What are you most vigilant about?

[lynns75]

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.

[Karou]

As a CNA, always double checking all my VS make it into the computer charting. One time a BP I got on a pt was hypertensive, and I didn't have any VS for eight hours before (pt was q4). The nurse was ****** because he wasn't properly notified to give his metaprolol.

Well, the error is on the nurse also. If the PCT is taking my vitals (rare) it is still my job as the RN to make sure they are done, vitals are done on schedule so I know when to check and look for an updated set.

Likewise if I medicate a patient for a fever or high blood pressure. It's my responsibility to ensure that it gets rechecked in a timely manner.

So I hope that nurse recognized their role in the problem. That being said, good for you for being hyper-vigilant about it :)

[cd365c]

Well, the error is on the nurse also. If the PCT is taking my vitals (rare) it is still my job as the RN to make sure they are done, vitals are done on schedule so I know when to check and look for an updated set.

Likewise if I medicate a patient for a fever or high blood pressure. It's my responsibility to ensure that it gets rechecked in a timely manner.

So I hope that nurse recognized their role in the problem. That being said, good for you for being hyper-vigilant about it

Are you in the icu or a setting where you monitor the v.s. often? It is routine where I work for tech to be delegated v.s.

[Karou]

Are you in the icu or a setting where you monitor the v.s. often? It is routine where I work for tech to be delegated v.s.

I work med surg night shift. Unless we are understaffed the RN's get VS at night. PCT's do VS on day shift though. It's a new thing that came about with a change in our staffing. In exchange for less patients (RN's have 5) we had to pick up something usually delegated to the PCT. Vitals were chosen. Most patients are every 8 hours unless otherwise specified. We do q4 for 24 hours after surgery or admission. When I am exceptionally busy I will ask the PCT to get my vitals, but that's rare. It's fast and easy to do, I usually cluster it around the time of a medication also.

[cd365c]

We do q4 for 24 hours after surgery or admission..

Wow, Q4 for post ops seems too little. We have to do Q1x4 for post ops and put them on continuous pulse oximetry monitors.

[Karou]

Wow, Q4 for post ops seems too little. We have to do Q1x4 for post ops and put them on continuous pulse oximetry monitors.

That is our policy. PACU only sends us stable patients, hourly would be unnecessary unless their vitals were off or an assessment warranted it, In that case they are not stable and should not have been sent to our floor. We do utilize the continuous pulse ox.

[Surprised1, MSN, RN]

Wow, Q4 for post ops seems too little. We have to do Q1x4 for post ops and put them on continuous pulse oximetry monitors.

After they get to us from recovery, we do q2h post op vitals and neuro checks for 24 hours. Plus continuous CP and O2 monitoring.

To answer the original question, I don't have just one thing I'm most vigilant about (there are so many!). But I'm extra cautious about ICP.

Sent from my iPhone using allnurses

[K+MgSO4, BSN]

Moùthcare and eye care.

[RNperdiem, RN]

Alarm parameters for ICU monitoring. I always check the settings first thing. Sometimes patients set off the alarms easily and the alarm setting get altered and changed again. Do you really want your low O2 sat not to alarm until the patient's saturations are in the 70s? Or your blood pressure readings not to alarm until the pressures are way down below 80?

I always start with fairly conservative settings on my alarms and adjust as needed.

[kungpoopanda]

Taking my breaks and leaving work on time.

[BSNbeauty, BSN, RN]

Taking my breaks and leaving work on time.

I second that !!!!!

[BSNbeauty, BSN, RN]

There are too many things to list. However documentation is high on the list. CYB

[emmy27]

Making sure anybody who is there for psych is undressed and gowned with their stuff given to security and security aware of their presence.

We had a reeeeal bad elopement situation with a violent psych patient who still had street clothes and, as it turned out, a knife, and who managed to walk out because nobody in security knew what was up.

Not my patient, never want it to be my patient.