they want are the true ad lib'ers, but if they're ad lib, they're usually out the door fairly quick and even they have to eat at least every 4 hours.

Every hour, I'll chart IVs, vitals off the monitors, and I&Os if they're on fluids/continuous feeds, but I'm not going to wake up a sleeping baby that's stable as soon as I walk in, lol. They can wait until 0900 when I wake them up even if they are sleeping.

psychonaut · Aug 13, 2009

It is very cool for me to read about the great variation in how even the most routine aspects of our job are done at different locales. Since I started in my NICU as a new grad, I have no basis for comparison beyond what I read here, and I value the insight greatly.

For my contribution: shifts start at 7:00, first round is 8, 8:30, or 9. First round includes full assessment. Vitals are q2, q3, or q4. Two hour vitals are actually q2/q4 (hands-on q4), as these are generally the very sick and NPO kids, although there are exceptions, e.g. HFOV kid (q2) on feeds (q3), in which case common sense and nursing critical thinking are the guides where the P&P have nothing to say on the matter.

Reposition is no less often then q4 except in extreme circumstances. I truly feel for you all that don't have access to the swivel attachment for HFOV tubing. On the rare occasion that a HFOV kiddo doesn't have one for whatever reason (last one was in an isolation room, so much equipment piled up,...), that 2-3 person reposition q6 is a dreaded event.

dawnebeth · Aug 18, 2009

I would never wait all of a shift to do a full assessment--possibly a couple of hours on a stable chronic, but not a baby on HFOV. I always immediately look the baby over with my eye and a quick touch of the extremities to check for warmth and look at IVs right at the beginning of the shift, just after I arrive. I've never heard of restricting assessments to when the unit thinks they are necessary. The nurse should, at least, do once over on the baby in the first hour, no matter when the last nurse did an assessment. Including using the stethoscope to listen, preferably in the first hour to two hours.

On our HFOV, the nurse rarely ever turns the vent off to listen to lung sounds, etc. But if the RT or doctor is there, too, then the nurse can listen.

Dawn

BabyLady, BSN, RN · Sep 5, 2009

Here is how we do our full assessments:

Non-vent babies:

Full assessments, q3 or q4...physician picks which schedule.

Vent babies:

Full assessments q6....vital signs q2....but the q2 doesn't include temperature...so the infant does not have to be touched to take the vital signs...BP is only taken during shift change which at our hospital is q12.

dawngloves, BSN, RN · Sep 7, 2009

I'm confused here. When some of you say full assesment, do you mean BP, temp, auscultate lungs and belly? Every two,three hours? Seems excessive and most be disturbing for the pts.

We do a head to toe assement (temp, bp, auscultated, good looksy) Q6. Of course a sick baby will get a BP at least Q1, more if things are REALLY bad and hopefully they'll have an art line.

We document HR, RR, Sats, hourly on babies with an o2 requirement, others are q3, (includes skin temp and isolette temp). Feeder/growers q4 and we can do a head to toe assesment q8.

BabyLady, BSN, RN · Sep 8, 2009

I'm confused here. When some of you say full assesment, do you mean BP, temp, auscultate lungs and belly? Every two,three hours? Seems excessive and most be disturbing for the pts.
We do a head to toe assement (temp, bp, auscultated, good looksy) Q6. Of course a sick baby will get a BP at least Q1, more if things are REALLY bad and hopefully they'll have an art line.
We document HR, RR, Sats, hourly on babies with an o2 requirement, others are q3, (includes skin temp and isolette temp). Feeder/growers q4 and we can do a head to toe assesment q8.

Full assessment means full assessment, so the answer to your question is yes.

We only take the BP q 12 because of the fragile nature of their vessels, but we write it down if they have an art line.

Once you get used to it...you can do it in less than 5 minutes..I can hold a thermometer under a baby's arm while taking the stethescope and listening to the lungs, heart, belly and counting respirations.

Femoral pulses are mandatory q 3/4 if they have an umbilical line..you do it with the diaper change...if they have antecubital PICCS...you also have to check for pulses as well as dressings.

We feed them last that way when they are set down they can go to sleep and they don't need to be touched again.

Even our sickest babies are not done q1 on BP...b/c of the vessel issue.

babiesRmylife · Sep 10, 2009

I always go around & check my kids when I'm done getting report, not necessarily touch them, but always check them & the monitors.

The very 1st time I get in with them I do a complete assessment. 1st time they eat assess them, etc. Just because the last shift did it don't count on there not to be changes & if you don't assess them at the beginning of your shift your not going to know if any emergent changes have occured in your patient.