Monday, 29 September 2014

Hospital Logic Part 3 : Obs

1. Wake up your patients very early to take their blood pressure, their temperature and to measure their heart rate. This should never be later than 6am

2. Do not take any notice of previous readings. Pretend this is the first morning you've woken them, not the 27th (In my case. God that's depressing, I wish I hadn't actually counted.)

3. When already low blood pressure reads a smidgen lower - due to the patient's extremely recent sleepy status - panic. Remember it is your duty to report this as though it is an unusual event. Even though it's the 27th time it's happened. And clearly caused by the fact that until 23 seconds ago, the patient was happily dreaming.

4. Repeat blood pressure reading every 15 minutes, every morning, until blood pressure rises. A smidgen, obviously.

5. Only once you are sure there is no chance at all of the patient going back to sleep should you look at previous readings and conclude. "Her blood pressure IS usually very low." As the patient has been assuring you for the last 45 fraught minutes.

6. Remember, if the patient should become in any way frustrated or cross about this and is unable to hide this irritation due to their extremely recent sleepy status, point out that it is for their "own good." In most cases, this will make the patient compliant, however, if they remain upset, you MUST make sure you mark "patient aggressive" in their notes.

7. Repeat daily.

NB : Should patients with low blood pressure suddenly show "normal" readings, you must NEVER take into account that for that particular patient, this means they are around 50% higher than usual. Even when patient is actually having a stroke, NEVER listen to them, simply reassure them their obs are "fine."

8 comments:

  1. Gotta love obs rounds. Due to having exceptionally cold hands whenever they try to get a sats reading on me it comes out as about 55. They then spend the next 10 minutes stressing about why that is and how I'm conscious. Until I've sat on my and long enough to make it warm enough to get a proper reading.
    I tell them every time that it might happen.

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    1. Don't they train them properly? Even humble first aiders are told that the point is whether a particular "sign" is normal for that particular individual!

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  2. I know that routine well. But you also have to include that the blood pressure device they use inflates the cuff to the point where the device on the finger registering heart rate is about to explode off the finger and aim directly at the nurse standing just a couple of feet away from you. Then the whole temperature check with that 'in ear' gadget - with the billion and one sensors - changed for each patient.
    Add onto all of that - the devices mentioned being conveyed on a trolly that has one wonky wheel and one squeaky wheel.
    I seriously feel your pain.
    The only trolly allowed to make any sort of rattling sound, is that of the tea trolly!

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    1. Hahahaha. Those ear thermometers used to crack me up. So inaccurate it was laughable, I'd ask what it was and get the reply "34.5" or "35.7" or some other reading that would have meant I was clinically dead, yet bizarrely, that one never seemed to worry them.

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  3. In Dani's case her very erratic obs while on dialysis sent no alarm bells - it was her fault for being non-compliant - so her heart infection on end of line not diagnosed until months later after she requested heart scan, which was reluctantly organised. They allowed massive damage to be done to her heart.

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    1. I never had obs done on dialysis! I had one patient on the chair beside me die after coming off the machine.

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  4. Great picture of people lurking behind nurses stations, waiting to pounce on unsuspecting patients and "ons" them all over again

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  5. Don't forget the illiterate doctors, totally unable to read the notes of their predecessors and therefore require your entire medical history from birth.

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