5 Vital Sign Errors to Avoid

5 Vital Sign Errors to Avoid

Vital signs are essential in every aspect and setting of medicine – whether that be inpatient such as in the emergency department, the Intensive Care Unit (ICU), the medical/surgical floors, or pediatrics – as well as virtually every outpatient office setting.

Vital signs are objective measures of a patient’s health and can tell A LOT of information about the patient.

This can give great indications of their health status and prognosis, as well as aid in the differential of many different medical conditions.

When a patient can’t speak, sometimes all the medical team has to go on is their vital signs. Vital signs, matched with a thorough history and physical assessment, can mean the difference between life and death.

To sum it up – vital signs are SUPER important. While ignored by many, the slightest changes in vital signs can clue the nurses and Providers into acute changes in the patient’s status, and diligence with early correction can avoid prolonged hospitalizations and improve patient outcomes.

Vital signs are frequently obtained by nursing assistants, patient care technicians, medical assistants, nurses, and sometimes even physicians or advanced practice providers. All are important to the healthcare team. We ALL know how to take vital signs, but it is up to the Provider (often notified by the nurse) to interpret those vital signs and make patient interventions accordingly.

It is because of this crucial importance that it is absolutely necessary that vital signs are taken correctly to give the most accurate readings. There are many errors that novices and even some experts can make when taking vital signs, but these 5 errors will help any member of the medical team to provide accurate measurements.

1. Incorrect Cuff Size and Location

Blood pressure is a key vital sign to obtain, and it seems everyone is worried about their blood pressure. This is because high and low blood pressure are indications of underlying diseases.

A very high blood pressure could indicate uncontrolled hypertension, a stroke, a medication reaction, etc. Low blood pressure could indicate internal bleeding, systemic infection (sepsis), an adrenal crisis, etc. The lists go on. So many different diseases affecting various body systems can affect the blood pressure, and this is why it is so important to obtain the right measurement.

Blood pressure cuffs should be sized appropriately to fit the patient’s arm. But what is appropriate?

The correct answer is that the bladder (the part that inflates with air) should encompass 80% of the person’s arm circumference. That means it should just about fall short of wrapping around their entire arm.

In reality, though, you just kind of know if it’s too big or too small after some experience. Most adults with regular-sized arms will fit the regular adult size, and larger individuals or gym-rats will benefit from the larger size. It should fit nice and snug, but not too snug.

Place the middle of the bladder (usually marked with some type of marking such as “Artery Here”) over their brachial artery. This is usually on the medial aspect of their antecubital fossa. Place the cuff 2-3cm above the crease, or about an inch.

So why does it matter so much? Incorrect cuff sizes will lead to incorrect blood pressure measurements. If you place a cuff too small on an individual, the blood pressure will likely be falsely elevated. If you place a cuff to big on an individual – you guessed it – the reading could be falsely decreased.

This becomes very important when blood pressures begin to push the boundaries of normal.Top 5 Vital Sign Errors from medical providers - Chalkboard Style

2. Incorrect Positioning

Patient positioning, which is also important in blood pressure, should not be overlooked.

In the office-setting, patients should be seated with uncrossed legs for 5 minutes before getting their blood pressure checked. This usually does not lead to many issues due to the routine and setting of the office.

However, in the hospital, this error occurs very frequently. While patients do not need to be sitting in a chair for 5 minutes prior to a blood pressure reading within the hospital, it is important to maintain proper positioning.

Patients are often going to be bed-bound, on bedrest, or perhaps sleeping when you go to take their vital signs.

Placing the patient in Semi or high fowler’s positioning for at least 5 minutes before checking the blood pressure is ideal, but supine is often accepted as well.

The MOST IMPORTANT thing to remember is that the blood pressure cuff is at the level of the heart (more specifically the right atrium) when the reading is taken.

Patients who are on their sides will give you inaccurate readings. The arm above their heart will read falsely lowered readings, and the arm below may render falsely elevated readings.

This is common, especially within the units that have constant blood pressure monitoring with frequent intervals (ER and ICUs).

3. Incorrect Waveform

Blood oxygen saturation is monitored with a pulse-oximetry sensor usually on a finger, and this is another important vital sign which we need correct measurements.

While of great value, sometimes oxygen sensors read incorrectly low, and with a little practice, it can be easy to learn when a low reading is actually dangerous vs when it is just artifact.

The important thing to check with a pulse-ox reading is whether or not there is a good wave-form.

