Do you trust automatic "vitals" machines??

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At our hospital the CNA's use "robo nurses" to take vitals. It is relatively fast for them, taking BP and pulse and o2 sats at the same time. However the more I work, the less I trust them. It seems like one night the CNA reports all my pts. BP's are up, another night they are low. Or they can't get the machine to work. I take them manually to check. Sometimes I agree with the machine, sometimes not. Also the pulse ox seems weird. It will often show lower sats then the hand held machine.

When I was in RN school we were told to not use these machines, but the BP cuffs in the rooms are not always in good shape either. I do prefer to check my pts. pulses on both sides during an assessment if I can and at the same time I can accurately check respirations.

What do you all think about these machines? Does your facility use them???

Specializes in ICU, telemetry, LTAC.

No, I don't trust the machines.

1. I don't see too many people cleaning them, god knows what we're passing around germ-wise. Ugh.

2. blood thinners, old age, and the fact that the thing takes a minute or so to mash someone's arm to all heck and back before deciding on a number is just plain cruel. It takes me 30 seconds or less and I'm done.

3. A-fib makes the machines do some crazy stuff.

4. Use the manual and you're 1/4 of the way done with a skin assessment when you do your BP.

Now I have a good tech. She's priceless! Any wonky crap out of the machines and she will do a manual BP and tell me the difference. I usually follow her the first time around and do my assessments while she's on vitals so if it's screwy, I can help right then and there. But honestly, I don't work with her too often. So I'm used to doing my own vitals and I don't have it in my mind to even look for a machine. I grab a thermometer, a hand held pulse ox if there is one, and go. (Pulse ox's are in our rooms but they are way up on the walls... long story!) During the VS I notice: what the inside of the mouth looks like when I take a temp, what IV's and tubes are where, when I do BP, skin assessment on arms for BP, oh yeah, JVD during temp! For pulse ox I'm seeing cap refill, temp of hands, tremor, are the fingers arthritic, etc. I can hold their hands if they need a little TLC. There's a conversation going on the whole time if the patient's awake, so I can get a lot of work done in the few minutes it takes to get vitals. From there it's natural to finish the assessment and it doesn't seem to take me more than 5-8 minutes to do my assessment and VS together. I take less time on VS later in the shift 'cause I've already got a good idea of what the patient looks like.

My assessments go faster when I've got a tech helping with VS but I always wonder what I missed.

Specializes in Cardiology, Oncology, Medsurge.

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I learned from them though.. I just graduated and passed my boards.. I will not be one of those nurses!

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Oh yeah!!!! And you won't have a large derriere from bossing someone around while you're sitting down all the time!

Specializes in ER, Medicine.
No, I don't trust the machines.

1. I don't see too many people cleaning them, god knows what we're passing around germ-wise. Ugh.

2. blood thinners, old age, and the fact that the thing takes a minute or so to mash someone's arm to all heck and back before deciding on a number is just plain cruel. It takes me 30 seconds or less and I'm done.

This is very true...the BP cuffs especially the automated (Dynamaps) that are used are very rarely cleaned in between patients. You just go room to room checking BPs and not cleaning them...:confused:

And yes, doing some things like pulses and even BPs is much more efficient manually. It's quicker, easier, more reliable, and for gosh sakes...did I say QUICKER!

There's just something about a Dynamap that takes them 5 minutes to get a BP that you could get in 30seconds...without all the repeated arm squeezing because of errors.

As far as trust. The thing I trust the most is myself. I have gotten some very strange readings from some machines...only to check myself and get something closer to what I expected.

:smilecoffeeIlovecof

Specializes in Rural.

At the place where I work we now issue cuffs to our patients, that get marked with their name and stay in the room. Yhis has cut down significantly on cross contamination.

The other issue about trusting the machine brings something to mind that we heard over and over in Nursing School: Treat the patient and not the machine. I think it is great to use dynamaps or passport machines, if you still use a dose of good old nursing judgement. Does your assessment correspond with what the machine tells you? Have you ever ran down the hall, because a telemetry read v-tach or worse, and been met by a smiling patient that is just a little bewildered by the look of panic on your face? I think the same goes for automatic BP's, pulse counts and SaO2.

Especially the O2 sat is often misleading. Our patient may have a sat in the 90's, but how much effort is he putting into maintaining that O2 sat?

These are all questions that can only be answered by one thing and that is a good nursing assessment.

Specializes in acute medical.

