and I want to teach them the importance of waking your patient when you come on shift, especially if they are a high risk patient. I can't find any literature which I find is odd because when I went to nursing school, my instructors always said you can't assess your patient's loc if they are sleeping so you must arouse them when coming on shift. Does anyone have any supporting literature?
Yes, I absolutely wake them. I understand sleep is wonderful for recovery but I don't trust any nurse telling me they are alert and oriented because been there, done that, fool me once...etc. Especially if it's a neuro diagnosis, you need to check for yourself st the beginning of shift! Status changes in an instant as we all know! The patient might not like being woken up, but if it saves even one life it's worth it. I came in one morning during report because I always check my patient with the other nurse during handoff (neuro, skin, wounds, drains) and guess what? Speech was off. We gave her a second to "wake up" but nope, she had a stroke. Last well time was just barely within the 4 hour mark for TPA because the nurse wanted to "let the patient sleep." I mean, how would you feel if you kept getting woken up? Sorry, this isn't the Hilton and I will wake you up!
If you do a neuro check in the middle of the night and they are lethargic (most people would be in the middle of the night) how do you interpret the results? Their LOC would be different than during the day but appropriate for 4am. If they were having a brain bleed at 4am, how would you know?
Just to clarify, what you are asking is how do you know if an 0400 assessment is accurate if you didn't get a baseline at midnight?
Well if the pt was woken up at midnight, how do you differentiate a brain bleed from the Ambien they had at 2200? How do we know a pt didn't get a brain bleed 15 minutes after we left them... is it really safe to let them sleep for 4 hours?
We need to use common sense and consider the situation: a pt 2 hours post tPA clearly needs a good neuro check or 50 -- they need to be disturbed. A 22 yr old post appendectomy pt? Do we really think that their danger of a brain bleed is more important than sleep?
How do we know the difference? Observation and experience: sleepy typically looks different than neuro compromised.
During my LTACH orientation 7 yrs ago, they really stressed: we need to keep sleep time sacred. (Yes, they said "sacred.") These folks had often spent the previous month(s) in an ICU, had become medically complex, had experienced polypharmacy and poor sleep and a noisy environment... they were at very high risk of delirium. We were to minimize waking them during 2300-0700, and if necessary at least cluster their care. So if someone had an IV antibiotic or a lab draw at 0100, we woke them once and did our assessment then.
As for enforcing bedside report (this is in response to another post, but I'm too lazy to post twice)... in school I was taught to advocate for patients -- not non-clinical managerial pet policies. We should have the spine to say "this pt has been awake for 3 days and fell asleep an hour ago. NO I am NOT waking him for bedside report."
If I am working 7a-7p and my 5-6 post op patients are all q2 or q4 vitals then yes I am waking them....I have one hour to get all of my assessments done before med pass starts at 8a. (Also docs round at 6a).
If I am working 7p-7a, then yes I will be waking my fresh post ops at midnight and 4a to assess. Caught many septic patients this way...
Obviously critical judgement is used. On the day 7 post op patient then yes, I will let them sleep (but still doing hourly rounds to make sure they are alive).
Well if the pt was woken up at midnight, how do you differentiate a brain bleed from the Ambien they had at 2200?
You might not have meant it as such, but an ironic choice given the news of the real world over the past 24-ish hour. I do know what is not an SE of Ambien.
As a student, I wake my patients in the morning and do an assessment. This gives me an early baseline assessment, allowing me to watch for and compare changes throughout the day!
CityofAngelsRN
80 Posts
Yes, I absolutely wake them. I understand sleep is wonderful for recovery but I don't trust any nurse telling me they are alert and oriented because been there, done that, fool me once...etc. Especially if it's a neuro diagnosis, you need to check for yourself st the beginning of shift! Status changes in an instant as we all know! The patient might not like being woken up, but if it saves even one life it's worth it. I came in one morning during report because I always check my patient with the other nurse during handoff (neuro, skin, wounds, drains) and guess what? Speech was off. We gave her a second to "wake up" but nope, she had a stroke. Last well time was just barely within the 4 hour mark for TPA because the nurse wanted to "let the patient sleep." I mean, how would you feel if you kept getting woken up? Sorry, this isn't the Hilton and I will wake you up!