What are you most vigilant about? - page 4

What things do you watch your patients for more vigilantly now after having missed before? Or maybe it is just because you have seen it happen more often or have seen another nurse have a problem... Read More

  1. by   firstinfamily
    This is for Big Goose concerning restraints, when I was working ICU in Virginia the use of restraints as a routine for intubated patients was revoked by the state inspectors. We had to learn how to use other items not considered restraints. There were many emergency extubations because of this ruling, we were lucky that those patients were able to be reintubated without any trauma or increase in airway edema. You are fortunate you can still use restraints with intubated patients, I have worked both areas where they are allowed and not allowed and I personally would prefer my intubated patients to be restrained for their protection and to prevent any extubation trauma.
  2. by   firstinfamily
    nurn---Yes, it seems turning is not always encouraged!! When I would get patients on the sub-acute unit they would say, "I cannot turn on my operative side." At which point I would educate them and also inform them of the hazards of not turning. (skin breakdown, lung congestion----pt education!) I had one patient who had chest tubes who was post day #1 and told me he "couldn't get out of bed." At which point I told him how we were going to do it and why he needed to do it and how the chest tube set up would not interfere." The sooner they are moving the faster they recover!!!
  3. by   ChristineN
    Quote from phaniea69
    Checking drug levels prior to administration. Also, checking any labs that go hand in hand w/ certain meds (i.e., Lasix/K+ levels). As a new nurse I saw a 20 year old post-knee arthroscopy pt. end up on dialysis after receiving several doses of Gentamycin after a critically high trough had been overlooked. I had always been quite vigilant but that cemented my habit.

    Stopping to look up drugs I don't know no matter how much of a time crunch I am in.

    There's others but that's the one that comes to mind immediately.
    This. I am a big on drug levels and if it isn't ordered I will ask for it to be ordered. Several years ago my mother was hospitalized following an overdose and no one checked drug levels for over two weeks. By that time they had restarted her meds and even titrated the dose up. By the time they checked she was in acute kidney failure. Fortunately didn't need dialysis but still very scary
  4. by   ChipNurse
    Drip concentrations.... we get different concentration when the pt comes up from OR that are different that what we stock/mix on the floor. I once had a very unstable patient on 3 pressors, one of which was signed off by the previous nurse as a certain concentration and programmed in the pump as said concentration but was a completely different concentration hanging, so they were getting double the amount. I always check at the beginning of the shift during my assessment. It only takes a minute.
  5. by   Christy1019
    Quote from ChipNurse
    Drip concentrations.... we get different concentration when the pt comes up from OR that are different that what we stock/mix on the floor. I once had a very unstable patient on 3 pressors, one of which was signed off by the previous nurse as a certain concentration and programmed in the pump as said concentration but was a completely different concentration hanging, so they were getting double the amount. I always check at the beginning of the shift during my assessment. It only takes a minute.
    That sounds like an unsafe pharmacy practice! Different volumes of medication like 250ml vs 500ml but the concentrations being different can lead to so many errors!
  6. by   TeflonNurse
    I'm very vigilant about making sure I keep an eye on any weird maintenance fluids running (stuff we don't keep on the floor) especially pressors and sedatives. i make sure to order the next bag from pharmacy before i run out.

    Had a lady once on a neosynephrine drip and she was REALLY sensitive to it. The new bag had come up and was hanging on the pole. while waiting for the old bag to finish my preceptor called me over to do trach care on my other pt. Had quite a bit left in the bag so I think, "why not?" In the amount of time it took for us to do trach care the Neo finished, and this lady's BP dropped! Couldn't hear the alarm in the other room. Luckily I work with some amazing folks and another RN and her orientee saw it on the monitor, went in and switched out the bags but my mind kept running through scenarios where I hadn't ordered the new bag, it hadn't come up yet, or the other RN hadn't noticed/ responded to the alarm. I always note how much is left in a bag and I always take the second or two to check any alarms that I hear, whether its my room or not!
  7. by   TeflonNurse
    oh I forgot, I don't let anyone make me feel rushed when giving a med and i label any IVPush drugs before taking them in the room.

    I also make sure to get ALL the air out of pressure bags for Art -lines etc. before pumping them up. I've had other nurses not believe me when I said this could cause an air embolism if the bag gets accidentally laid down.
  8. by   stevengarbs
    Knowing first the patients recent medical records, and always making sure you have entered the correct information about him. It could be useful if the patients comes back again.

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