This is usually within the hospital where a bedside monitor or dynamap displays the “pleth” – that is, the waveform that “beats” in congruence with the heartbeat.

Peripheral pulse ox’s can measure how much blood is passing with each beat through the device sensor. This should look equal, symmetric, and have adequate amplitude.

If all you see is a straight line with occasional movements, this is NOT a good pleth, and likely an inaccurate reading.

The waveform or pleth may look poor due to poor circulation (cold fingers, peripheral artery disease, hypotension, etc), or the patient may be shaking or moving their finger too much.

Try changing to a different finger or hand. With cold fingers with poor circulation, try using an earlobe (infant probes are often easy to use in this location).

If the patient has nail polish on, you may be able to get a reading but it is possible that this is interfering with the spectrum of light for the sensor. If you are getting a bad reading – it may be wise to remove the nail polish on one finger and try again.

Another important fact to remember is to ALWAYS CHECK THE HEART RATE from the pulse-ox. Does this match their HR on the heart monitor? If they are not hooked up to the heart monitor, does this match their peripheral pulse? If your heart monitor reads a HR of 82, and your Pulse-ox is reading 78% and a HR of 30 – this is likely not a good reading as the heart rates do not match up. The exception is an arrhythmia, so make sure they are in a Sinus Rhythm before assuming it is an error.

4. Incorrect Temperature Method

Infections often present with fevers, and severe infections can have either really high temperatures or really low temperatures.

It is important to use the correct temperature method for the correct situation, as using the wrong method can lead you to not picking up on a fever.

Oral Method

In most settings and for most patients, the oral thermometer is adequate. As long as the patient can follow instructions and leave it under their tongue for 10 seconds or so, you will likely get an accurate reading.

However, if the patient recently drank something, this can lead to a falsely lower reading. The colder and more recently they drank it, the more likely it is to interfere with the reading.

Cold beverages can decrease the temperature for up to 30 minutes, and hot beverages can falsely elevate the temperature for up to 5 minutes or so. Interestingly enough, if the patient is chewing gum this can also slightly increase the temperature reading.

Additionally, if the patient has a high respiration rate (greater than 20 breaths per minute), this can lead to falsely low readings. In these instances, it may be prudent to check the temperature with another method.

Rectal Method

The rectal thermometer is the “gold standard” because it is the closest to the core body temperature, but it is not always practical.

Studies have shown that a significant amount of fevers are missed in triage due to less invasive methods. Rectal temperatures should be obtained on anyone with whom there is suspicion of fever when other methods are afebrile.

A basic summary is that a rectal temperature should be performed on those suspected of serious infection or sepsis, those with hypothermia from the field, and those who are critical or unresponsive.

Rectal temperatures are also frequently obtained in children under a certain age. It depends on facility protocol, but obtaining rectal temperatures in infants and young children (often under 2 years) is common, especially if they present with complaints of fever.

Rectal temperatures tend to be 0.5-1.0°F HIGHER than the “normal” oral temperatures – 98.6°F.

Temporal Method

The temporal method is dependent on the facility and available equipment but does offer quick and fairly accurate temperature readings.

If the patient is not very acute, has no symptoms, and simply needs a quick screening temp – the temporal thermometer can be your best friend.

However, the diagnostic accuracy of the temporal thermometer is iffy, and if there is concern for altered temperature, another method should likely be used.

Forehead sweat is a common cause for false low readings. 

Tympanic Method

The tympanic method is commonly used in and out of the hospital setting but often can yield lower-than-accurate readings.

This is often due to the fact that the end of the probe needs to be pointed directly at the tympanic membrane. Improper technique can lead to inaccurately low readings.

If done properly, tympanic readings actually tend to run hotter than oral readings, similar to rectal readings at 0.5-1.0°F higher than 98.6°F.

The tympanic thermometer has shown to be useful, comfortable, and generally tolerable. It is generally appropriate to use 6 months and older, depending on the device.

Axillary Method

Axillary temperatures tend to be unreliable and are not often recommended in the hospital setting.

They can be used for screening purposes in the office-setting if the patient is not complaining of fever. Additionally, they can be used for screening in an infant or young child, but some settings will accept an axillary temperature for children above 2 years old.

This method often yields results about 0.5-1°F lower than 98.6°F. If there is any doubt, use another method.

These readings will be inaccurate in very sick patients who have compensatory peripheral constriction or dilation, so this method should generally be avoided within the hospital.

Long story short – do a rectal when the patient is severely sick or unresponsive, in those very young (generally under 2), and in various specific circumstances when asked or ordered by the provider.

