How do your patient care techs (CNAs) check pulse rate with vitals?

[Carrie2244]

On our unit the patient care techs complete all the vital signs. They check vitals and document the heart rate based on the reading from the pulse oximeter on their finger. We recently had a patient in uncontrolled fib, and the documentation of all the patient's heart rates were wrong due to the use of the pulse oximeter for vitals. Just wondering what other areas practice for heart rate. Patients are on continuous telemetry, but the patient care techs do not see this nor know who is in afib when doing vital signs.

[MunoRN, RN]

Pulse and heart rate (EKG rate) are two different things, so I'm not sure what you mean by saying "the documentation of the patient's heart rates were wrong due to the use of the pulse oximeter for vitals". When it's getting an appropriate reading, the "pulse" a pulse oximeter shows is a fairly reliable measurement of the pulse at the specific location it's being measured, this might be completely different from the "heart rate" which is often used interchangeably with the EKG rate (number of QRS's per minute). Just because the pulse is different from the HR, that doesn't mean the pulse wasn't accurately read.

[brownbook]

I concur MunroRN. How much of a difference are you registering?

Ideally an irregular pulse is taken via the radial artery for one minute. This would be if no pulse oximeter or telemetry was available. I can't imagine the one minute radial pulse, vs the pulse oximeter, vs what telemetry shows would differ dramatically? If there was that dramatic of a difference the patient would have some serious cardiac issues going on.

Any bodies pulse is going to have a reasonable variation.

[RainyDayParade22, BSN, RN]

Our PCAs are instructed to look at the patient's tele pack for the HR and to document that. In your case, doing it this way would capture the higher HR of uncontrolled afib.

[LauRN3367, MSN, NP]

Our unit documents from tele monitors. Not only the situation you explained, but PACs or PVCs may not get conducted all the way down the arm into the finger, which leads to false low readings from a pulse ox! Best.