Caring for patients is getting more complex. One reason is that only the really sick are actually admitted to a hospital – everyone else is being treated as an outpatient. Years ago on a medsurg unit with a 6:1 assignment, you would have one or two really sick patients; the rest were “walkie talkies.” Now you have the same number of patients but they’re all really sick!
To effectively care for patients requires you to anticipate problems early and intervene quickly. One of the best ways to do this is by understanding the importance of trending.
I teach nursing students during their clinical rotations and always ask them to give me a report. When they tell me vital signs or lab results, I reply by saying, “I don’t care.” They look at me like I’m crazy! Then I explain: The current vital signs really don’t matter unless I know what they were before. What’s the trend? Is the blood pressure trending up or is it trending down? What about the heart rate?
Why does trending matter?
A patient was admitted for a “simple” procedure and died during the night from a retroperitoneal bleed. When reviewing her vital signs, it was noted that her heart rate was increasing throughout the night while her blood pressure was dropping. Each value by itself could have been considered normal but when you put them together (trending) you could clearly see what was happening. Unfortunately, nobody looked at the trends.
It’s important to understand that one set of labs or vital signs is only gives you a snap shot of the patient’s status. The key to effective patient care is to identify if the patient is getting better or worse, and then act on it quickly before they deteriorate.
The same goes for labs.
Is the WBC count trending up or down? Is the H/H improving or getting worse? For example, if your patient has a surgical infection, a WBC count of 12,000 is meaningless unless I tell you what it was yesterday. If tell you that the value was 16,000 yesterday – I know that patient is getting better. If it was only 10,000 yesterday, I know the patient is getting worse. My actions should then reflect knowing the trend.
When giving report, share the trends. When receiving report, always ask for them. You have to know the trends to anticipate risk and to improve patient outcomes. It makes a huge difference in your ability to care for these complex patients!
Thanks so much for reading. What are your thoughts on trending? Have you seen this in your practice? Feel free to share examples!
Thanks for choosing to become a nurse. Take care and stay connected!
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