Published Aug 23, 2005
caroladybelle, BSN, RN
5,486 Posts
Sorry, but I must vent.
I am at a hospital, that has a BP cuff and a stethoscope in EVERY room.
So why is it that no one can possibly get vital signs without access to a dynamap???
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When I was a tech, I worked in a facility that did not have access to dynamaps on the MS floor, and we did VS manually...ALL of them. But it seems that the techs at the facilities that have been at, are physically and or mentally incapable of taking a manual BP. They have little tiff fights over who gets to use the dynamap first.
If the machine cannot get a reading, they keep trying to again until it does. And if it just will not read, they are completely mystified as to what to do.(a clue...if the patient has Afib or an arrythmia..the machine may not be able to read or may give an incorrect reading)
They get a totally absurd result but don't recheck it manually.
They spend 30 minutes trying to find the dynamap....they could have been finished with vitals if they did them manually by the time that they find it.
I have given up on the "I need a set of VS, stat."..because they would go running for the machine..it is faster to do it myself.
The other night of my patients needed to be on the dynamap for two hours as he was having serious issues. I ask the tech for a set of VS on another patient getting blood. I find that he didn't do it...because he couldn't find the machine. Of course, he didn't let me know either. Thankfully, both patients were fine.
Really, how hard is it to do a manual BP? Especially when EVERY single room has access to the equipment.
Do any of y'all have problems with this issue?
Jolie, BSN
6,375 Posts
I think this is a result of our over-reliance on technology in virtually every aspect of healthcare. Why should a physician actually examine a patient when he can order a bunch of tests instead? Why should a nurse hold and cuddle a preemie during a feeding when she can simply put it on a pump? Why should a nurse's assistant take a hands-on set of vitals when some machine can do it for her?
One answer is time, although this clearly doesn't apply here. Another is loss of skills, which may be the real problem.
ckh23, BSN, RN
1,446 Posts
I agree with the above poster. I would also verify that the techs know how to take a manual BP, you may be shocked by the answer. They may be so spoiled with using the machine that they may not remember or have trouble using the manual cuff.
sunnyjohn
2,450 Posts
They may well have forgotten or don't know how to take a manual bp.
A skills refresher and check-off may be in order.
sbic56, BSN, RN
1,437 Posts
Yup. Could be they haven't taken a manual B/P since they were originally taught. It seems like a no brainer, but taking a manual B/P is a skill that isn't perfected until it is done many times. Lots of people can't hear one on an obese patient, for example...or what about one with severe contractures? I think it's a skill deficit more than anything and it is getting more prevalent all the time.
pink2blue1
295 Posts
At my hospital we have both kinds of machines. I am the CNA so when I am taking vitals on 29 patients (As is the case most days) I use the dynamap. If I have isolation patients I do manual. If I cannot get a pressure on a patient, or if the reading is way high or low, I immediately do manual and report BOTH to the RN immediately. I think at my hospital the reason for using the machine is mostly because of time and it has everything on it, pulse ox, thermometer and BP so it's much faster. I do know how to take manual BP's though and do so every shift with at least a handful of patients.
DusktilDawn
1,119 Posts
Same problem where dynamaps are concerned. None of our CNAs carry stethoscopes, if the machine gives a reading that doesn't correlate with a patient's previous readings they don't recheck. Heaven forbid you ask for a manual. Frankly I'd rather recheck manually myself, it's just easier. I agree manual readings are becoming a lost art. :angryfire
elthia
554 Posts
You are definitely the kind of CNA I love to work with. It drives me crazy when I'm given a truly off the wall BP reading on a patient and have to gently ask for a manual BP because it's policy to have a manual before I notify the MD that the BP is outside of parameters. (It happens at least three times a week).
Many of the techs are RN students. I personally can't imagine an RN instructor that allows all dynamap use....ours made us do manuals.
It is one thing to need a dynamap on BPs on the legs or for obese patients..quite another to argue over the dynamaps or neglect VS waiting for one, IMHO
jnette, ASN, EMT-I
4,388 Posts
They may well have forgotten or don't know how to take a manual bp.A skills refresher and check-off may be in order.
Couldn't agree more !
It IS rather disconcerting.......... :uhoh21: as WELL as frustrating to the nurses as Caroline states above.
Spidey's mom, ADN, BSN, RN
11,305 Posts
I think it is because using a machine is faster ...
Our CNA's do carry stethoscopes and will take a bp manually that is hard to get or the numbers don't add up. They do know how to take vitals.
Also, at the beginning of the shift, the CNA and I go in to do vitals and assessment so we don't wake the patients up twice (this is 4 a.m.). So if the CNA is troubled by the machine's reading she tells me and I re-take it manually. When I work in the ER, we re-take manually any bp we are uncomfortable with. All the EMT's know how to do bp's.
So for me, it isn't that they don't know how . .. it is just that the dynamap is quicker.
steph
Jo Dirt
3,270 Posts
I don't even know what a dynamap is.