In all other scenarios, use the most appropriate, comfortable, least-invasive method which is likely to yield accurate results.

5. Respiration Rate

The respiration rate is crucial in evaluating those with respiratory complaints.

It can clue the clinician into impending respiratory failure, indicate acid-base balance, and guide patient interventions. However, it seems as though most hospital workers (nurses, techs) don’t actually count respirations.

It happens very often when someone just puts “16”, “18”, or “20” – without even thinking twice. I can’t even tell you how many times another medical professional put in a normal respiration rate and the patient actually had a rate greater than 30, sometimes above even 50.

I get it – do you REALLY want me to stand here and count their respirations for 30-60 seconds?! AINT NOBODY GOT TIME FOR THAT, and we are BUSY. However, accurate respirations can lead to quick and timely recognition of a change in patient status.

All in all, you should be counting. But if the patient appears to be breathing fast, having respiratory difficulty, is an infant, or came in with a respiratory complaint – this becomes a necessity and there really is no excuse for “just putting 16”.

Hopefully you found these errors illuminating and helpful. Remember to always try to obtain accurate results in the least-invasive, most respectful manner possible.

When in doubt, consult with the nurse, physician, or advanced practice provider.Let me know in the comments if you’ve seen these errors occur, and any other errors that might be helpful to other readers!

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Top 6 Charting Tips for Newbie Nurses

Top 6 Charting Tips for Newbie Nurses

The joys of nursing: making a difference, decent pay, and… charting!? Adjusting to the new role as a medical professional is exciting, but unfortunately, there is SO much to learn that nursing school unfortunately just can’t teach you.

One obstacle that new nurses face is learning how to chart quickly and effectively. Learning a new computer system, especially when you’ve never even professionally charted, can be daunting.

Learning time-management and charting skills are difficult enough, let alone actually taking care of the patients! Use these Top 6 Charting Tips for Newbie Nurses to help you transition into the nursing role and help you chart like a pro!

1. Have a System

A critical factor in organization and time-management as a nurse is to have a system for whatever you do. If you go through a literal checklist, you are less likely to miss something, especially as a new nurse!

It can be difficult to chart an entire patient encounter and not miss details, and going through your personal system that you’ve created can help you minimize charting errors. Remember this charting tip throughout the rest of the tips below – developing your personal system is critical in your time-management as a nurse.

Knowing where you write things down, where you chart things, and in what order will help you stay organized in a chaotic environment.

Your system should be flexible as patients and hospitals can be unpredictable. With time, you will be able to adjust your system to be less task-oriented and more holistic.

2. Write it Down

Something that almost EVERY organized nurse does is write down their patient information in some form or another.

You are probably somewhat familiar with this as you likely wrote down every piece of information you could in clinicals. But now you’re in the big leagues – you are responsible for your patient and the information you write down is important.

Seeing multiple patients with similar scenarios, it is easy to forget specific information or mix up information between two similar patients. What you write down will be your brain.

When a physician or other medical professional asks you a question about your patient – the last thing you want is to NOT know! Even if it takes you 10 seconds to find on your paper – this is better than saying “I don’t know”, and physicians and other healthcare staff will respect that.

Many different electronic medical records (EMRs), especially within the hospital, will have printable “patient care sheets” which can provide you with information in the medical record such as the patient’s demographics, medical history, ordered medications, and recent labs.

This can be VERY helpful – but you must have a system in place. Find a specific place to write down the information that isn’t pre-populated.

Where is their IV and what gauge? What is their history of present illness, aka what brought them into the hospital? Find specific places to write this information down on the sheet, and this will help you stay organized and be able to draw accurate information quickly and efficiently for accurate patient charting.

Quickly write down your patient assessments, as well as any new information the patient presents. I also recommend writing down vital signs on your sheets as well to be able to monitor and trend them accordingly. Sometimes when just reading them on the screen, you can miss important information.

Learn your medical abbreviations. If there’s not one – make it up! As long as YOU understand what you are writing – it serves its purpose. This will save you time AND wrist-pain.

If you’d like, I have free patient care organization sheets which you can print and copy to write down patient information and stay organized. You can sign up with your email for free here.

One last note – write down your times; the time you assessed them, the time you emptied their urinal, the time you assisted them to the bathroom, you get the point.

I can’t even count how much time I wasted trying to estimate what time I performed some sort of patient care because I didn’t write it down.

