Today had to be one of the most stressful situations that I have had to deal with lately. I worked a shift in ICU (small 3 bed ICU) and myself and another nurse were taking care of 3 patients. 2 of these patients were fresh MI's and the other was pneumonia, sinus tachycardia and septicemia (really sick). So we sit down and get our report at 730am and the 3rd patient described above had had a horrible day yesterday (very restless, aggressive. etc) and overnight had received 2 doses of IM Haldol. In report the nurse working nights had said that she let the man rest the entire night as he had been through so much the day before and was fine this morning. So the other nurse and myself decided between us that we would take care of the other 2 patients (do assessment, vitals, etc.) and attend to out 3rd patient last (we figured we would let him get a little more rest. Upon entering the room the patient looked a mess, bedclothes messed up, looked like he hadn't been touched all night. In checking his vital signs he had a temp of 33.4 and BP of 66/33, no urinary output since 6am. We immediately checked his chart from last night and not a single BP charted, not a single temp charted. In reading the night nurses notes, the patient's spO2 had dropped to 70% on 5 L of O2 and the doctor was not even called. I called the doctor to inform him of the patients condition which was poor, low BP, no urinary output, unresponsive, etc. The orders given to me was to D/C the Haldol and give a 250cc bolus of NS over 1 hour. About 10 minutes later the doc calls back again and tells us to hold all of his po meds (the patient was not alert enough to swallow them anyway). By this time our gentleman in Room 3 developed chest pain and we were in the middle of doing EKG's, giving NitroSpray, taking BP's, etc. The doc calls back once again and asks to start our sick man on a dopamine gtt and to give some more boluses. By this time the man is having 5-10 second periods of apnea, becoming bradycardic and eventually having periods of asystole and expires on us while we are right there in the room (he was a no code thank goodness). Finally about 10 mins after the man passes, the doc comes in and gets all upset saying that we were too late in calling him with the low BP, more or less implying that he died because of our negligence to call him earlier. This situation upset me for 2 reasons, in that the night nurse gave us a false impression of the patient status (how could she know his BP was in his boots if she didn't even bother to do one!) and the doc not giving proper orders the first time that he was called regarding the patients status and having the nerve to say that we were not doing our jobs. Our nurse manager was informed of the situation and we were told that we followed the correct steps, apparently this doc gets upset when he loses patients and tries to blame everyone else. He should have come in to assess the patient after the first phone call! Sorry this post is so long but I need to vent!!! I'm probably going to be working ICU again tomorrow. :uhoh21:
Today had to be one of the most stressful situations that I have had to deal with lately. I worked a shift in ICU (small 3 bed ICU) and myself and another nurse were taking care of 3 patients. 2 of these patients were fresh MI's and the other was pneumonia, sinus tachycardia and septicemia (really sick). So we sit down and get our report at 730am and the 3rd patient described above had had a horrible day yesterday (very restless, aggressive. etc) and overnight had received 2 doses of IM Haldol. In report the nurse working nights had said that she let the man rest the entire night as he had been through so much the day before and was fine this morning. So the other nurse and myself decided between us that we would take care of the other 2 patients (do assessment, vitals, etc.) and attend to out 3rd patient last (we figured we would let him get a little more rest. Upon entering the room the patient looked a mess, bedclothes messed up, looked like he hadn't been touched all night. In checking his vital signs he had a temp of 33.4 and BP of 66/33, no urinary output since 6am. We immediately checked his chart from last night and not a single BP charted, not a single temp charted. In reading the night nurses notes, the patient's spO2 had dropped to 70% on 5 L of O2 and the doctor was not even called. I called the doctor to inform him of the patients condition which was poor, low BP, no urinary output, unresponsive, etc. The orders given to me was to D/C the Haldol and give a 250cc bolus of NS over 1 hour. About 10 minutes later the doc calls back again and tells us to hold all of his po meds (the patient was not alert enough to swallow them anyway). By this time our gentleman in Room 3 developed chest pain and we were in the middle of doing EKG's, giving NitroSpray, taking BP's, etc. The doc calls back once again and asks to start our sick man on a dopamine gtt and to give some more boluses. By this time the man is having 5-10 second periods of apnea, becoming bradycardic and eventually having periods of asystole and expires on us while we are right there in the room (he was a no code thank goodness). Finally about 10 mins after the man passes, the doc comes in and gets all upset saying that we were too late in calling him with the low BP, more or less implying that he died because of our negligence to call him earlier. This situation upset me for 2 reasons, in that the night nurse gave us a false impression of the patient status (how could she know his BP was in his boots if she didn't even bother to do one!) and the doc not giving proper orders the first time that he was called regarding the patients status and having the nerve to say that we were not doing our jobs. Our nurse manager was informed of the situation and we were told that we followed the correct steps, apparently this doc gets upset when he loses patients and tries to blame everyone else. He should have come in to assess the patient after the first phone call! Sorry this post is so long but I need to vent!!! I'm probably going to be working ICU again tomorrow. :uhoh21:
I think you had a part in this in that the first thing you or the nurse you worked with should have done was to obtain a brief assessment of the pt. Also keep in mind that even if the patient had been stable during the previous shift, ot's status in icu is always changing.
