What happen to taking Vital Signs???

DusktilDawn · Aug 25, 2005

No, but taking one cuff throughout an entire facility sounds pretty hinky to me.
Then, I work hemo/onco...way too many neutropenics with resistant infections and high risk for Cdiff to go room to room with the same cuff. That is why the scopes and BP cuffs in each room.

Defnately an area that's high risk for nosocomial infections.

Unfortunately where I work there are no BP cuffs in each patient's room. In fact rarely are any BP cuffs cleaned routinely whether they are portabale manuals or dynamaps unless I clean it myself. I doubt many facilities have any routine cleaning of cuffs. I'm sure that many nosocomial infections have been spread by unclean BP cuffs or other equipment (IV poles, curtains, stethoscopes etc). I'm one of these nurses who continually cleans my stethoscope before/after use with disinfectant wipes.

DusktilDawn · Aug 25, 2005

Yanno, that might explain the time I found a NH patient with a BP of
44/20. Yes, it was THAT LOW. I had two other nurses confirm it because I couldn't believe my ears.
I don't know how that patient remained sitting in her W/C!! At that facility, the CNAs took vitals and patients were medicated based on those vitals.
Now I wonder how long it'd been since someone actually took her real vital signs! Don't these CNAs who fake vitals realize that they could literally cost a life???

Unfortunately Angie, there are some WHO JUST DON'T CARE.

laurakoko · Aug 25, 2005

gotta vent too...........

i do case management, and when i review charts on this certain floor, everyone's respiratory rate is either 18 or 20. Never under 18, never over 20. I don't think this can be correct.....................

chadash · Aug 25, 2005

Guessing VS places the patients in danger. Are the nurses aware that this is going on? This is serious.
Initially as an RPN student (many years ago) I had trouble listening for Korotkoff sounds when I was learning to do manual BPs. I worked with my instructor until I felt confident that I was doing it right. On patients that I have trouble finding the sounds, I locate the brachial artery to ensure proper placement of the stethoscope.
BTW I would have no problem helping any tech become more proficient at manual BPs, pulses, etc.

I agree totally. There was a lot of eyerolling when I would go back and redo someones vitals because I wanted to be sure. The nurses were more satisfied with the other aides work because they got their vitals in faster. Oh well, guess I am not cut out for this kind of work!

I think the other girls just needed some inservice time to practice. Many times the more concientious ones would ask me to check a BP for them. The guessers were just a couple of girls.

DusktilDawn · Aug 25, 2005

I agree totally. There was a lot of eyerolling when I would go back and redo someones vitals because I wanted to be sure. The nurses were more satisfied with the other aides work because they got their vitals in faster. Oh well, guess I am not cut out for this kind of work!
I think the other girls just needed some inservice time to practice. Many times the more concientious ones would ask me to check a BP for them. The guessers were just a couple of girls.

Are the nurses choosing to ignore this problem or are they unaware of it? If they are SHAME, SHAME, SHAME on them.

They may be on your case because they think your slow, not because your are doing it correctly. Has anyone asked you why you take longer?

Doing things accurately and correctly makes you more "cut out for this kind of work" than others.

chadash · Aug 25, 2005

Just an recommendation, though this is not a negative on nursing assistants, since I am one myself. Whenever you hire a new aide in your facility, you might want to make vitals part of your orientation. If someone is having problems, it is no indication of whether they are a good aide or not. Probably they just havent had training or experience that is adequate. I remember in my first nursing home (where I was trained), I was sick and they put me on light duty for one day. They had me do every vital in the building. By the end of the day, I had pinned it down. I had to do a couple of them twice, but after that day, I was much more proficient. I haven't needed to take vitals very often in home health, so if I go back to LTC or a hospital, I would need some practice.

It is so important to just be honest about our weak areas. It was very embarressing to sometimes have to go to a nurse and say, I really think you should take this BP, I dont feel confident I am getting an accurate reading. Depending on the nurse, I would get either a smile and "no problem" , or eyerolling and "what's wrong with you?" But I felt an accurate reading was more important than my embarressment.