3. RTC

This is probably my BIGGEST recommendation – learn to chart it in real-time.

This is one of the key skills I’ve learned which tremendously helped my first year on a telemetry floor, and subsequently my time in the emergency department.

This is easier if you have a portable computer on wheels, as many units will. By real-time, I don’t mean while the patient is talking. Focus on the patient and give them your undivided attention and assessment skills.

Chart directly AFTER your patient encounter, exit the room (or stay in), and set aside 5 minutes or so to chart everything that occurred right outside the room.

This accomplishes a few things:

  • Everything is FRESH in your mind, and your charting will be more accurate.
  • If you realize you forgot to ask or assess something and realize it while you are charting, you can just walk right into the room and ask/assess the missing information. This happens much more than you expect!

As a new nurse learning a new charting system, you may not be able to finish the entire chart within 5 minutes. If not, I recommend still setting aside about 5 minutes directly after seeing the patient to chart.

Start with your patient assessment, as this is what will be the most difficult to remember specifics later on (you’re going to be doing 5+ assessments).

If you do not get to your patient care plans, patient education, tasks, or another facility-specific charting, that is okay! You can chart this information when you have some downtime later. Just keep a checklist and know what else needs to be charted to come back to later. You will get quicker with time!

4. Nancy Drew it

Once you get to know the electronic medical record, you can really start to use it to streamline your patient care and investigation skills.

One way you can utilize the system is to find information that you didn’t write down (like you should have). One common way I “Nancy Drew’d It” was when I forgot to write down times I performed patient care.

You can go back into the system and cross-check your times. By this I mean, look to see something already charted in the system that you can relate back to when you performed the task.

Did you administer the patient’s medications 10 minutes after your assessment? Look into the EMAR and see what time the medication was administered (already charted in the system), and subtract 10 minutes. Easy enough right?

Learning the EMR and being able to navigate it quickly and efficiently will help you gather appropriate patient information. Learn to look back at old labs (I’m talking 6-12 months ago.. What exactly is their baseline creatinine?), at old medication lists, at imported data from primary care offices, pharmacy information, and at History & Physicals from previous admissions.

Your specific charting software will limit or expand your ability to do this, but all EMR software will have ways of gathering information which you will learn to navigate with time.

5. Work Smart!

As a nurse, you work hard enough! When you are able, try working smart!

If your EMR allows, duplicate a previous assessment and adjust what needs to be changed based on your assessment. Whether it is your assessment or another nurse’s, it really doesn’t matter – just make sure that the charting reflects your actual assessment.

This mainly just saves you mouse clicks – but also your valuable time.

Providers have shortcuts with charting as well. When dictating or typing their H&Ps, they often utilize “macros” or templates that list out a normal Review of Systems and Physical Exam. They change what needs to be changed and it allows them to chart relatively quickly.

Unfortunately, nurses tend to have to chart in a less convenient way, which usually involves multiple clicks, checkboxes, and forms. This is convenient for coding and billing, as well as for insurance companies for data mining purposes, but it is NOT convenient for the nurses.

When the EMR allows, it will save you a good amount of time by duplicating an assessment. Some EMRs will have offer better functionality in this aspect, and others will not allow it at all. It will also depend on the facility and its policies regarding charting duplication.

6. CYA

Nurses are the backbone of the healthcare industry. Unfortunately, the responsibility of our patient’s health ultimately can trickle down to the RN taking care of them, and this can be stressful.

A nurse can find themselves in legal trouble if a medical error occurs and he or she did not catch it (or worse – caused it).

Due to the unfortunate trend in patients suing hospitals and staff, it is vitally important to cover yourself with your charting. Chart EVERYTHING that you can.

Always document each notification you made to the Provider, and the conversations you have with the patient/family. Use direct quotes when possible, even if what was said might not be rated PG…

When in doubt, inform your charge nurse or director of anything that you don’t feel comfortable with – and CHART it! By initiating the chain of command, you did your duty as the nurse.


Hopefully, with these charting tips, you’ll be a little less stressed about charting and able to focus more on what truly matters – patient care!

Drop a comment below if you have any other charting tips that will come in handy for new and experienced nurses alike! As always, let me know of any other blog suggestions you’d like written about!

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Nurse Charting Nurse Documentation Abbreviations

10 ER Nursing Hacks You Need to Know

10 ER Nursing Hacks You Need to Know

William J. Kelly, MSN, FNP-C
William J. Kelly, MSN, FNP-C

Author | Nurse Practitioner

ER nursing hacks can be just what you need to make your shift go from terrible to not-as-terrible. As nurses, we aren’t afraid to get our hands dirty. We take charge, do what needs to be done, and then find a way to laugh about it in the end.

