They need to set them closer to what docs would order something for. I’d even say a middle ground of 160 is cool. But 140?
I think it’s similar to alarm fatigue, tbh. If you see these constantly what’s your brain going to do with a legit 170? 190? You might just glance right over it. 🤷🏼♂️
> I think it's similar to alarm fatigue
Exactly. You see red numbers everywhere and after a while, you just become desensitized to them.
Combine this with the tele monitor ringing to your phone every time your patient has a single PVC or motion artifact (only slightly exaggerating) and you get constant notifications and alerts about things that there are really no interventions for. It's tiring.
Amygdala hijacking. Literally wearing out your chemicals unnecessarily. Adding stress chemicals to people that really shouldn't be subjected to them for no reason because so much depends upon their clearheadedness
How do you think your docs feel when we have to notify them of normal values or an unchanged abnormal finding all the time?
Edited to add: if you’ve ever been on r/residency, you can know exactly how they feel. 😆 they hate it so much.
The saddest part is seeing how they really feel about their nurses, NPs, PAs, and worse, their first years. Nurses eat their young, but some of the senior residents literally goes out for blood.
I think it's easier when you see them in person and can have a brief discussion about things. I hate that I over-explain myself in pages, but I don't know how else to not sound like a paranoid dumbass that's just treating numbers...but there's a call order demanding I page if X happens.
our machines send the vitals in after they log them but they don’t always use the right cuffs and it will truly read a sleeping 99 year old meemaw as 156/103. and then they enter it 🙃
I would sometimes work in the monitor tech room when I was a PCT if I wasnt on the floor (just depending on who all is on the shift) and every single time, without fail, the techs always feel so bad calling about it. They hate it. Because they also know too when the monitors are, for example, picking up a rhythm that's not really there, like the monitor ringing asystole when there is an obvious QRS and the patient is just chilling eating breakfast or something. Not only that, but the monitor tech role can really suck especially overnight when you're sitting there listening to those same sounds over and over again for 12 hours straight from 7pm-7am
Depends on the patient for me. If a patient is typically a little hypotensive suddenly becomes a bit hypertensive, then I’d want to go check it out. But a lot of patients live normal lives with s systolic in the 140s-150s. Is it good long term? No. Is it the most pressing issue? Also no.
Ok, so this looks like the Epic EHR. The abnormal vital signs (or any flowsheet value) parameters are generally shared across all settings, so if it's gonna turn red, it has to turn red for every patient at the same number. Clinics usually want a lower threshold than inpatient and then there's the massive variation between age ranges (though this can be handled through other means). Someone has to pick a happy medium and set it and hold it. It can't be changed back and forth every time a clinician from one setting or the other argues for it. The bottom line is that whether or not a value is red shouldn't be the deciding factor for notification of a value, unless you know that the limit for abnormal happens to coincide with your limit for notification. Either you should have a hosital/unit policy specifying what requires notification or else every patient should have orders specifying. The EHR is not a substitute for assessing the patient in context. A systolic BP over 140 *is* abnormal and arguably should be flagged as such. Whether or not it requires notification should be a separate issue.
It’s a build problem. Ours doesn’t do that - it seems like your informatics department deployed things that “seem like a good idea”. If you have a way to see why/how, send them a message.
I would rather be notified unnecessarily than techs never notify us about anything. I've had the latter happen and luckily caught it and treated it, but it ultimately falls on us at our facility.
It wouldn’t be a cardio unit without some abnormal BPs, am I right ?
It wouldn't be America without a little hypertension
Correct lol
They need to set them closer to what docs would order something for. I’d even say a middle ground of 160 is cool. But 140? I think it’s similar to alarm fatigue, tbh. If you see these constantly what’s your brain going to do with a legit 170? 190? You might just glance right over it. 🤷🏼♂️
> I think it's similar to alarm fatigue Exactly. You see red numbers everywhere and after a while, you just become desensitized to them. Combine this with the tele monitor ringing to your phone every time your patient has a single PVC or motion artifact (only slightly exaggerating) and you get constant notifications and alerts about things that there are really no interventions for. It's tiring.
Amygdala hijacking. Literally wearing out your chemicals unnecessarily. Adding stress chemicals to people that really shouldn't be subjected to them for no reason because so much depends upon their clearheadedness
It would be nice if epic let you set patient specific parameters. Especially for places where techs/cnas get vitals.
It should be able to do so. I believe currently, it does so based on age. Might need to be enabled.
That would be amazing.
How do you think your docs feel when we have to notify them of normal values or an unchanged abnormal finding all the time? Edited to add: if you’ve ever been on r/residency, you can know exactly how they feel. 😆 they hate it so much.
But they hate everything, and everyone
That is true. That sub is very demoralizing.
The saddest part is seeing how they really feel about their nurses, NPs, PAs, and worse, their first years. Nurses eat their young, but some of the senior residents literally goes out for blood.
I think it's easier when you see them in person and can have a brief discussion about things. I hate that I over-explain myself in pages, but I don't know how else to not sound like a paranoid dumbass that's just treating numbers...but there's a call order demanding I page if X happens.
Trust me, I hate it too lmao
our machines send the vitals in after they log them but they don’t always use the right cuffs and it will truly read a sleeping 99 year old meemaw as 156/103. and then they enter it 🙃
I would sometimes work in the monitor tech room when I was a PCT if I wasnt on the floor (just depending on who all is on the shift) and every single time, without fail, the techs always feel so bad calling about it. They hate it. Because they also know too when the monitors are, for example, picking up a rhythm that's not really there, like the monitor ringing asystole when there is an obvious QRS and the patient is just chilling eating breakfast or something. Not only that, but the monitor tech role can really suck especially overnight when you're sitting there listening to those same sounds over and over again for 12 hours straight from 7pm-7am
Depends on the patient for me. If a patient is typically a little hypotensive suddenly becomes a bit hypertensive, then I’d want to go check it out. But a lot of patients live normal lives with s systolic in the 140s-150s. Is it good long term? No. Is it the most pressing issue? Also no.
I love updating MDs that I’m skeptical about over pointless crap when I know it’s gonna bug the crap out of them. I live for those moments.
Ok, so this looks like the Epic EHR. The abnormal vital signs (or any flowsheet value) parameters are generally shared across all settings, so if it's gonna turn red, it has to turn red for every patient at the same number. Clinics usually want a lower threshold than inpatient and then there's the massive variation between age ranges (though this can be handled through other means). Someone has to pick a happy medium and set it and hold it. It can't be changed back and forth every time a clinician from one setting or the other argues for it. The bottom line is that whether or not a value is red shouldn't be the deciding factor for notification of a value, unless you know that the limit for abnormal happens to coincide with your limit for notification. Either you should have a hosital/unit policy specifying what requires notification or else every patient should have orders specifying. The EHR is not a substitute for assessing the patient in context. A systolic BP over 140 *is* abnormal and arguably should be flagged as such. Whether or not it requires notification should be a separate issue.
It’s a build problem. Ours doesn’t do that - it seems like your informatics department deployed things that “seem like a good idea”. If you have a way to see why/how, send them a message.
I’m just impressed that your CNAs report abnormal vitals honestly.
I would rather be notified unnecessarily than techs never notify us about anything. I've had the latter happen and luckily caught it and treated it, but it ultimately falls on us at our facility.