Tuesday, April 22, 2008

Flash! SPIRIT lowers high blood pressure!

What's one of the most common things a nurse does upon entering a patient's room? Check the blood pressure. So just imagine the work-arounds that were happening over and over again before this problem was called out as part of BIDMC SPIRIT. I post the results from the problem log.

Type of Problem -- Save Time; Improve Patient Care
Campus -- East
Setting -- Inpatient Ward
Location of Problem -- 12 Reisman
Problem -- Many of the patient rooms missing blood pressure cuffs and/or parts.
Person Describing Problem -- AnnMarie Grillo, RN

Root Cause
Many of the nursing staff unaware of storage location of BP cuff and extra parts (kept in a closet at the end of the hall). Because of this, missing cuffs and parts not getting replaced.

Solution (after investigation)
Change storage location to more central area.

Action Plan (who, what, by when)
1) Immediately -- room rounds done and all missing cuffs and parts replaced. (Done by AnnMarie Grillo and Gina Murray.)

2) Moved storage location of BP cuffs and parts to a drawer in the medication room at the nurses' station. Labeled drawer and notified the staff. (Done by AnnMarie Grillo and Gina Murray.)

3) Obtained current list of BP cuffs and supplies from Bill Pyne in Distribution. Posted this list in medication room above BP supply drawer for staff to make re-ordering easy. (Done by Kerri Petraitis and Gina Murphy.)

Investigation -- Closed (Complete w/ root cause, solution, action plan complete)


Paul Levy said...

(From a patient's comment to this blog; but I have taken off identifiers. Dear patient, thanks for writing. We'll follow up.)

Day One

I was given scrub pants, walking socks, and a patient top that would fit quite well when I arrived.

Day Two

I took a shower as requested and as ordered. I require considerable assistance from nursing to cover my Hickman to prevent it from getting wet during bathing. I was given some very good soap and shampoo for the job. When I completed the shower, the scrub pants (Labeled X- Large) I was given were so old they were two sizes to small. An expedition was sent out to find a pair of pants that would fit. Fortunately the hunting trip found a pair that fit quite nicely. Hospital walking socks that fit a size 12 are also, always in short supply. But I am not a big person, but I always have trouble with scrubs and socks. It never seems to get any better. Larger scrub pants exist because Doctors and Nurses can be readily seen in privately owned sizes that would fit. In five minutes on Google I was able to find supply for socks. What is wrong with hospital supply?

Day Three

The Co-worker nurse on Day Two grabbed two pairs of each so I would have less of a dressing problem on Day Three. Bless her heart.

Day Four

I took a shower each day. That’s the good news. The worry is that I won’t have clothes that fit when I get out. Today, I tried on pants before the shower to see if they fit. It took 4 hours and 3 special requests to find a pair of walking socks that were close to fitting.

Anonymous said...

Back to the BP cuff issue... Why doesnt BIDMC have automated BP cuffs in every room as most other hospitals seem to?

Anonymous said...

So the BP problem is fixed on 12 Reisman. (At least until automated BP cuffs are installed, as should be the standard for the hospital). Do other departments fix their BP access problems? Or does this depend on another independent call out in another silo?

Paul Levy said...

A very, very good question. The theory is that the story should be shared, as, at a minimum, it is posted on a public log that other nurse managers will read. But is will also be mentioned in the regular meetings with those nurse managers.

None of this, though,is perfect yet, by any means, so there is liekly to be occasional repetition.

BTW, there is some disagreement among our clinical folks on your point about whether the automated cuffs should be standard.

Paul Levy said...


I have stopped printing your notes because they are very patient specific. I have, however, forwarded them along to the relevant folks here.

Michael said...

Blood pressure is pretentious by a number of factors. These include the strong point of your heart, blood vessels' order and the kidneys' fitness. A person who movements regularly, most often has a healthy heart that can drive more blood with each drive and will not need to beat as often in order to keep a normal blood pressure.High Blood pressure also depends upon the artery. Hardened and narrowed arteries caused by old age or a high fat diet can make it harder for the blood to flow, causing the blood pressure to rise. When the arteries begin to stop up, the heart is then subjected to harder work. The kidneys' health also affects blood force. Because the kidneys functions to maintain water and salt volume in the body, if the kidney retains too much water and salt then the blood pressure will also boost.