Published Aug 7, 2016
jk2185, BSN, RN
1 Article; 34 Posts
This is my least favorite "go-to" that I hear all to often. Why even have monitoring in the first place? I trust the monitors more than my own ability to intuitively know a patient's condition based on my limited assessment skills; and just to ward off evil comments spawning from this notion I want to remind everyone that we all have limited assessment skills, our senses can only do so much. And of course, if your monitor screams asystole or vfib and your patient is smiling at you politely asking for more apple juice, I do hope that we all know to check lead placement or something.
We didn't have numbers 100 years ago and look what kind of healthcare we had...not the greatest.
I just wish we could flush this saying out or maybe change it.
Ruby Vee, BSN
17 Articles; 14,036 Posts
This is my least favorite "go-to" that I hear all to often. Why even have monitoring in the first place? I trust the monitors more than my own ability to intuitively know a patient's condition based on my limited assessment skills; and just to ward off evil comments spawning from this notion I want to remind everyone that we all have limited assessment skills, our senses can only do so much. And of course, if your monitor screams asystole or vfib and your patient is smiling at you politely asking for more apple juice, I do hope that we all know to check lead placement or something.We didn't have numbers 100 years ago and look what kind of healthcare we had...not the greatest.I just wish we could flush this saying out or maybe change it.
Numbers have been around far longer than a century. Just saying.
I'm sorry you dislike the expression. Does "look at the patient, not the monitor" appeal to you instead?
Years ago -- decades ago, actually -- I worked in an old, decrepit hospital. A brand new hospital was built, and many new nurses were hired to staff the additional beds the new hospital afforded. Moving day came, and we moved into the MICU with it's bright, shiny new, state-of-the-art monitors. The first patient was moved in and hooked up to the monitor with a lot of fumbling because the monitors were new and unfamiliar. The second patient was moved in and also hooked up to the monitor . . . And so forth. Not long afterward, the nurses were gathered around the nurse's station when the monitor alarm went off. Patient 1 was in ventricular tachycardia. Everyone went rushing into his room with the code cart and code drugs, following accepted ACLS protocol. The rhythm deteriorated from ventricular tachycardia to ventricular fibrillation to asystole, despite the interventions. Then a wondrous thing happened . . . The patient began to strenuously object to defibrillation and chest compressions despite the asystole on the monitor.
During the construction process, somehow the monitoring wires in the two adjoining rooms was crossed. Patient 1 wasn't in asystole; Patient 2 was. And because all those brand new nurses and former medical students (did I mention this was July?) were treating the monitor instead of the patient, a patient died. And the patient they were treating had some pretty bad burns and broken ribs.
Use your judgement. Sometimes, the monitor can alert you to the beginnings of badness before anything else will alert you. Other times, the monitor's malfunction will send you careening down the wrong path. According to Samuel Shem in "House of God," the first pulse to check in a code is your own. Maybe you like that expression better.
brownbook
3,413 Posts
I like the saying!
Seeing "bad" numbers on the monitor can really freak me out....(note to self, take my own pulse first). I take a deep breath and assess the patient.
I'm not going to call a code or start ABC's per what any monitor shows. I know you aren't implying that. I just don't see any harm in the saying?
"Look at the patient, not the monitor" doesn't work for me either. I've seen plenty of patients that look fine chatting away with a CI of 1.8 or an SBP around 200. So...as long as my equipment is calibrated correctly and not being assessed by someone who doesn't know how to properly use the devices, more often than not, I believe what my monitor tells me 100%.
Your story is interesting and it sounds like it made for a terribly stressful day. Seems to me there may have been a failure in protocols. Did anyone check a pulse or responsiveness? Even if a monitor shows a shockable rhythm you still follow the BLS survey first. It also seems odd that the monitor in room A (which was presumably hooked directly up to the patient in room A) would show data from a different room. I'm no IT guy for sure, just seems very odd.
I'd say my point of view only works if you know what you are doing. It doesn't work if you put the wrong size BP cuff on a patient, or if you have bubbles in your pressure lines, or if you don't check your patient's pulse and responsiveness when you have some strange artifact that often does look fib-ish.
I just find this old expression to be only mildly useful. Of course you use your intuition and assessment skills, but the notion that you should treat based on what you see over data drawn from high-tech equipment seems a little over the top.
I think treating the patient and the monitor should be on an equal plane....use all the data you can get.
CryssyD
222 Posts
I'm torn--I have watched nurses rush to put patients on oxygen because the pulse oximeter was showing a sat of 75%; meanwhile, the patient is calmly doing a crossword puzzle or, if the patient is 2, jumping up and down in his crib. Or starting chest compressions on a baby because the monitor was reading (incorrectly) a heart rate of 54--baby was conscious and pink, but the nurse felt it necessary to start CPR because the monitor reading dictated it was necessary. These sound like stupid mistakes, and they are. But they are exactly what happens when you fail to filter what the monitor is telling you through the evidence of your own eyes.
