Only Charting "The Good Vitals"?

Nurses Safety

Published

So I have a question for everyone.

The scenario: I had a patient the other day who was 88 RA and 78/49 with a HR of 92 at beginning of my shift. Came in for weakness and fever. The CNA put the patient on O2, sat the head of the bed up, and got a new set of vitals 92 on 2L, 102/68, HR 96 and only charted those last vitals and didn't tell me about the first set. When I assessed him after vitals were taken he was a little pale but had no s/s of anything, just tired.

At midnight I take his vitals because the CNA was busy and see a patient whose pale, diaphoretic, nauseated with BP 79/48, 90 on 2L, and 102 HR. The blood cultures come back with gram+ cocci 5 min later. I call the doctor and we get a Lactic Acid and send to tele with dx of Sepsis.

The CNA then tells me that they were told to only chart the good vitals and he didn't tell me what the first one's were because he got better ones and "it didn't matter."

Here's the question. Has this happened to anyone else?

I've had CNA's who take vital signs while the patient is on the bedside commode, while ambulating, getting temps just after drinking. Really?

Specializes in Med/Surg, Academics.
I don't get how "charting both sets" would work logistically in a hospital setting. Say the aide gets a BP of 71/39. Obviously, you would go recheck manually. You get 94/52. If you charted the 71/39, and it's there in the computer, don't you have to call the doctor? And if you told the doctor, "well I rechecked manually and it was 94/52" wouldn't the doctor be pi**ed that you wasted his time? The first set was clearly bogus. So why not just disregard it an chart only the good set?

That's what I don't get about some of the responses. The auto set is rechecked because we think it's not accurate!!! If we thought it was accurate, we would do an intervention immediately. The manual set is the one we are confident is accurate, so why chart a set that isn't accurate?

The only way I see that charting the inaccurate auto set would be helpful is if a nurse thought of the manual set as the intervention with a final evaluation of the auto set as being inaccurate, like this on a nurse's note:

assessment: auto bp 71/39 performed by PCT; pt denies dizziness, sob, states "I feel ok"; all other VS w/in baseline; SR on telemonitor

intervention: took bp manually to check accuracy; 94/52 with manual technique performed by RN

evaluation: auto bp was inaccurate

Specializes in Med/Surg, Academics.
I have seen lazy RNs instruct CNAs to only enter "good" vitals in patient records. I believe they encourage this so they don't need to perform/document any additional assessments themselves. I agree with previous posters that it is best to record both the abnormal and any retake values.

No. If I get a set of abnormals, I quickly review previous VS on my SBAR, perform my own reassessment of any abnormal vitals and the patient as a whole, and use my nursing judgement to determine if the PCT set was inaccurate based on a host of considerations about the patient (diagnosis, co-morbidities, baselines, etc.) The reason I occasionally instruct the PCT to enter the second set of vitals is because I have determined them to be inaccurate.

This is exactly why I don't think CNA's are qualified to take vital

Specializes in Med/surg, Quality & Risk.

I think they can take them, but I wish they just wrote them all on one clipboard and left them at the desk. At work they automatically port to the computer documentation and you have to go look them up. Sometimes you can't even get in front of a computer, let alone have the time to look them up.

I don't get how "charting both sets" would work logistically in a hospital setting. Say the aide gets a BP of 71/39. Obviously, you would go recheck manually. You get 94/52. If you charted the 71/39, and it's there in the computer, don't you have to call the doctor? And if you told the doctor, "well I rechecked manually and it was 94/52" wouldn't the doctor be pi**ed that you wasted his time? The first set was clearly bogus. So why not just disregard it an chart only the good set?

It's the same with the Accu-chek machine. You get a sugar of 482 and then recheck it and get 246. Both numbers will populate in the computer. But if you look it's obvious. "What?! 482?!. . . oh a recheck five seconds later with a 246."

Just because you chart both sets of vitals doesn't mean you have to call the doctor on the crappy set. If the aide had charted both sets, it might have alerted me that this is someone that I need to keep my eye on more, or recheck their vitals myself.

I guess my main pet peeve was that they set the patient all the way up to high Fowlers, then retook the blood pressure, and set the head of the bed back down. Wow, way to elevate those vital signs there.

Specializes in Critical Care.

Reason 6495 why I work in the ICU - I know my patient's vital trends by heart

Specializes in ER, progressive care.

CNAs getting vitals are a great help but at the same time it does you no good when the abnormals aren't reported promptly. 99% of the time my CNAs report abnormals promptly. There have been a few times where I didn't know about a patient's 103F temperature until 2 hours later when they were being charted in the computer... :flmngmd:

As for blood pressures, they're great for letting me know ASAP if it is too low or too high. Abnormals are charted by both the CNAs and me, but of course you need to chart what was done about it.

I still think to this day that there needs to be a CNA advocacy!

Absolutely!

I also believe we should raise the bar on their education and what is expected of them, as far as knowledge.

There is no reason, in my mind, why individuals who are in such a position of responsibility, should be allowed to remain ignorant and/or irresponsible.

Our first response may be one of frustration at their poor knowledge base, but we need to move beyond that and teach... and hold them to a standard.

If a CNA can't learn and meet expectations, they need to go.

Specializes in hospice.

