Patient decompensated on the floor, sent to ICU, Have you had this happen?

Magsulfate, BSN, RN · May 20, 2009

What's really bad is when the patient has been decompensating ALL NIGHT, and has gone into severe septic shock by the time you arrive for your shift at 7am,, and realize that the nurses have no idea this patient is really sick,, and they almost killed them by doing NO INTERVENTIONS at all whatsoever.

stressgal, RN · May 20, 2009

I work in an ICU and our pt's decompensate from time to time. . . except there's no place to move them. . . we are it. I floated to a med/surg (but only 4 pt's a nurse, kind of a 'holding floor', if you will) where all four of my pts were able to get out of bed, use the bathroom, feed themselves, etc. and I was totally freaking out. I could not see them from the nurses' station. None of them were on tele monitors; while the other nurses were taking a break or going about routine business, I was peaking into my pts' rooms (it was night shift) just to make sure they were all still breathing!
I was freaked out because even though they were less ill than my usual pts, I knew that if something started to go wrong I had a LONG way to go before I could get them the the point of maximum intervention. In the ICU, even though the pts are critically ill, I know every little thing that is going on with them. I know if they are breathing, what their heart rhythym is, I can see them all from where I sit, and if something goes wrong they are already where they need to be. Kind of funny I guess, being more comfortable in the ICU than with 'walky talky' pts.
What I hate is when we downgrade someone an move them to a new floor and then later that day or within a couple of days they come back to us. Kind of depressing. But don't feel bad about having a pt decompensate. That's why they are in the hospital and not at home.

From one ICU nurse to another.......DITTO! :chuckle

Nurseangel10 · May 20, 2009

I wonder how many codes could be prevented if we catch the subtle and sometimes obvious changes?

Tait, MSN, RN · May 20, 2009

I wonder how many codes could be prevented if we catch the subtle and sometimes obvious changes?

Some can't be prevented at all, such as my first code and death (not my patient, but my floor). PE moved, pt went brady to 39, already blue on the floor.

Other codes I believe can be prevented when people actually think about the orders they have. I feel a lot of codes are related to over medication/sedation.

And then there are just the ones you watch, hover over, call in rapid response on, call four different MD's on begging for a transfer, then just wait.

Of course you should always be wary of any fragile 80+ year olds who just got a really "good bath and bed change". Those buggers seem to code fifteen minutes later!

Tait

Nurseangel10 · May 21, 2009

I just hope the codes are few and far between!