Treat the patient, not the monitor

[offlabel]

Can we think of something else to say? This phrase is older than most nurses and is usually a glib crack made by someone who is seizing the clinical expertise high ground in a condescending way.

Besides, it means nothing in real clinical practice, really.

For as many times as someone "treated the monitor" when nothing was wrong, someone else ignored it when something was really wrong. How come there isn't some wise cracky "believe the monitor" dig?

There's a thread right now that describes several people ignoring a patient in RVR afib for more than a day.

So what's the real problem? It's not asking for help when there is something odd going on. It's cowboying a problem when you're out of your depth. New people do that but so do more experienced folks that think they know it all.

Look at the wise sages of your specialty....the ones everyone looks up to and goes to for advice. Not one of them, odds are, would hesitate for a second to ask someone else for an opinion.

The irony is, every single person around that is available for them to ask doesn't have nearly the time in grade they do. Their time and experience dwarfs most everyone else's. But they ask...

Coincidence? I think not...

[Pheebz777, BSN, RN]

What scares me is that some nurses take the phrase "Treat the patient" in it's most literal simplistic meaning.

For me, it is universally understood that "Treating the patient" incorporates all levels of critical thinking and looking at the entire clinical picture as it is. I don't know if some nurses need to have everything spelled out word for word but in my experience, that's not a far possibility.

The same is implied when you "administer" a medication to a patient. The MD will not give an order to "Give 1mg of Morphine Sulfate IV PRN while checking for the 7 patient rights, and please explain the medication to the patient, explain what the medication is for, explain the possible side effects, explain how it is to be administered, and please explain how frequent he is to take his medications... etc. Because to me "administer" already incorporates all of the above interventions as a prudent nurse. I am not simply going to "administer" a medication without doing the aforementioned interventions just because the MD ordered it.

Some of you have lost focus on what the OP was initially asking for. He/She was seeking an alternative catchy phrase that should be incorporated to replace the old and inaccurate phrase "Treat the Patient, Not the Monitor."

I think "Treat the Patient, (which includes everything from taking vitals, checking lung sounds, EKG, Labs, critical thinking, etc...), Then treat the Monitor." should suffice. LOL!

If this catches on, you guys heard it here first!

[canoehead, BSN, RN]

What you described was more operator errors.

I would rather respond AND CORRECT an alarm then do the charting on a dead patient. Surely you can troubleshoot a pleth or an ECG well enough to know how to correct it.

Are we wasting our time by doing vitals and having monitoring? That seems to be the message here. Just because you can point out one or two incidences where the monitor was "wrong" doesn't mean it is not a valuable tool. Do doctors just look at a patient and send them home or do they collect all the data from the monitors, vitals and labs?

If you want to discard the value of the pulse ox because you don't know how to place it correctly or know that trouble shooting equipment is part of the job then maybe it is time to retrain and gain more knowledge about that equipment. Radiology, US and many other professions know how to get the best picture or data and know when something is not quite right or poor data.

With experience you will also learn to verify blood pressures. The patient might look great but if the BP is taken manually or on another arm, you get a different value which can as to a more definitive diagnosis.

A patient can appear to be great but if you disregard the equipment's data you have and don't at least try to get a correct number, you aren't doing a good service to your patient.

Don't just take a patient's appearance as an end all to any exam.

It doesn't have to be all or nothing either way. I think using the patient assessment as the first look, and then investigating more, AND/OR troubleshooting the monitor are both important.

[Emergent, RN]

I always thought, and was taught, that this saying means that when an alarm goes off, go in and take a look at your patient. Don't Defib someone who's brushing her teeth.

[sammiesmom]

What about "Treat the patient, THEN the monitor?" (if this catches on, then you know where it started!) LOL!

I don't know how many times I've seen a patient with O2 sats in the 90's while the pulse Ox was on the floor. Or a monitor saying the patient's HR is 180's but the actual HR was in the 80's with a tall T wave that the monitor was reading as a QRS complex.

I had my first experience with the pulse ox reading in the 90s while off the patient's finger. Quite scary. My experience is always getting blood pressure while the patient not wearing the cuff.

[Thedevinestman]

Excellent topic. I've heard the phrase used by old jaded nurses many times, and I'm of the opinion that it isn't entirely useless. But really, as someone said earlier, it's just a reminder that not every patient follows the rules clinically speaking. The patient IS the monitor. We TREAT monitors all the time; we also treat the patient. I choose not to use the phrase because I'm afraid it will make me look jaded and dogmatic (in my opinion).

[tcvnurse, BSN, RN]

I am actually a firm believe of 'treat the patient, not the monitor.' First of all, any question, ANY question of a wacky monitor reading means you GET UP and go look at your patient. I can tell an awful lot about how a patient is doing just from eyeballing them from the doorway.

Are they breathing? Yay! Are the blue? No? Also, YAY. Is there urine in the urimeter? Is the pulse ox sensor lying in the bed? (That could explain the reading of 75%-true story)

Are the extremities warm? is the patient clammy? Are they awake even? MOST of the time, if the patient 'feels fine' they're fine. Even with a heart rate of 170. If they feel okay, then I'm not as worried as I am about the guy that has a HR of 60, but looks like garbage-grey, clammy, not really so awake...

Monitors are great and I LOVE all of mine, but you really gotta understand that sometimes they lie, and sometimes they will tell you a patient is alive when they are really, really not.