I don't understand why vital signs were not collected at each visit. They're painless (for the most part), non-invasive, and offer great insight into a patient's condition---especially when trended over time. It seems that vital signs don't get any respect.
One of the best journal articles I have shared with others is "Make Vital Signs Great Again." In the hospital, we have several early warning systems (NEWS, PEWS, MEWS)----but they don't work if staff don't enter the vital signs, and they're definitely not helpful when staff "batch" the vital signs after they finally have a breather at 2 in the morning. Unfortunately, when they go to draw labs at 4 in the morning, the patient is in rigor.
I actually have a dot phrase i order at discharge to repeat the vitals and notify me if abnormal....if im worried about it i will do them myself still as it still sometimes is not done.
Agree. I've also had situations where I reviewed multiple vitals sets, then discharged the patient, then the nurse takes one more set on the way out the door and suddenly there's new tachycardia or something like that. Very irritating.
I agree, unclear whether they are not documented or just not included in the court documents but the lack of reference to vital signs, especially when arguing about the need for inotropes, is bizarre.
Speaking of carvedilol pharmacokinetics, one point that isn't mentioned is it's metabolism is mostly hepatic and there is a large amount of first pass metabolism so it's possible that in someone with severe liver dysfunction (which it sounds like he may have had depending on how high the INR was) you can have supratherapeutic levels even if it was otherwise indicated
Fascinating, excellent point! Someone on Reddit found an article that there actually is a significant amount of absorption by 20 minutes, so I may have to edit my theory mentioned above.
I don't understand why vital signs were not collected at each visit. They're painless (for the most part), non-invasive, and offer great insight into a patient's condition---especially when trended over time. It seems that vital signs don't get any respect.
One of the best journal articles I have shared with others is "Make Vital Signs Great Again." In the hospital, we have several early warning systems (NEWS, PEWS, MEWS)----but they don't work if staff don't enter the vital signs, and they're definitely not helpful when staff "batch" the vital signs after they finally have a breather at 2 in the morning. Unfortunately, when they go to draw labs at 4 in the morning, the patient is in rigor.
Yep. This has been an issue on other med mal cases too, in regards to getting a 2nd set of vitals in the ED. The vitals,... are vital.
I actually have a dot phrase i order at discharge to repeat the vitals and notify me if abnormal....if im worried about it i will do them myself still as it still sometimes is not done.
Agree. I've also had situations where I reviewed multiple vitals sets, then discharged the patient, then the nurse takes one more set on the way out the door and suddenly there's new tachycardia or something like that. Very irritating.
I agree, unclear whether they are not documented or just not included in the court documents but the lack of reference to vital signs, especially when arguing about the need for inotropes, is bizarre.
Speaking of carvedilol pharmacokinetics, one point that isn't mentioned is it's metabolism is mostly hepatic and there is a large amount of first pass metabolism so it's possible that in someone with severe liver dysfunction (which it sounds like he may have had depending on how high the INR was) you can have supratherapeutic levels even if it was otherwise indicated
Fascinating, excellent point! Someone on Reddit found an article that there actually is a significant amount of absorption by 20 minutes, so I may have to edit my theory mentioned above.