Routine assessment on night shift - how thorough?

UM Review RN, ASN, RN · May 22, 2005

We have to wake our patients to assess them, sometimes as often as once an hour for some stroke patients. Typical stroke orders include a neuro check and vitals q2h for 24 hours, then it's tapered down, but still leaves the patient sleepless.

And if you think about it, what's more important? A few hours of sleep or catching an infarct before it irreparably damages the brain?

I only had one guy get combative with me and refuse his neuro check and vitals. I charted it as such and contented myself with just looking in on him, since apparently this behavior wasn't signalling a sudden personality change. :stone

Cardiac patients are assessed once each shift unless their rhythm or rate go out of whack. Then we have to wake them for interventions.

I always warn all patients on admission how frequently they can expect to be wakened for assessments, vitals, and labs. I always remind the patients that I wake about the qs assessments as well. If they have a timed lab draw, I give them a heads up about that too.

Believe me, very few of our patients get a full night's sleep. But at least they understand why it's so important to assess them in the middle of the night.

mommatrauma, RN · May 23, 2005

We have to wake our patients to assess them, sometimes as often as once an hour for some stroke patients. Typical stroke orders include a neuro check and vitals q2h for 24 hours, then it's tapered down, but still leaves the patient sleepless.
And if you think about it, what's more important? A few hours of sleep or catching an infarct before it irreparably damages the brain?
I only had one guy get combative with me and refuse his neuro check and vitals. I charted it as such and contented myself with just looking in on him, since apparently this behavior wasn't signalling a sudden personality change. :stone
Cardiac patients are assessed once each shift unless their rhythm or rate go out of whack. Then we have to wake them for interventions.
I always warn all patients on admission how frequently they can expect to be wakened for assessments, vitals, and labs. I always remind the patients that I wake about the qs assessments as well. If they have a timed lab draw, I give them a heads up about that too.
Believe me, very few of our patients get a full night's sleep. But at least they understand why it's so important to assess them in the middle of the night.

I 100% agree..they can sleep when the get home...while they are under my roof...my rules...Their safety is in my hands...stable is only one second away from unstable...and its better safe than sorry...they will thank you later when they are able to go home alive because you woke them up and found they were talking funny only to find their sugar is only 30...let that same person sleep who "looks quietly rested" and when the next shift comes in to do their assessment and their sugar is now 10 and they are unresponsive with brain dysfunction because of their low glucose for the shift...well you get my point...

UM Review RN, ASN, RN · May 23, 2005

I 100% agree..they can sleep when the get home...while they are under my roof...my rules...Their safety is in my hands...stable is only one second away from unstable...and its better safe than sorry...they will thank you later when they are able to go home alive because you woke them up and found they were talking funny only to find their sugar is only 30...let that same person sleep who "looks quietly rested" and when the next shift comes in to do their assessment and their sugar is now 10 and they are unresponsive with brain dysfunction because of their low glucose for the shift...well you get my point...

Exactly. Just last week we had a patient whose BG was 20, twice in one week. :uhoh21:

mstigerlily · May 23, 2005

I work 7pm-7:30am. When I arrive I look over the Kardex, write down the info on my "brain" paper, get report, quickly flip through the charts to see if there are new orders, read progress notes, etc. Then I get their meds out of the Pyxis and make my rounds to assess. Mom/baby get a thorough assessment some time between 2000-2200. We have a rule all assessments must be completely by 2200 at the latest, I try to have mine done by 2100 (not always possible).

If they are sleeping, I might go on to the next patient and come back but I feel it's necessary to assess them thoroughly or I just don't feel comfortable. If we worked 8 hrs and I came on at 2300 I could see this question would be more relevant, but most of my patients are still up at 2000 :)

Providing your patient is stable and sleeping... How thorough is your qshift assessment?