Working in the Emergency Department can be especially draining – physically, mentally, and emotionally. However, just because nursing is HARD doesn’t mean we can’t utilize tips and tricks to make that 12-hour shift a little bit more bearable. Use these “10 Nursing Hacks Every ER Nurse Should Know” to save time, save your senses, and save your sanity!

Please keep in mind the following hacks are anecdotally based. You must use these within your own judgment and within your facility’s protocols. You can read more about this on my disclaimer page.

ER Nursing Hacks: Featured 2

1 ER Nursing Hacks: Double-Glovin’ in the Oven

As you know, personal protection equipment including clean gloves and gowns are absolutely necessary in a hospital environment. For some procedures, clean gloves are “good enough”. However, for high-risk infection procedures, sterile gloves are necessary.

Foley catheter insertion is one of those procedures, as catheter-associated infections are very common. While putting in a Foley catheter can become like second-nature rather quickly, there can be some difficulties with the sterile procedure.

ER Nursing Hacks 1: Double Glove

For one – those cheap sterile gloves that come with the foley kit are typically a size 5.0. So unless you have baby-hands, I’d recommend grabbing an appropriately sized package of latex-free rubber gloves. You might want to go a half-size above your normal for this method.

After grabbing your foley kit and sterile gloves, position the patient, and then wash your hands (duh). Afterward, put on a pair of clean gloves FIRST, then proceed to open your kit and apply your sterile gloves, and continue the insertion per normal.

Using this nursing hack, once you insert the foley and blow up the balloon, you can take off your previously sterile gloves which are now likely dripping with Betadine and other fluids. Luckily – you still have a pair of gloves underneath to secure the cath-secure, position the foley bag, and clean up your pile of trash! Once that’s done, slip off the gloves, wash your hands, and you’re done! Easy-peasy-Kegel-Squeezy.

2 Burp that Bolus

This concept is a little more confusing, but it can save time! In the ER, we hang A LOT of boluses and every ER nurse knows that pumps are harder to find than a rectal thermometer. So naturally, ER nurses are resourceful and use gravity. Patients often require multiple boluses, and Lord knows you are almost always sometimes just too busy to switch out bags before the bag runs out and half of the tubing is now air.

In this predicament, you could flush out the rest of the line in a trash can, then unspike and re-spike your new bag, and THEN re-prime the line. Or you could get a whole new tubing set and just throw out the old bag/tubing. As you can see – this wastes either valuable time or equipment/money!

But what if I told you there was an ER nursing hack to solve this? When you go to prime the original bolus, clamp your tubing and spike your bag. Do NOT squeeze fluid into the drip chamber yet. Now, turn the bag upside down. Unclamp the tubing, and “burp” out the excess air at the top of the upside-down bag.

ER Nursing Hacks 2: Bolus Burp

Once the air is gone and some fluid is forced into the drip chamber, turn the bag right-side-up. Now prime the tubing as normal and hook the patient up. You’ve essentially created a vacuum so that the fluid will stop flowing before it empties the drip chamber – ready for your second bolus when you are. 

3 Juice cup? Change it up!

ER Nursing Hacks 3: Juice cup

Unless you work at an adult-only ER, you are likely seeing patients that span the clinical spectrum – this includes pediatric patients. One thing about pediatric patients is that they HATE taking their medications.

One particularly difficult medication to give a child PO is Dexamethasone oral solution. Unfortunately, it’s usually made with a good portion of alcohol content, and it smells and tastes like…vodka?

After forcing it down, kids often vomit it up – all your hard work for nothing. One ER nursing hack to avoid having to give an IM shot is swapping oral Dexamethasone for the IV solution.

IV medications cannot always be used orally, but sometimes they can! IV Dexamethasone has successfully been administered mixed with cherry-syrup, juice, or followed by a popsicle – and children take the medicine MUCH easier! Don’t forget though, you must run this by the provider before trying it, as studies are somewhat mixed on the efficacy (pharmacokinetic info here).

4 Septic Sock

Now I KNOW you have smelt some SMELLS in the ER (or anywhere in the hospital for that matter). There is nothing stronger than a nurse’s nose. C-diff, fungi, and bodily secretions aside – sometimes the worst smell comes from down under (the feet – ya nasty).

