q4 hour vital signs in the ER...

[mamaxmaria]

So last night was a normally busy night in the ER where I work as a tech. All pt's are supposed to have vital signs q4, and we try to follow that the best we can but with pt's constantly coming in and out it's is sometimes hard to keep track.

When I come on shift I usually check the computer to see who needs vital signs and I right it down and try to do some rounds which are often interrupted with stat EKG's and bloodwork....It seemed everyone and their mother was complaining of chest pain last night.....:-\

So it was about 1am and I'm in the middle of my millionth EKG, when the PA gets up and starts yelling at me... "I need a BP on this pt! He hasn't had vitals since 8pm! you are suppose to do them every 4 hrs!" ...I was kind of taken back with the way he was speaking to me so I just told him okay and continued what I was doing.... When I was finished with that I was going to go do the vitals.... when yet another chest pain comes in....And when he saw me go in with the EKG machine he gave me the look of death! Sorry buddy but I don't need an RN to tell me that the chest pain takes priority of routine vital signs...He was so rude about this and while i understand he was and hour pass due for vital signs....If I had past up the chest pain to do the vitals I would have had bigger problems then a PA with a stick up his butt...

I just dont understand if it was SO EMERGENT why not...

1.) Do it yourself!

2.) Have the pt on continuous monitoring (which I asked if he wanted me to place the pt on the monitor and he said no)

How do you handle and keep track of vital signs q4 in the ER? People are in and out so often and it is so easy to get side tracked

It is so damn frustrating!!

[Been there,done that, ASN, RN]

You need to train the almighty PA. I am sure it is obvious you are running your tookas off!

Simply state "I am doing my best here.. feel free to get that blood pressure yourself."

If this parameter is vital to provide the best patient care and assessment, the PA needs to know that!

[NeoPediRN]

We don't do scheduled q4h vital signs. Unstable patients get q5-15 minute vs, pts we are concerned with get q1/2-1hour vitals, and stable patients get them checked after meds that can alter bp/hr and before we d/c them....there's no written policy on vitals in my ER, it goes by nursing judgment.

[hiddencatRN, BSN, RN]

We have q1 hr, q2 and q3-4 hr vitals depending on the acuity of the patient. Sometimes we get behind but I try not to on the sick patients. I keep track by looking at the clock that says how long the patient has been in the ER and time my vitals off that (ex, patient on q2 vitals has been here 3 hours and 45 minutes, I need to think about getting another set soon). Sometimes there's a wait to triage so a patient might not be "due" based on their clock but it's the easiest way I've found to keep me on task and extra vitals aren't the end of the world.

When you have more work than you can handle, who is there to help you with the overflow? If I'm running behind I'll ask another nurse or tech to grab a set for me or do another of my tasks so I can get caught up, and if everyone's busy, I just have to prioritize what's most important. Is that PA new to your ED? We have residents put in orders for vital signs and they'll ask us to grab another set sometimes, but no one has ever been rude to me about it. Also....the PA doesn't want them on a monitor, but if it makes your life easier, why not put them on one anyway? I try to put my q1 hr vital patients on full monitoring so all I need to do is recycle the BP and grab a temp when it's time for their vitals which makes life easier.

[JBudd, MSN]

We do it by acuity and need, with a minimum of q2h. I'd love to be only q4! We are even supposed to wake up the drunks sleeping it off out of the cold through the night. That one..... doesn't always happen

[KelRN215, BSN, RN]

A patient in the ER on q 4 hr VS must be pretty stable... (I don't work in the ER, but I know in our ER, the minimum is VS q 2hr). I would say it's unlikely to cause him any harm if he has his BP taken at 1am instead of 12 midnight. And if the almighty PA needs VS right this second, he can feel free to take it himself.

[Anna Flaxis, BSN, RN]

In my ED, like JBudd's, it's a minimum of Q2hr for stable patients, more frequently based upon acuity, with the exception of our Fast Track patients, who get VS at triage and at discharge.

My strategy is to keep all of my patients on continuous monitoring with the BP cuff set to the appropriate intervals. The only time this fails me is if they come back from radiology and don't get hooked back up, or if someone else unhooks them to go the bathroom and doesn't hook them back up.

[AgentBeast, MSN, RN]

Sounds like this PA has what I like to call Little member Syndrome. Feels small and insecure in his position as a PA, not being a MD/DO. So he has to berate others he sees as being below him.

[That Guy, BSN, RN, EMT-B]

I would have handed him a Stetho and BP cuff. **** like that does not fly with me. If it is that important, no one is above getting vital signs.

[ckh23, BSN, RN]

I would have asked him if his hands were broken. If he has enough time to sit there while everyone else is running around, he damn sure has the time to get a blood pressure if it is that urgent

[Anna Flaxis, BSN, RN]

Next time, do the Cincinnati Stroke Scale on him, then look very puzzled and say "Hm, you don't have any focal neurological deficits, so I'm confused as to why you're unable to take vital signs yourself. Is there something I'm missing?"

[lckrn2pa]

Not saying the PA is right in his/her actions because it was completly inappropriate to yell at anyone for any reason but where was the patients primary nurse? I see your the tech, so are you the only person that does vitals on the ER patients? Just curious as to why you would be the one held accountable when the ultimate responsiblity falls to the primary nurse or at least that's the way I was taught in nursing school and the way I would teach those I precepted when I was still working in the ER.