Poor Understanding of Vitals Amongst CNAs

[LJOHRrn]

I work 6p-6a in a facility where pretty much everyone gets vitals at least twice a day.

We frequently have issues with inaccurate vitals, improper technique while obtaining vitals, and we also have *major* delays in reporting "abnormal vitals." I put that in quotes because 97% of the time, vitals are not being verified when an abnormal value is obtained using a device. I am forever finding myself having this conversation at work with the same staff members:

CNA: 146 has a BP of 68/32.

Me: Uhhhhhh, was that done manually?

CNA: No, with the cuff.

Me: Did you use the cuff correctly?

CNA: I dunno. I guess.

Me: Did you recheck the blood pressure manually in both arms after you saw 68/32 on your cuff?

CNA: No.

Me: Why not?

CNA: Uhhhhhhh.

I am updating our vital sheets to have reference ranges on there, along with steps to verify vitals when abnormal vitals are obtained, and correct procedure for obtaining vitals. What else can I do to help with these issues? Drives me nuts. This is Nursing 101.

[Nurse Beth, MSN]

Updating the form is a great idea, and it seems obvious to understand abnormal vitals but CNAs are often so overloaded that their primary goal is just to get the vitals taken.

It's helpful to have parameters that identify abnormal (ex., HR 110) and a policy for reference. "Abnormal vital signs must be reported immediately"

Then when orienting to the policy, explain that immediately means right away and before completing vitals on the rest of the patients.

Can you put a chart of abnormal parameters up in the break room or on the vital sign machines on a laminated card? Best wishes!

[KatieMI, BSN, MSN, RN]

Same problem here. "Acute" LTACH with many unstable patients.

Only one satisfactory solution I came to after almost 3 years there is to do it myself, because 1) I can educate CNAs till loss of my voice but they just do not have basics for understanding of what is going on and why, where they see "hand goes funny every time I do his BP", I see ionized calcium going too low too quickly and some plausible reasons for it, for one example; and 2) if I do it myself, CNAs get more time to get their part of job done (of what they carry a whole lot before any vitals Q4). Parameters bring more trouble than they worth on long run because, CNAs, not having basic knowledge of pathology (and often not willing to get it anyway) start to run crazy if they see BP of 70/50 (patient is quad from C4 level for the last 20 years and just had fluid widrawal HD run)and when nurses tell them "that's ok" all the time they either become even more negligent or think that they are dismissed and not valued. Nobody gains as a result, so it is just easier to do it all myself - and visit (and access) my patients one more time.

[ArrowRN, BSN, RN]

Why not bring this up with the management and have it addressed at a staff meeting. Also remember a CNA lacks assessment skills. Their job is to collect data and report it if abnormal. You can ask them to recheck it but if its still abnormal, It should be the nurse to reassess.

Only other thing I would do is instead of asking the CNA a bunch of questions about their technique, it could make them feel dumb and less appreciated...I would go in there with them and coach them, or demonstrate proper technique. It's time consuming but remember most CNA programs are like what 2 to 8 weeks long?

[fsudmbRN, ASN]

I know this is a pretty old post, but I felt the need to comment. I am a Staff Developer in a LTC/SNF and that sounds like a GREAT teaching moment! I get that we are all busy, but wouldn't it be better if you showed them how it was to be done? Then you could use that person as a peer educator! It is the little things. Instead of being upset everyday due to poor vital signs, help and educate.