Sunday, February 20, 2005

Hospiblogging at Instapundit: the 5 AM weigh-in

Glenn Reynolds posts about his wife's medical ordeal, and wonders why hospitalization itself must be so arduous (interrupted sleep, bad food, etc.). I wonder how many nurses and doctors will e-mail a response. I think hospitalization has become more difficult for inpatients, for a host of reasons: staffing shortages, increased severity and complexity of illnesses and treatments, and the pressure for shorter hospital stays. Inpatient treatment has become much more focused and intensive, and the patients are feeling it. (Staff feel it, too!)

He asks why his wife must be awakened at 5:00 AM to be weighed. It makes no sense to him. Weight is one of the more critical parameters for a heart patient (if his wife's heart is having trouble, a weight change will send a signal. And all those IV fluids that have been going in...what if they decide not to come out? Sick hearts, lungs, and kidneys can make that happen. You'll see it in the weight.) It has to be measured at the same time daily, and the results entered in the computer in time for morning rounds. It will be assessed with other measures of heart function and fluid balance for the preceding 24 hours.

So, when to measure the weights for each of the 20 or 30 (I'm guessing) patients on that ward? Geena, the RN at Codeblog, can tell you: it must be close to the start of day shift, when docs make their assessments of the previous 24 hours. It can't happen during shift change (usually between 6 AM and 7:30 AM). It can't happen when patients are eating breakfast, or when nurses are passing morning meds. (Too much chaos, not enough staff.) After morning meds and breakfast, they'll measure a weight if they can get it. But by then, nurses are putting out one fire after another. Patients are leaving their rooms for tests and procedures. Docs will already be demanding those weights, which guide treatment decisions for the next 24 hours.

Hospitals look at the schedule and ask: when can we consistently get weights on our patients, and have the results when we need them? The time that worked for their system: night shift, 5 AM. Great for diligent, coordinated, non-negligent, quality care. But from the patient's perspective, it's a mindless, meaningless irritation.

Geena would likely also tell you: that 5 AM weigh-in is not just about weight. Staff are checking so many other things about Glenn's wife at that time: is she arousable (big trouble if she's not!), can she respond verbally, is she strong enough to get on the scale, is her gait steady, is she dizzy, is she short of breath? Sometimes staff enter the room with a scale, and find the patient on the floor, or in a medical crisis, or eloped, or (horrors) dead.

Geena can tell Instapundit all about it, I'm sure...

Addendum: I'm a big Geena fan, and a fan of nurses in general. My first job out of high school: nurse's aide, in a hospital. Yes, I did the 5 AM weigh-ins. I tried to be nice about it...

I remember being completely amazed by the nurses, who always knew when someone was going to die! How did they know?? I was 18 years old and didn't know anything about anything...particularly, I knew nothing about falling blood pressures and diminishing heart rates! But my awe of nurses has never left me.
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