Photo credit: Otisarchives3′s
Health-care is becoming more and more complex. Increasingly nurses are having to manage a patient that is encapsulated by a multiplex of highly technical life support equipment. A labyrinth of ventilators, monitors, infusion pumps, defibrillators, patient controlled analgesia devices, automated CPR machines, Glucometers, blood gas analysis machines, CPAP, BiPaP.
Machinery entangles our work.
Equipment that needs to be maintained and operated with a high degree of precision, for unlike other complex computer systems, when life support equipment crashes you are about to lose more than just data.
And if all that hardware wasn’t enough, there are the peripheral data gathering programs, and patient tracking programs, and rostering software programs that all must be appeased.
It almost seems as if there are more people in the health system interested in the data than the patients. There has become an almost insatiable thirst for the collection of data and statistics.
From studies to audits to records to key performance indicators, nurses must collect, and enter vast oceans of data.
So. How do we break free from the robots steely grip? How do we manage all this technology without loosing the human touch?
Here are some quick thoughts on how to nurse in the machine:
Focus on the patient, not the machine. Patients in the emergency department are sick. And the sicker they are, the more their monitoring equipment will try to compete for your attention.
In most instances you can learn far more from spending your time fiddling with the patient rather than the machine they are attached to.
Start at the center and work out. Your patient is the center. When the ventilator or the monitor is alarming, first look at your patient.
Begin with: Airway. Breathing. Circulation.
Start troubleshooting from the ABC’s and from there work your way back out to the equipment.
Don’t send in a machine to do a nurses job. Not every patient you care for will need to be plugged into a monitor. Many patients in the ED get hooked up to monitoring equipment they really don’t need.
Ask yourself: what level of monitoring does this person actually require? Does that lady with a fractured hip waiting for a ward bed still need full cardiac monitoring? Does that man with the tendon laceration really need 30 minute blood pressures?
If in doubt, read the manual. Try to get to know the machines. Have you seen the manuals that come with these things? Five hundred and twenty six pages of technical specs, warnings and legal disclaimers. I just want to know where the batteries go!
Most staff are only familiar with only a small portion of the full capabilities of most monitoring and interventional equipment.
Take time to distill some of the key operating functions out of those voluminous instruction manuals laying around gathering dust as they prop up a computer monitor. Become a super user.
Make sure you understand how to change basic parameters and trouble-shoot simple problems with your equipment.
Remember: KISS ME (Keep It Simple but Show Me Everything)
Alarm silence is the devils button. Most monitoring equipment will have some form of alarm silence that will cut the klaxons for 60 or 90 seconds. In our acute care ward, each of the 20 beds has its own monitoring equipment and it is pretty easy to get caught up walking around silencing all the alarms only to have the first alarm start up again.
Instead of hitting the silence button as a reflex action, take a moment to try and correct the cause of the alarm.
The robots cant touch this. Don’t ever misplace the art of taking a manual blood pressure, or palpating a pulse, or (heaven forbid) actually counting the patients actual respirations.
Traditional Tibetan doctors spend years learning how to diagnose a multitude of patient conditions by simply concentrating on the qualities and characteristics of their patients radial pulse and examining their oral mucosa.
Imagine if todays doctors and nurses were to take the time to sit down and spend 3-4 minutes quietly holding the wrist of their patients, feeling the blood pulse under their touch.
The human body is a much more complex and reliable piece of monitoring equipment than anything you will find hanging on the walls of the ED.
Don’t let your patient catch a computer virus. Have you ever been hooking your patient up to some piece of equipment only to discover the cables slash sensors slash tubes are smeared with gobs of blood slash sputum slash unidentified gross particulate matter. It can be pretty embarrassing to you. It can be pretty harmful to your patient.
Keep the surfaces of the equipment clean. Refer to those voluminous manuals for acceptable cleaning protocols.
Know where the silicone ends and the flesh begins. There is no doubt that all this technology can be beneficial in improving the quality of patient care. And the future will hold far greater injections of technology into our profession. Multi-national companies and start-up businesses are all queued up behind those big pharma drug reps to peddle that next whiz bang, cannot do without piece of technology to the hospitals.
Never forget the important stuff. The person before you and the people that they are connected to. This is where the flesh begins.
And when it comes to technology…. show me the machine that will help me remove a bedpan topped with a shimmering meniscus of diarrhoea from the sweaty buttocks of a bariatric, demented patient…….and I will be all ears.
Thanks for the excellent reminder focus on the manual skills. Helpful. I’ll never forget the Canadian doc who walked into the exam room, looked intently at me for about 1/2 a minute w/o speaking and without laying a finger on me made the correct dx. I’d never been there before and they had no access to my H&P. A constant reminder of the power of informed observation.
We have very basic equipment in our ED and save a LOT of lives daily.The overseas doctors are always surprised when they see the amount of trauma and the lack of ‘fancy’ equipment. Stick with the basics and patients lives are saved daily. Loved your post
Great post. It’s true, we get too into machinery that we forget about the patient.
We transitioned to a new EMR last year and everyone was freaking out about it. The complexity, the computer, the scanning of meds, in a word, chaos. Our manager sent an email to remind us: it’s about the patient in the bed. Everything else will come as long as you take care of the patient in the bed. Guess what? It did.
As for the families worrying about the monitor, I tell them this: that screen is mine to worry over, not yours, when you see me freak, then you’re allowed to. In the meantime, be with your loved one.
Oh, and for palliative patients first thing I advocate for (after adequate analgesia/anti-anxiety) is loosing all the crap, the telemetry, the frequent vitals, all of the machinery of modern medicine. The intrusion is just jarring.
Amen.
Those machines are MUCH of the reason that health care in America is so exorbitant. It’s why we have an illness system, not a wellness system.
Breaks my heart every time we have a patient in the ICU on whom we are withdrawing care…family is at the bedside and the monitor is alarming an O2 sat of 60% or pulse of 20, whatever. Family keeps looking at the MONITOR, not their loved one.
Whoever designed our system does not allow us to monitor those things centrally and also shut the noise off at the bedside.
Time after time, I say to the family…don’t look at the machine, focus on your mother/father/sister/brother. I end up obtrusively being in the dying patient’s room just to shut to keep the alarms shut off.
Hate that.
/jo
Bravo for patient centered care. As useful as all this technology is, the patient must be our focus. The cardiac monitor alarms a rapid heart rate. Check your patient. What is her baseline? Is she on cardiac meds? Is she up walking? I have seen many cases when the cardiac monitor alerts the nurse to a situation that requires a transfer to a critical care floor, but it’s the nurse’s judgment in conjunction with the M.D.’s order that makes that happen. That is the essence of patient centered care.
Some times kiss works.
Drip rates over Imeds
Manual pulses, BP and resp rates. You need to feel the pulse any way, you might as well count it while your there. It is also a chance to silence your patient and just stop and reflect.
[...] When I think of progress, I think of London and the rest of England: the home of the industrial revolution! In this way, I suppose we can thank London for all the technology and equipment that we must use on a daily basis in our jobs as nurses. Ian over at ImpactEDnurse reminds us, it’s not always about the technology! [...]