I posting to give all those who responded an update on the situation described above. The situation has become more heated as the days go on. The gentleman that died that day was the father in law of one of a nurse in the hospital. She asked the nurse that I worked with that day about what happened and she proceeded to tell her about the vitals not being completed the night before and our hesitance in doing his BP first thing on our shift. She was upset understandably and our nurse manager was involved the first day it happened. That nurse then proceeded to ask our manager about what happened and what would be done about the situation regarding her father in law and our nurse manager told her that all of his vitals were done and charted (which was an outright lie!). I looked at that charting a lot that day, there were no vitals charted since 1800hrs the evening before and I also wrote that in my nurse's notes. Needless to say there is a lot of tension between the night and day nurses during this shift, a lot of conflicting stories about the care that was done on nights. The nurse that worked with me is upset about the care that was not provided that night and the night nurses are accusing the day nurse of a breach of confidentiality in telling the nurse who works in the hospital about what happened with her father in law. :stone
Get the head of your nursing dept (whatever she's called) or hospital administrator involved now -- at least inform them of what's going on. I would also journal everything you can remember about this event and keep it at home for the time being. Make sure you date it and sign it.
There's nothing worse than the sinking feeling you get realizing the shift before you has not done their job, and your patient is suffering for it. Unfortunately it was a regular occurrence in my last ICU job...this made it hard to go in every day. I KNEW I would get 'dumped on'.
'Wanting to let a patient rest' is not an excuse to deviate from ICU standard of care. This needs to be reported. I'm sorry you guys believed that last shift report and thus prolonged the innattention to the patient's failing vital signs. Unwittingly you became part of the problem too. We live and learn.
I am sorry you have found yourself in a mess you did nothing to create. There is no excuse for the lack of care, the lying, the HIPPA violation, the lack of notification of the attending and the list could go on and on.
Are you going to continue to work in a facility with such poor ethics? I wish you luck and my advice is to document, keep very clear records, file incident reports, talk to every supervisor available, and try to keep your back off the target range. Good luck.
Ok, first things first, this should have never happened in a hospital, on any floor, let alone an ICU. Vital Signs need to be taken at a bare minimum every 2 hours in an ICU unless otherwise specificed. As far as the condition of the patient and room, I have a simple solution.
This was a HUGE problem in the unit that I worked, patients left in disarray, labs not called, things not done, room a mess, etc. So, the nurse manager and I devised a plan to stop this and it worked. It increased the accountability of the nurses and increased patient care as well.
Every oncoming and offgoing shift during report goes over all orders from the previous 8 or 12 hours, we then sign a "chart check" to verify that these were reviewed and discussed. Next, we go into the patient room and actually look at the patient, are IV's dated and labeled, are IV bags labeled and not dry, is IV tubing outdated, are dressings done and dated, are linens clean and dry, is the patient clean and dry, after reviewing this there is a sheet hanging on the cabinet door in the room labeled Room Check; both nurses sign this. If you sign, that says you are accepting the patient in whatever condition you received them in. So, if things are not done and you let the other nurse leave without correcting it, or without you saying that you don't mind correcting the problems, than you have no one to blame but yourself.
At first, there were some nurses that had a huge problem with this, but they were the ones that were the worst culprits. Over time it all stopped and things were done, patients and rooms were clean, labs were called, and people were actually taking pride in their work again. People don't like staying behind to fix messes they should have fixed long before and this gave the nurse manager a tool to evaluate performance as well. It works for us and all the nurses are happy.
No kidding... I work in a lousy....CHEAP hospital.... but in ICU...I know there are monitors that continuously monitor the pts. Unless the volume on the alarms were turned down... the nurse should have been aware immediately. WOW!!! And I thought my hospital was negligent!
one tip.... I always get to work a bit early...find out my assignment and after I clock in, I walk into my pt's rooms and check them out BEFORE getting report. I like to know what i'm getting into.
I'm a senior nursing student and had to say wow! Thank you for putting yourself out there and sharing your story. This has been a learning experience for me!
I used to have troubles like this (not as severe an outcome usually tho) in ICU's where they routinely float non ICU nurses in. They simply did not understand the ICU standard of care, they thought it was OK to 'let the patient sleep' all night unassessed...they do it on the medsurg units routinely.
Hospitals who randomly float nurses into critical care without making sure they KNOW the SOC are to blame in these instances, as well.
I have learned the hard way to check my patients immediately ....frequently before I've even gotten report, so I can catch discrepancies and ask questions from the getgo.
Scary to think this really happens............ very disconcerting.
This IS an ICU, afterall ! I just don't get it . I'm no ICU nurse, but I certainly would have taken vitals regularly during my noc shift, and done some assessments...
And hte noc nurse's report about having "let him rest all night" would have also raised an immediate red flag for me.
On my unit, IMCU, not only do the techs take the vs q 4, but I will take vs too, especially before giving meds and through out the night. I don't care if my patients get irritated. I explain to them that it is better to be MORE safe than REALLY sorry, especially when being sorry is TOO late. It's awesome that our patients are all on telemetry....a since of ease to a slight degree, to know that someone is watching their hearts all of the time.
:) I also walk the unit during the night and peek on my pts....anything to assure me that they are stable.
VickyRN, MSN, DNP, RN
49 Articles; 5,349 Posts
We had DNRs in our tertiary level ICU all the time.