Vitals on routine IFT

[MS Medic]

On a IFT, going from the floor of one hospital to the floor of another with a stable pt for a routing upgrade in services, does everyone have to check vitals every 15 min even though both hospitals might check them once an hour at most? If so, has anyone ever gotten a better answer other than some variation of thats just what we do?

 

[TransportJockey]

On a IFT, going from the floor of one hospital to the floor of another with a stable pt for a routing upgrade in services, does everyone have to check vitals every 15 min even though both hospitals might check them once an hour at most? If so, has anyone ever gotten a better answer other than some variation of thats just what we do?

Depends how long the transfer. The old service I worked for wanted at least two sets minumum. And in a city where there are seven hospitals, plus tons of rehabs and SNFs, that could be something from a 2 minute transport to a 30 minute transport.
And also, not all hospital floors check vitals every hour. My floor that I work on is Q4. Some others are mixes of Q4 and Q8. Really the unit is the only place that does Q1. Step-down usually winds up with Q4 too.

 

[rescue99]

On a IFT, going from the floor of one hospital to the floor of another with a stable pt for a routing upgrade in services, does everyone have to check vitals every 15 min even though both hospitals might check them once an hour at most? If so, has anyone ever gotten a better answer other than some variation of thats just what we do?

1. Hmm, standard of care seems to apply here.
2. To even be paid by insurance there must be 2 sets of recorded vitals signs.
3. In the name of good care, 2 sets minimum is appropriate for a simple IFT.
4. It is good care to know what a patient's vitals are prior to moving the patient onto your
cot, eh?

 

[VentMedic]

And also, not all hospital floors check vitals every hour. My floor that I work on is Q4. Some others are mixes of Q4 and Q8. Really the unit is the only place that does Q1. Step-down usually winds up with Q4 too.

In many hospitals, if a patient is transported to and from procedures just within the hospital a set of vitals is generally obtained before and after. If the patient is tele or ICU, continuous CR (as well as other hemodynamics) monitoring is generally done with the BP cycling q 5 - 15 minutes. Various other services also record vitals before and after procedures including OT, PT, SLP and RT. Some patients have vitals taken very frequently for any therapy or treatment even on med-surg.

 

[MS Medic]

My floor that I work on is Q4. Some others are mixes of Q4 and Q8. Really the unit is the only place that does Q1. Step-down usually winds up with Q4 too.

That was exactly my point. The average transport for me is 1 hour.

 

[rescue99]

That was exactly my point. The average transport for me is 1 hour.

Standard is q15. It is what it is. Even if one does a minimal job, there will be 3sets. Before, middle and arrival.

 

[VentMedic]

That was exactly my point. The average transport for me is 1 hour.

But if a patient leaves the floor for any reason which is considered "transport" even within the walls of the hospital and even on med-surg, vitals may be done before and after just a procedure that may take only a few minutes. If the patient is on tele, licensed staff may accompany them with a monitor that continuously monitors HR, RR and SpO2 with the BP that can be done every 5 minutes or every 15 minutes including initial and end. If a patient in ICU, again all vitals are continuously monitored and may even have an A-Line (as to some tele pts) for continuous monitoring of the BP. Shouldn't vitals also be of similar concern if a patient is transported between facilities?

If the patient is just laying in bed, they will get their base vitals done per the floor protocol. They will then get vitals done with certain activity, treats or therapies such as with PT, OT, SLP, RT and Rad. T. They will get vitals done for PRN medication as well as certain routine medications. They may get vitals done every 15 minutes when rec'g blood products. If a med-surg RN has 3 patients rec'g blood at the same time, he/she is may still be expected to get those vitals his/herself as well as taking care of 5 - 7 other patients. Every 15 minutes should not be too much to ask for an IFT if you only have one patient.

 

[Buzz]

4. It is good care to know what a patient's vitals are prior to moving the patient onto your
cot, eh?

This.

I've, on more than one occasion, taken a set of vitals on a patient that was either going to be discharged home or back to an extended care facility and found patients extremely hypotensive or hypertensive, or a low SpO2, or anything else like that.

I generally don't take any en route, but my average transport time is usually no more than 10 minutes.

 

[LondonMedic]

I've, on more than one occasion, taken a set of vitals on a patient that was either going to be discharged home or back to an extended care facility and found patients extremely hypotensive or hypertensive, or a low SpO2, or anything else like that.