WOW. Just wow. The attitude of some of the nurses on this thread, is, frankly, REALLY ******* me off. Do you think I wanted to be that crappy CNA? I took my training seriously (during which, BTW, I was trained in manual BP and pulse) and tried to be a really good one. And then I got a job in a hospital surrounded by nurses who would do ANYTHING to keep that sepsis alert from firing in the computer from us charting our vitals. Well, anything except take vitals themselves, usually. We were expected to do them Q4 along with accucheks, input/output, and all the care and housekeeping tasks we had to perform on our constantly short-staffed floor. Plus we were expected to manually chart all of it into the EMR. Supposed to have 3 CNAs, nearly always only have two, so what get it all done anyway! And oh, by the way, come put this patient whose bed I am standing right next to on the commode, because I am an RN and I don't do that. Sure, there are great nurses out there who are not like that, but in my experience with hospital employment, they are the minority! Most of them wanted us to chart vitals that would not cause a sepsis alert, and thus put them on a time limit to call the doctor. This was on a tele unit in a major hospital chain whose name you would all recognize. Patient's sat is below 90? Have them take deep breaths until it comes up and chart that. I even watched RNs do that themselves, so where do you think we CNAs learned it? BP seems off? Retake it until it looks better, even if the cuff reinflates on the same site 3 or 4 times. I watched RNs do that too, usually when they finally got exasperated enough with me reporting abnormals that they finally went and did vitals themselves. When I did report abnormals to the nurses, they would tell me DO NOT CHART THAT go take it again, even if I had rechecked it already. When I tried to mention these and other patient safety issues, it was made clear that I was the problem, and I learned to keep my head down and shut up so I could keep my job.

Before I knew better, I had the job of doing the first set of vitals on a patient after a blood transfusion was started delegated to me. I was less than six months certified. You tell me whose fault that was? Jeez.

So, seriously, get off your high horses about writing us up. How about you write up your colleagues who demand we do this crap? Nice how you want to try and destroy someone else's career instead of admitting where this attitude actually comes from.

I am so glad I work in hospice now. I hardly ever take vitals. I actually CARE FOR my patients, instead of just doing tasks TO them.

WOW. Just wow. The attitude of some of the nurses on this thread, is, frankly, REALLY ****** me off. Do you think I wanted to be that crappy CNA? I took my training seriously (during which, BTW, I was trained in manual BP and pulse) and tried to be a really good one. And then I got a job in a hospital surrounded by nurses who would do ANYTHING to keep that sepsis alert from firing in the computer from us charting our vitals. Well, anything except take vitals themselves, usually. We were expected to do them Q4 along with accucheks, input/output, and all the care and housekeeping tasks we had to perform on our constantly short-staffed floor. Plus we were expected to manually chart all of it into the EMR. Supposed to have 3 CNAs, nearly always only have two, so what get it all done anyway! And oh, by the way, come put this patient whose bed I am standing right next to on the commode, because I am an RN and I don't do that. Sure, there are great nurses out there who are not like that, but in my experience with hospital employment, they are the minority! Most of them wanted us to chart vitals that would not cause a sepsis alert, and thus put them on a time limit to call the doctor. This was on a tele unit in a major hospital chain whose name you would all recognize. Patient's sat is below 90? Have them take deep breaths until it comes up and chart that. I even watched RNs do that themselves, so where do you think we CNAs learned it? BP seems off? Retake it until it looks better, even if the cuff reinflates on the same site 3 or 4 times. I watched RNs do that too, usually when they finally got exasperated enough with me reporting abnormals that they finally went and did vitals themselves. When I did report abnormals to the nurses, they would tell me DO NOT CHART THAT go take it again, even if I had rechecked it already. When I tried to mention these and other patient safety issues, it was made clear that I was the problem, and I learned to keep my head down and shut up so I could keep my job.

Before I knew better, I had the job of doing the first set of vitals on a patient after a blood transfusion was started delegated to me. I was less than six months certified. You tell me whose fault that was? Jeez.

So, seriously, get off your high horses about writing us up. How about you write up your colleagues who demand we do this crap? Nice how you want to try and destroy someone else's career instead of admitting where this attitude actually comes from.

I am so glad I work in hospice now. I hardly ever take vitals. I actually CARE FOR my patients, instead of just doing tasks TO them.

I was working on a response that was eerily similar to this one but you beat me to the punch, this is exactly how it works and even if the nurses in this thread are not like this, they need to recognise were this problem originates from. To the nurse who said CNA's are not qualified to do vitals, I suppose she also wants a return to a nurse also having less responsibilities. Remember, at one point, only Docters could take vitals and I know many nurses are scared that CNA's might just eventually be allowed to do more as that could cut their salary and comfy position in the future.

Specializes in geriatrics.

There are good and bad workers in every profession. We aren't implying that ALL CNA's aren't doing their job. I work with some outstanding CNA's, and some who should be fired. The same is true of nurses, doctors, etc.... And I wholeheartedly agree that all CNA's require additional education, as a general rule, so that you can understand and accurately interpret the whole picture, not just the set of vitals taken. The clinical picture of each patient is related to their vitals.

Specializes in NICU.

And suddenly, I'm really happy that my floor utilizes team nursing (at night it's two teams of an RN and LPN with 8-12 patients and one or two aides for the floor). Our LPNs do the vitals and meds while the aides do the accuchecks, I/Os, turns, lights, incontinence care, ect (they're quite busy). Usually the LPN is very good with notification of wonky vitals and initiating whatever intervention is in her scope. There is one LPN though who we have to watch and ask for any unusual vitals or if she's done them at all (just because vitals are qshift and they are sleeping does not necessarily mean wait until 0630 to see them).

I haven't seen too much evidence of just charting the 'good' vitals except for temps--if they are post-surgical and the temp is 99, they are often encouraged to cough/deep breathe and recheck.

+ Add a Comment