tang - nighttime vitals

tang - nighttime vitals

by Victoria Tang -
  1. Describe one tool that you will employ in your intervention strategy using the following domains:

 

Tool—type: Identification of barriers in the prevention of nighttime vitals in low-risk patients

Target Population: Nursing Aides, Hospitalists

Target Behavior: Stop checking nighttime vitals in low-risk patients

PRECEDE Category: Enabling

Platform: education through learning from peers and staff meetings

B. For a multi-tool intervention strategy, use the PER worksheet attached to describe how you will address each of the PRECEDE framework components 

PER Worksheet. 

Target Behavior

Stop checking nighttime vitals in low-risk patients

Target Audience

Hospitalists, nursing aides

Other Key Individuals

Patients, nurses, administrators

PREDISPOSING

ENABLING

REINFORCING

KNOW

BE ABLE TO DO (skills)

REMINDED

Disruption of sleep increases risk of delirium in hospitalized patients.

Recognize the patient does not need nighttime vitals

Signs on doors for the nursing aides and sign-out reminders to hospitalists

 

 

 

BELIEVE/VALUE

ACCESS TO

POSITIVE REINFORCEMENT

Nighttime vitals is “better and more” care; however, most nighttime vitals collected on low-risk patients require no change in care.

  

Assurance that patients will sleep better and may be more engaged in their care

 

 

 

INTENTION

ACCESS REMOVED

NEGATIVE REINFORCEMENT

Decrease disruption of nighttime sleep in hospitalized patients

 Nighttime vitals in low-risk hospitalized patients.

patient dissatisfaction

 

 

 

 

OTHER

 

SOCIAL SUPPORT

 

 

Peer pressure from staff and patients

 

 

  

 

 

 

Re: tang - nighttime vitals

by Nicole Ling -

Hey Vicky,

Great job. In your multi tool, it may be worth adding "know which patients are low risk and don't need vitals" - even though you've already included this in your enabling (skills) section. I think this idea blurs lines. Also: access removed, you could put "expectation/reflex for all patients to get q4 vitals (or whatever it is) as standard of nursing care".  Access to was tough, and may be personalized nursing schedules for checking vitals overnight.  I liked your idea of signs on the door as a reinforcing factor, pretty cool!

 

Nikki

Re: tang - nighttime vitals

by Jessica -

Hi Vicki, 

Would you consider staff dissattisfaction as negative reinforcement? I also like the idea of signs on the doors as a reminder to nurses' aides. Consider using a sign on the blood pressure machine, as well. 

Re: tang - nighttime vitals

by Brian -

Victoria- the sign tool is an excellent idea- similar to other efforts (falls risk, fluid restriction, no bp's for fistula etc)

wondering if access to- would include changes in the order set that allow physicians to order "no nighttime vitals". other things might be educational tools for nursing/hospitalists on the type of patients that might be able to benefit from not checking vitals (and vice versa- those patients who shouldn't have this policy). 

access removed- another one may be the ability for nurses to "check in" on the patient physically. the q4 vitals policy allowed nurses to periodically see and check in on the pt and this behavior would be lost at night with your intervention