rpe

Perhaps they are just being a little flippant when they describe the order process. I don't know about the Mental Health aspect but for medical at our jail, we have about a 1 1/2" thick binder of Standard Orders that the RNs can use for evaluation and can even use to issue medication orders. This isn't an aberration but just an extension of a process that is used elsewhere. At the local hospital, many physicians had standing preop orders for all of their patients. You didn't have to call the physician for orders on those patients as long as everything fit the baseline. At the long-term care facility that I worked, certain physicians also had standing orders for certain situations. The Standard Procedures we use are structured almost as a decision tree. The process used is that if these conditions are met then you may administer this drug. If these conditions are not met then call the on-call provider. If an MD doesn't like any aspect of the Standard Procedure then, with the proper review process, they can change it. However, the Standard Procedures have to be adhered to strictly. We did have a nurse that got fired for, among other things, not adhering to the Standard Procedures.

I work in a correctional facility. The inmates often are wearing heavy sweaters underneath heavy jumpsuits. They often are not able to push up the sweater and jumpsuit sleeves in a way that would not affect the BP reading. They are housed in a cement dorm structure with two televisions going and 40 people talking. Depending on what is going on in the dorm, I have asked to step aside into a side room where I can obtain a "normal" BP. However, sometimes that is not an option. I have threaded my stethoscope up under the sleeve to the antecubital area but that isn't always an option either. I have palpated a systolic when the inmate was in handcuffs and uncooperative and I needed a quick check. However, the case I am referring to in this thread is when I need a fairly accurate BP to use in tracking HTN or detox conditions. Thanks, rpe

I often am required to obtain BPs through clothing on patients that are moving in noisy surroundings and I often have difficulty with this. Does anyone have a similar experience and if so, what stethoscope has worked for you? Thanks, rpe