Published
Most excellent question.
I have no specific example.. however, when my patient says "this has never happened before"
or their family member says.. "they have never been like this before".. my antenna went up.
Moral of the story is... listen to your patient and their loved ones. They are the best source of your data collection.
Pulse oximeters, vital signs in general. This sounds basic but it obviously isn't to everyone... but I always double check abnormal VS. That may mean rechecking a temporal temp with an oral (or rectal), getting a manual BP, or whatever is necessary. I prefer to take my own VS because I trust them more.
I get frustrated when I get a patient at shift change and find some wacky VS, then see only perfect VS from day shift or no vitals at all.
Ex. Patient is tachycardic, has a known infection, and 97-98 temporal temps documented all day. No one knows why he is tachy, but they put them on tele monitor, and he is sinus tach. MD aware. No interventions ordered for tachycardia-- His temperature is 101+ oral when I take it. No one thought the temporal thermometer might be off. Once I treat then fever the tachycardia resolves.
Or that pneumonia/CHF/COPD patient who hasn't had an spo2 documented all shift since the portable pulse ox is hard to hunt down. I hook him up to continuous and he is in the 80's. Nasal cannula on the floor. Time for a breathing tx and let's get a new nasal cannula.
Little old lady is hypertensive all shift, multiple interventions made my day shift, ect...I get a high reading with the electric cuff at the start of my shift so I check manual. She is WNL! Even get a second nurse to check. Makes me wonder about what she really was during the day.
All real situations. I am pretty neurotic about making sure my vitals are accurate.
Also, home medications. After making a big mistake with a patient due to me not verifying his home medications, this is now the FIRST thing I do with a new admission. Even if I am swamped and have time for nothing else, I make time for that.
lynns75
3 Posts
What things do you watch your patients for more vigilantly now after having missed before? Or maybe it is just because you have seen it happen more often or have seen another nurse have a problem because they didn't monitor something they should have? For example, I had a nurse tell me during an OB rotation that she is more vigilant about having patients empty their bladder sooner than later after delivery because most of her hemorrhages have occurred because of full bladders.