I've discharged hundreds of patients who are, by the numbers, hypo- or hypertensive or with low saturation reading on the probe.

Doesn't mean that they're sick, does it?

 

[VentMedic]

I've discharged hundreds of patients who are, by the numbers, hypo- or hypertensive or with low saturation reading on the probe.

Doesn't mean that they're sick, does it?

Does that mean you don't take vitals on someone who is chronically ill? Should there be no vitals done on CVA patients? Dialysis patients? COPD patients? We know they are chronically ill so are vitals a waste of time on them? Is there not a chance there can still have an acute change? Are you going to say in your report "stable vitals" with only one set for comparison? Buzz probably knows the patient's condition but still is doing good patient care by monitoring these patients.

 

[LondonMedic]

Does that mean you don't take vitals on someone who is chronically ill?

It means that I accept that a patient can be well for discharge despite not having perfect numbers.

I am going to say in my 'report' "stable vitals" (although I much prefer 'obs stable') based on knowing the patient for days or weeks and monitoring their obs and understanding their normal physiology. I am not going to accept someone reporting the same patient "obs unstable" based on the one reading that they've taken - which is precisely what Buzz was implying that he would do.

To give an example, I was called to a patient in the middle of the night who 'probably had a GI bleed' and was hypotensive at 75/30. Having jogged half the hospital I found a small young lady sitting up in bed happily munching an apple. Her BP was about 75/30 but at no point in the week long admission had her SBP made it past 80. Maybe I was remiss in not fast bleeping the anaesthetist and screaming for the O neg...

 

[VentMedic]

It means that I accept that a patient can be well for discharge despite not having perfect numbers.

I am going to say in my 'report' "stable vitals" (although I much prefer 'obs stable') based on knowing the patient for days or weeks and monitoring their obs and understanding their normal physiology. I am not going to accept someone reporting the same patient "obs unstable" based on the one reading that they've taken - which is precisely what Buzz was implying that he would do.

To give an example, I was called to a patient in the middle of the night who 'probably had a GI bleed' and was hypotensive at 75/30. Having jogged half the hospital I found a small young lady sitting up in bed happily munching an apple. Her BP was about 75/30 but at no point in the week long admission had her SBP made it past 80. Maybe I was remiss in not fast bleeping the anaesthetist and screaming for the O neg...

Your situation is very different. You are in a controlled setting of working in a hospitals and establishing a trend over many days. EMT(P)s that are called to transport do not have that luxury and must rely on their initial set of vitals and any report given. Often that report only consists of one very general diagnosis, the last set of vitals and a billing info sheet.

Buzz was replying to this statement:

4. It is good care to know what a patient's vitals are prior to moving the patient onto your

cot, eh?

If there is a reason for the vitals being out of "normal" range, hopefully that will be relayed. And, of course it would be within reason to follow up on any abnormal vitals regardless of the "chronic" report.

Buzz also stated HE took his own set of vitals on the cot which from his own findings he can investigate further as to whether that is "normal" for his own documentation or determine if the move caused a change. Thus, there will be no surprises when he arrives at the ED with a hypotensive patient. He will at least have a decent report to relay from his own initial assessment.

Even in the ICU we will get a patient transferred from the floor with the report VS stable for days with "abnormal" readings thought to be "normal" but with no one questioning why until the patient crashes. "They've been like that", does not necessarily mean that is to be considered "normal" even in the hospital setting.

 

[Sasha]

When I did a stable IFT transfer, I used a nurses PTA, and took my own before moving the patient to the stretcher. That was usually the end of vitals. Most of our transfers were less than 15 minutes.. AND the medical director, clinical director and billing had OK'd the use of a nurses' PTA and one set of your own.

 

[Buzz]

It means that I accept that a patient can be well for discharge despite not having perfect numbers.

I am going to say in my 'report' "stable vitals" (although I much prefer 'obs stable') based on knowing the patient for days or weeks and monitoring their obs and understanding their normal physiology. I am not going to accept someone reporting the same patient "obs unstable" based on the one reading that they've taken - which is precisely what Buzz was implying that he would do.

If I take a set of vital signs and they are not within the "normal" range, I'll check with whomever was taking care of that patient and find out what's been going on with them and whether or not that has been normal for them during their stay.