Indy, LPN, LVN · Aug 25, 2005

I've worked as a phlebotomist in hospitals for five years. Whenever a bleeding time (an archaic clotting time test) is ordered, we have to ask a nurse on the unit for a manual blood pressure cuff. 9 times out of ten, the first two don't know where it is kept, and we are off a wild goose hunt. When we do find one (or if we try to use the one in the room), it is broken, or not the right size.
I hate to say it, but (at least in the hospital setting), I think just as many nurses as techs rely too much on the automatic BP machines!
Because this happens so much, my lab mangers just bought a manual cuff for us to carry up to the floors! :chuckle
CrazyPremed

Oh, I got to do one of those once, like about 15 years ago. It was great to sit down with a patient for ... over five minutes... but I don't remember doing it with a B/P cuff. Maybe it's been too long ago, all I remember was the little circles of coffee filter material and making it out like a clock, and soaking up little blood drops all around the edge. I used several circles on that patient. We also had a funky thing to cut 'em with that resembled a lancet but was a very small (short) razor blade inside instead.

-Indy

CseMgr1, ASN, RN · Aug 25, 2005

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.

THANK you! I was a patient in the E.R. in January of this year, and I thought the nurse who was attempting (he never got it) to take mine was going to amputate my arm, before he finally gave up.... :eek:

not now, RN · Aug 25, 2005

Oh, I got to do one of those once, like about 15 years ago. It was great to sit down with a patient for ... over five minutes... but I don't remember doing it with a B/P cuff. Maybe it's been too long ago, all I remember was the little circles of coffee filter material and making it out like a clock, and soaking up little blood drops all around the edge. I used several circles on that patient. We also had a funky thing to cut 'em with that resembled a lancet but was a very small (short) razor blade inside instead.
-Indy

When I first started as a phlebotomist we had to do it that way. It took forever and all the phlebotomists would try to get out of doing it. Then the lab switched over to a blue top tube flagged so the MLS knew it wasn't for a PT/PTT.

CseMgr1, ASN, RN · Aug 25, 2005

Because it's a medical device...therefore it can't be simple
Just like anything that one cannot find the cause to is "Idiopathic". Hair loss is alopecia.
If they can't name it a big word, theycan't charge as much for it.

You got that right! :rotfl:

cardiacRN2006, ADN, RN · Aug 25, 2005

When I first started as a phlebotomist we had to do it that way. It took forever and all the phlebotomists would try to get out of doing it. Then the lab switched over to a blue top tube flagged so the MLS knew it wasn't for a PT/PTT.

Get out of doing them?? I love doing them. I do maybe one a week/2 weeks. To be accurate it must be run for over 10 minutes (in our facility), so that was a 10 minute break! Plus, as mentioned before, it would take me nearly that long to find a manual BP cuff that was actually calibrated within the last year. If the result takes longer than 10 minutes, then they have failed the test.

sabrn2006 · Aug 26, 2005

I agree 100%. I am entering my second year of an ADN program and knew how to take VS before becoming an aide this summer at a local hospital. At work, If I did all my VS manually that is all I would have time to do! I have at times worked as the only aide for 26+ patients. The norm on my usual unit is 12-15, though. Of course, I recheck manually any that are out of line and there are always certain patients who have to have BP done manually anyway.

Its just not practical. I am a nursing student and I work as a tech. I know how to do manual vitals, and when I am at clinical with my 1 to 3 patients and all the time in the world I take them manually. But when I work as a tech and am responsible for a whole group of patients (9-15) I just dont have time. The dynamap allows you to take bp, pulse, temp, pulse ox all on one machine, in seconds. It usually takes almost an hour to take vitals using the machine, because everytime you go in a room someone needs something (water, help to bathroom, needs to be cleaned, etc...). So I could imagine how long it would take taking each set of vitals manually. Now if it comes up abnormal- sure, I go get my stethescope and take it manually. But I would think as a nurse, if a tech came to me with abnormal vitals from the machine, I would want to recheck them manually myself. Why would I rely on the tech when there is a potential problem and I might have to give drugs based on this or call the doctor, etc.? I have heard of techs making up vitals and some will just tell you that they retook it manually. I would not want to risk my patient or my liscence that I am working so hard for.
just my opinion though. :wink2: