7 ms·

What percent of patients have a medical need to be woken up every few hours then?

rscho 4y ago
You'd be surprised to see what happens to staff going against waking up patients all night. You get the "dangerous sloth" sticker on your forehead real quick on the morning grand rounds.
- gowings97 4y ago
  With all the focus on EHR and billing, they can't have all the machines taking vitals hooked up and in a ready only state thats sent to the nursing station? This is the type of stuff I have a gripe with. Sinecure and fiefdoms of power.
  - rscho 4y ago
    Silencing monitors is actually forbidden by law in many places. Staff is supposed to be near the patient at all times => monitors beeping. That's certainly a bad state of things, but not a "fiefdom of power". It's so ingrained in our education that most staff don't even think about it but would certainly agree if asked whether the patient would sleep better without it.
    - gowings97 4y ago
      Not saying monitors should be silenced. You can monitor someone without waking them up. Fiefdoms of power - nursing union not wanting to give up the night shift premium pay when the job description changes to monitoring a screen and half the physical workload vs. day shift.
    - haldujai 4y ago
      I’m not sure where you’re getting this from. I / my nurses silence alarms at literally every hospital I’ve ever worked at (granted they’re temporary silences by design so you have to hit silence q1h/q30mins depending on the alarm). Stanford Healthcare recently installed a system where all alarms/notifications get sent to a hospital assigned device the nurse carries rather blasting in the sleeping patients room as 90%+ are false alarms (aka IV or SpO2 sensors). The real issue is that hospital technology is outdated and most places don’t have the option for this level of telemetry. I’ve never been told / instructed my staff to “be near the patient at all times”. In fact, most places have 1:8 nursing coverage on the ward…
      - rscho 4y ago
        You're right that silencing alarms is strictly forbidden in anesthetic territory only, not ICU. I'm biased bc I'm in Switzerland, and here the coverage ratio is usually 1:1. The country is so rich, that many things are different here... they really are near the patient at all times. To give you an idea: the day COVID really hit, we received 180 shiny new Hamilton respirators complete with additional staff overnight, in an ICU that's usually ~30 beds. And you can't order "your nurses" around, because they've got a lot more power. Yes, in most places it's different and I should have mentioned that.
        haldujai 4y ago
        I want to clarify two points given the language used in your response: 1. I used the possessive “my” in reference to nursing staff for simplicity in writing and clarity to the reader rather than to indicate ownership, we are on a team. This is akin to saying “my goalkeeper wears Nike soccer cleats”. 2. I do not “order nurses around.” I verbally communicate and leave medical orders in the chart that nurses act on. It is not about a power struggle, we are all trying to do our jobs and do what’s right by the patient. I’m grateful when nurses question my medical orders (as long as it’s a positive/educational discussion, which it is 99% of the time) as they catch my mistakes and we all learn together. If you are concerned that you can’t order nurses around, I strongly suggest reflecting on whether this leadership style is the most conducive to providing quality patient care as this can increase barriers and hostilities in the workplace resulting in communication breakdown and adverse events.
        rscho 4y ago
        Thanks for the lesson, mate. I'll be strongly reflecting over the past 15 years of clinical practice and see the errors in my ways.
        barry-cotter 4y ago
        Any doctor who says they treat nurses as valued professional colleagues should be presumed to be lying unless you have seen it yourself, in person. Doctors treating nurses like shit is the norm, not the exception. How badly varies a lot.
ghufran_syed 4y ago
pretty much every patient in the intensive care unit - that’s kind of what the “intensive” is referring to. If nothing else, you either take the blood pressure the normal way with a pressure cuff, which is going to wake you up. Or you put an intra arterial catheter, which reads continuously without bothering the patient, but has a small risk of damage to the vessel, infection etc
- gowings97 4y ago
  Based on my knowledge of US based urban (downtown) / suburban metro hospitals - vast majority of beds / patients aren't in ICU/CCU beds. I would say only 30% are in a critical state under observation - ICU/CCU/post-op/etc.

You'd be surprised to see what happens to staff going against waking up patients all night. You get the "dangerous sloth" sticker on your forehead real quick on the morning grand rounds.

gowings97 4y ago
With all the focus on EHR and billing, they can't have all the machines taking vitals hooked up and in a ready only state thats sent to the nursing station? This is the type of stuff I have a gripe with. Sinecure and fiefdoms of power.
- rscho 4y ago
  Silencing monitors is actually forbidden by law in many places. Staff is supposed to be near the patient at all times => monitors beeping. That's certainly a bad state of things, but not a "fiefdom of power". It's so ingrained in our education that most staff don't even think about it but would certainly agree if asked whether the patient would sleep better without it.
  - gowings97 4y ago
    Not saying monitors should be silenced. You can monitor someone without waking them up. Fiefdoms of power - nursing union not wanting to give up the night shift premium pay when the job description changes to monitoring a screen and half the physical workload vs. day shift.
  - haldujai 4y ago
    I’m not sure where you’re getting this from. I / my nurses silence alarms at literally every hospital I’ve ever worked at (granted they’re temporary silences by design so you have to hit silence q1h/q30mins depending on the alarm). Stanford Healthcare recently installed a system where all alarms/notifications get sent to a hospital assigned device the nurse carries rather blasting in the sleeping patients room as 90%+ are false alarms (aka IV or SpO2 sensors). The real issue is that hospital technology is outdated and most places don’t have the option for this level of telemetry. I’ve never been told / instructed my staff to “be near the patient at all times”. In fact, most places have 1:8 nursing coverage on the ward…
    - rscho 4y ago
      You're right that silencing alarms is strictly forbidden in anesthetic territory only, not ICU. I'm biased bc I'm in Switzerland, and here the coverage ratio is usually 1:1. The country is so rich, that many things are different here... they really are near the patient at all times. To give you an idea: the day COVID really hit, we received 180 shiny new Hamilton respirators complete with additional staff overnight, in an ICU that's usually ~30 beds. And you can't order "your nurses" around, because they've got a lot more power. Yes, in most places it's different and I should have mentioned that.
      - haldujai 4y ago
        I want to clarify two points given the language used in your response: 1. I used the possessive “my” in reference to nursing staff for simplicity in writing and clarity to the reader rather than to indicate ownership, we are on a team. This is akin to saying “my goalkeeper wears Nike soccer cleats”. 2. I do not “order nurses around.” I verbally communicate and leave medical orders in the chart that nurses act on. It is not about a power struggle, we are all trying to do our jobs and do what’s right by the patient. I’m grateful when nurses question my medical orders (as long as it’s a positive/educational discussion, which it is 99% of the time) as they catch my mistakes and we all learn together. If you are concerned that you can’t order nurses around, I strongly suggest reflecting on whether this leadership style is the most conducive to providing quality patient care as this can increase barriers and hostilities in the workplace resulting in communication breakdown and adverse events.
        rscho 4y ago
        Thanks for the lesson, mate. I'll be strongly reflecting over the past 15 years of clinical practice and see the errors in my ways.
        barry-cotter 4y ago
        Any doctor who says they treat nurses as valued professional colleagues should be presumed to be lying unless you have seen it yourself, in person. Doctors treating nurses like shit is the norm, not the exception. How badly varies a lot.

ghufran_syed 4y ago

pretty much every patient in the intensive care unit - that’s kind of what the “intensive” is referring to. If nothing else, you either take the blood pressure the normal way with a pressure cuff, which is going to wake you up. Or you put an intra arterial catheter, which reads continuously without bothering the patient, but has a small risk of damage to the vessel, infection etc

gowings97 4y ago
Based on my knowledge of US based urban (downtown) / suburban metro hospitals - vast majority of beds / patients aren't in ICU/CCU beds. I would say only 30% are in a critical state under observation - ICU/CCU/post-op/etc.