I have found that electronic sphygmos in the main, are accurate, and really help when it is difficutlt to hear a BP. But I have found them to be totally in accurate when there is an arrhythmia, eg AF, which then means that a manual is essential. What I often find inaccurate are the "ear thermometers" - how embarrassing, I can't remember the proper name! And these days there are no manual instruments around as anything containing mercury is banned...

Indy can be my nurse any day!

I was taught by an excellent preceptor to do the first set of vitals manually, then if the machine agrees, ok. However if the machine later tells me something else, check it and see if I agree. Another thing she said was "Before you do CPR on a patient who's telemetry says they've coded, ask them if they have a pulse, if they say yes then don't start CPR!" Of course we all know about v tach with a pulse, but the basic principles she taught me still work.

Specializes in Utilization Management.

By the time I have a machine hooked up and working properly, I could've done ten BPs. We have the worst machines in the world.

Besides, as others have noted, if the patient's pulse is irregular, they're useless. This is why I check HR and rhythms up at the monitors before I ever step into a patient's room.

As far as cross-contamination is concerned, we have manual cuffs in every room--and they're never changed with each patient. I'm sure some of them have been there since the Ice Age. And who knows when the machines were actually washed; I have a hard enough time trying to clean off the tele leads and monitors when patients are DC'd.

I don't blame the hospital, though. The equipment is very expensive and theft is such a problem, not from visitors or patients, but from one department to another, that it's a wonder that we still have the equipment that survived.

One unit went so far as to modify the label on our machines so that it looked like that machine "belonged" to that unit! How utterly gauche.

So I use my own manual cuff, the tele monitor, the bedside thermometer, and I hunt down one of the two pulse oxes floating around the unit, which may or may not be accurate.

Any wonder why I hate doing vitals?

And for the poster who noted how many tasks the CNAs were assigned and then asked, "What do the nurses do?" the answer is that we know how to troubleshoot and fix all the problems associated with the wrong answers that the CNAs get. Nursing is a whole lot more than simply performing tasks and charting.

Specializes in NICU.

I completely agree with everyone about doing the first set of vitals manually. And when I was a tech I always wondered... How can these nurses not ever want to do the vitals themself... Just to get an idea of their patient's status? They just trust the techs completely; which I guess made me feel good? But also concerned me...

But to stick up for the techs... Cavi wipes are attached to our "nurse on a stick" and I do clean them between every room. And our isolation patients have their own BP cuff and thermometer that stays in the room.

I start as a nurse on monday (I just passed boards) HURRAY!! And y'all have given me some great assessment tips... How to do vitals and my assessment all at once! So thanks!! I'll take all the tips I can get!

I'am a nursing student right now doing clincials and I started out doing B/P manually but by the end of day i didnt have enough time to do alot of my other agenda's done, so i started using the automatic machines. I really havent thought that much about what your talking about but it really makes me start to think about how accurate they are! thanks for bringing that message up!

Specializes in post-op.

I can't even get that manual BP machine to work for me:) The few times I have tried to use I spent more time trying to get it to work and could have taken a manual in half the time. The other night one of the techs on my unit was using the machine and I got a fresh post op, so she was in there with me and it took about 10 minutes to get a BP, I just kept wanting to say why don't you just get the manual cuff!

Specializes in Tele, Renal, ICU, CIU, ER, Home Health..

During a code a few weeks ago, I got a palp B/P of 60. (After getting a rhythm back of A fib). One of the fairly new nurses on the floor started yelling, "No, the dynamap says his B/P is 100/50". Although a code is not the ideal time to explain why the dynamap could not be trusted with an irregular rhythm, I tried. She would not listen to reason. The doc, of course, started Dopamine and then asked loudly for a Manual B/P.

I guess I know what my next in-service will be about!

The last hospital I worked at had a policy that B/P's must be checked manually once a shift. I think that's a good idea.

And for the poster who noted how many tasks the CNAs were assigned and then asked, "What do the nurses do?" the answer is that we know how to troubleshoot and fix all the problems associated with the wrong answers that the CNAs get. Nursing is a whole lot more than simply performing tasks and charting.

That would be me . . . . . :D

Dressing changes, blood sugars, foley caths, blood draws . . . those are all RN or LVN duties where I live. Within the scope of practice of nurses. Not CNA's or patient care techs.

There are specific guidelines for what nurses do and I guess I'm just seeing more and more of nursing responsibilites given over to others (med passes by CNA's, etc.)

steph

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