Yes, treat the patient, not the monitor--I know of a little boy who died because his vent tubing came off his trach, adhered with wet suction to his bare chest, and, because the vent was alarming high pressure (potentially serious, but generally allows some leeway in response time) rather than low pressure (requires immediate, top-speed response) the extra 30 seconds in response time cost the child his life.
KatieMI, BSN, MSN, RN
1 Article; 2,675 Posts
That's why some folks speak behind my back that I'm a witch or something. Because I can stay in the door and say "if I were you, I would leave that PICC alone and call 'cause it is DVT", and sure there will be DVT. Or when I always do "my" special assignments with no gloves, policies be d***ed, I wash my hands before and after. Or when I found that spinal infarction on patient on therapeutic paralysis to 1+ and sedation to GCS4, and a couple of retroperitoneal hematomas before CT scan.
OP, you are quite correct that one has to know what he is doing. The fact, though, is that you do not know how to use physical assessment skills and what you will be able to do if you master them. Sorry.
The fact, though, is that you do not know how to use physical assessment skills and what you will be able to do if you master them. Sorry.
wow..thanks for the encouragement.
I can't help but feel very misunderstood by these responses, as I prefaced, of course you should assess your patient with both your physical assessment and your data from monitors. I am simply stating that the saying "treat the patient, not the monitor" can get you into just as much trouble as fumbling into a room and starting cpr bc of some artifact.
They should both be used equally to care for our patients. I think using suggestions/cliches like this is ultimately misleading.
RNperdiem, RN
4,592 Posts
I think I do understand. A new nurse often does not have that trained eye to see a patient and see trouble.
In some settings you will see a couple of experienced nurses look at a patient, then look at each other and see the subtle look of alarm. That instinct of a patient who "looks bad" is learned through experience.
A new nurse is still developing this and does have to rely more on labs, monitors and other measurable data. I once had a dance instructor who loved the phrase "use the floor". It meant little to me as a beginner, but a lot to her.
CanadianAbroad
176 Posts
In my experience, 8/10 the monitors are going off due to lead placement errors or patients pulling the leads off completely. There was a patient that had just come to our unit that just didn't "look right" to me, and I had alerted her nurse. The nurse brushed me off and kept saying that nothing was showing up on her monitor. I just had that inner knowing that she was going to be a code. Fast forward, the patient had gotten up and was getting back to bed and she coded. The nurse in the room tending to the next patient, had no clue. That monitor went off and we went flying in the room. The patient's nurse thought she looked fine, yet we all knew she was in VTach. The patient ended up being a full code, and was out for over 13 minutes. After the fact, she was lucky to not have suffered any neurological deficits. It was a situation where had we not relied on the monitor, the patient would have surely died; as the nurse caring for her visually inspected her and thought she was fine. Long story short, trust that inner gut knowing that a patient is about to code and never underestimate that knowing feeling. That saying exists for a reason, due to errors by the nurses jumping the gun and calling a code due to what a monitor says; but remember there are always exceptions to the rule.
Sour Lemon
5,016 Posts
It reminds me of an old Monty Python skit where they're preparing for surgery by collecting "the machine that goes ping" and "the most expensive machine in case the administrator comes". Then they realize they've forgotten the patient.
Mom2boysRN
218 Posts
I love that saying. I take it as saying slow down, don't just look at the monitor, actually look at the patient before deciding interventions.
When talking about this saying I use this example where I said it to someone. We were in a patient's home, I had a nursing student with me that was just about to graduate. We got a pulse ox reading in the 80s. She asked in a panicked voice "should we call 911?" I told her to relax and look at the patient, does she look like she is in distress? The patient was pink, vitals wnl, she was just fine. That was when I told the student that we treat patient's not monitors. The reason for the low pulse ox reading was that the patient's hands were cold.
TriciaJ, RN
4,328 Posts
That's why some folks speak behind my back that I'm a witch or something. Because I can stay in the door and say "if I were you, I would leave that PICC alone and call 'cause it is DVT", and sure there will be DVT. Or when I always do "my" special assignments with no gloves, policies be d***ed, I wash my hands before and after. Or when I found that spinal infarction on patient on therapeutic paralysis to 1+ and sedation to GCS4, and a couple of retroperitoneal hematomas before CT scan. OP, you are quite correct that one has to know what he is doing. The fact, though, is that you do not know how to use physical assessment skills and what you will be able to do if you master them. Sorry.
You say "witch" like it's a bad thing.