What are you most vigilant about?

4 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.
Meds drugs and dosages...right patient right med right dose....no matter how hurried I am I ALWAYS check myself and the patient.

Always, always make absolutely sure arterial bleeding stops completely before walking away (after ABG's, line removal, etc.) If the patient has a newer AV fistula and cannot be trusted to leave it alone, take action immediately. Exsanguation is not pretty.

Always flush IVs/G-tubes during your initial assessment.

Blood sugars. They're easier to get now than they used to be, and you can have an answer in seconds.

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.

In PICU, my 'thing' is cage cribs. If a kid can pull to stand- they need to be in a cage crib. (My home care kiddo climbed/ fell out of his crib simultaneously decannulating himself AND pulling out his Mic-Key button. Good times.)PS: He's fine

Eye drops. Make sure you know if ordered for left eye only, right eye only, or both eyes. That was a med error for me. I was very very rushed that day with 7 patients. Now I do not interrupt my med passes, not even to go to rounds or answer a call light.

Hanging chemo accurately and safely: correct dose, appropriate dose, any possible toxicities reported, good and reliable IV access to avoid infiltration, proper PPE to minimize my exposure.

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.

I watch for any indications of fetal distress in utero. Fetal tracing can go from great to bad in a split second. I am always watching the fetal tracings especially on patients with risk factors.

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.

Quote from cd365cAs 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.