I'm also mindful of what the receiving facility is going to say when they see similar numbers. Many places around here have taken to refusing to accept the patient until they have taken their own set of vital signs after we arrive. I've transported the same patient as a discharge from the ED, gotten to the nursing home and had to return them back to the ER because they thought the patient was too hypertensive still only to discharge them back to the nursing home again a couple hours later. I've also taken a set of vitals on a patient and found the BP to be elevated and had the doctor decide to keep the patient longer based on that.

 

[rescue99]

This.

I've, on more than one occasion, taken a set of vitals on a patient that was either going to be discharged home or back to an extended care facility and found patients extremely hypotensive or hypertensive, or a low SpO2, or anything else like that.

I generally don't take any en route, but my average transport time is usually no more than 10 minutes.

Yep...I was ah, hem, cough, cough...speaking into a closed palm :lol: Of course there's a reason to take our own. Besides the obvious, has something changed? I want to know what the trend has been. Perhaps this patient runs in the low 90's. Perhaps staffs last vitals were 3 hours ago when discharge papers were being prepared. On a 5 minute lump to the neighborhood NH, I might even use the last hospital set IF it was within the hour. Oh, the decisions!! :lol:

 

[LondonMedic]

Your situation is very different. You are in a controlled setting of working in a hospitals and establishing a trend over many days. EMT(P)s that are called to transport do not have that luxury and must rely on their initial set of vitals and any report given. Often that report only consists of one very general diagnosis, the last set of vitals and a billing info sheet.

Because everyone else, apart from a small handful of EMTs and the occasional RN (so long as they're a flight nurse), don't know how to monitor a patient (or cannulate or whatever it was in the last thread) and can't be trusted?

Buzz was replying to this statement:

That's nice, but this is what he said.

I've, on more than one occasion, taken a set of vitals on a patient that was either going to be discharged home or back to an extended care facility and found patients extremely hypotensive or hypertensive, or a low SpO2, or anything else like that.

If there is a reason for the vitals being out of "normal" range, hopefully that will be relayed. And, of course it would be within reason to follow up on any abnormal vitals regardless of the "chronic" report.

Do you think Usain Bolt needs an ECHO or CMR for his bradycardia and high BMI? Will you be doing that in the ambulance while it's moving or before you set off?

Even in the ICU we will get a patient transferred from the floor with the report VS stable for days with "abnormal" readings thought to be "normal" but with no one questioning why until the patient crashes. "They've been like that", does not necessarily mean that is to be considered "normal" even in the hospital setting.

We look at trends rather than numbers.

 

[FLEMTP]

Sometimes just the simple act of moving a patient from the environment of the hospital to some place new and unfamiliar can stress a patient out and change the whole presentation of a patient. I think you owe it to your patient's well being and yours to recheck vital signs regularly ( every 15 minutes ) and as often as every 5 minutes or so if its an unstable patient... and of course after any and every medication you give the patient, and yes, IV fluids count as a medication.

 

[Outbac1]

It depends on the pt. and where they are going. If they are discharged to the nursing home next door they will get one set of vitals before we go or maybe not if the RN staff have just taken them. On a longer trip 1 - 2 hrs. I want to know what their trend is. And it is very dependant on how stable or serious their condition is. A very stable pt going for an appointment may only get one set of vitals taken. If they are sitting up talking to me or maybe sleeping there is no need to take multiple sets. On the other hand a very sick or unstable or a high risk to become unstable pt. will get more frequent vitals taken. Especially before and/or after interventions. How often to take vitals depends very much on the pt.

That 90lb little old lady may never have a SBP over 90 on a good day. So the question becomes what is normal for her? Treat the pt. not the numbers.

 

[Akulahawk]

As a general rule, for supposedly stable patients, I'll find out when the last set of vitals was done, get one of my own on-scene, compare the two (or compare with trend, if available), load, get one en-route, and q15 or q30, depending upon how long the trip is. Typically, I'd end up getting 2-3 sets on shorter trips and more on longer trips.

Really, it all "just depends"...

Of course, I'd usually be chatting with the patient as a continuous mental status check...

 

[Jon]

At the transport service, policy is at LEAST 2 sets of complete vitals - Pulse, Resp. Rate, B/P. Our paperwork has space for 2 sets of signs. Our continuation sheet allows for more sets of signs. For a unremarkable BLS IFT transport, I usually don't need a continuation, so I just document 2 sets.

On any ALS transport, I use a continuation sheet to document rhythm strips anyway - so I document vitals q-10-15 minutes, with at least 2 sets.