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!
Renee
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Thank you. This is awesome advice. I am a new nurse and on a cardiac med surge floor. I have patients that have hourly antibiotics that need to be hung as well as their and all the other pts meds that need to be given. I am averaging 7 miles a day at work. It is wearing me out. Any suggestions?
ReplyDeleteThanks Lyne. Try to group activities together, like patient care activities. Start identifying why you're walking so much. Is it because your patient assignment is scattered, you forget supplies, patient's requests, etc. See if you can anticipate what you might need every time before you walk into their room..also think about your to do list and try to group those things together.
ReplyDeleteI know when I was new, I ran around more than I do now. I'm much better at anticipating needs and planning ahead. You can do the same.
Don't give up!
Cheers
Renee