Unfortunately, working 12-hour shifts where you are constantly on your feet and running around, you might find yourself with some STANKY feet. The good news is, even if you don’t have stinky feet, this ER nursing hack can help you deal with a patient’s particularly putrid piggy-toes. But first, a quick science lesson.

While sweat is the main cause of foot odor, sweat doesn’t actually smell. Instead, it creates a perfect medium for bacteria. These bacteria include Brevibacteria and S. epidermidis (known for their cheese-like smell), as well as propionibacteria (known for its vinegar-like smell).

Regardless of which bacteria are causing the odor, they are all highly acidic. So here’s the hack: If you or one of your patients has particularly powerful foot odor – use an antacid! Lather Maalox or Mylanta on the feet, put surgical booties over top, and you won’t believe how fast it can help! Another option is to scrub the feet with Hibiclens or betadine for antibacterial action. Better yet – do both!

Fair warning though, if there is any fungi growing – these methods might not work as well. To prevent foot odor, it’s recommended to wear breathable shoes, breathable socks (cotton or wool), and wash and exfoliate your feet frequently. A little dab of foot-powder in your shoes every few days never hurt anyone either (Gold Bond anyone? #NotSponsored)

Related Article: Six Steps for Sepsis Management

5 Thinking Outside the Vial

Every nurse knows that lidocaine is extremely helpful as a topical anesthetic for suturing , regional blocks, and even intra-articular injections to numb pain. However, lidocaine is not limited to only these uses. While not quite a “nursing hack”, these alternative uses of lidocaine are important to know so you can offer suggestions to the attending when indicated.

Gastritis

OK, you probably knew this one – viscous lidocaine is often mixed with an antacid and sometimes an antispasmodic to create a “GI cocktail” to help with the pain of gastric or esophageal etiology. This is always a good suggestion for those young chest pain when GI etiology is suspected.

NG Tube Insertion

They have done research to see if lidocaine gel, nebulized lidocaine, and anesthetic spray have been useful for NG tube insertion. Not too surprisingly, patients who get lidocaine gel or spray administered intranasally/orally had significantly less pain with insertion – but can have a more difficult NG experience. Additionally, nebulized lidocaine has proven to decrease pain and increase comfort during NG tube insertions, but can increase the chances of nosebleeds.

Cough

Sometimes with persistent laryngospasm, nebulized lidocaine can be used effectively to help with a cough. However, there isn’t a significant amount of research on this, so you likely won’t see it ordered often and will depend on the Provider.

Oral Pain

Those experiencing pain in their mouth from a painful lesion such as an aphthous or herpetic ulcers can benefit from viscous lidocaine “swished” and either swallowed or spit afterward.

Foley Insertion (males)

This is also more common, but the provider may order 5-10ml viscous lidocaine to inject into the urethra before a difficult-anticipated foley insertion in males. Luckily, this usually comes pre-packaged in a syringe called a Uro-Jet. This should be injected directly into the urethra a few minutes before attempting the foley insertion. This can help reduce pain and be especially helpful in patients with a small meatus, anatomical abnormalities, or prostate enlargement.

Renal Colic ER

While meds like morphine and Dilaudid are used frequently in the ER and hospital, sometimes there are effective alternatives to opioids that actually work really well. Slow infusion of low-dose IV lidocaine can be used effectively for kidney pain. It’s recommended for use if NSAIDs and Opioids are contraindicated or risky. One study even indicates that IV lidocaine at appropriate doses safely lowered the patient’s pain more than morphine.

Related Article: Opioid Alternative Analgesics in the ER

6 Alcohol Swab Nursing Hacks

There are a few things we nurses usually load up our pockets with. Usually, these consist of tape, band-aids, paper, pens, and alcohol pads. But did you know how versatile alcohol pads can truly be?

Blood Cleanup

This is more of a no-brainer, but when you accidentally make a mess with blood while putting in an IV, patients appreciate it if you help clean up your mess. Busting out an alcohol swab can easily clean up dried blood on their skin. If alcohol doesn’t do the trick, sometimes using KY jelly lube works even better. Alternatively, you could use hydrogen peroxide.

Nausea Nursing Hack

Did you know that a few whiffs of alcohol pad can relieve nausea almost immediately? Sure – Zofran is still our bread and butter, but this nursing hack works pretty quickly!

When your patient is nauseous, break open an alcohol swab and place it right under their nose. Tell them to take 3-4 deep slow breaths. Before you know it – they should start feeling somewhat better. In fact, clinical research suggests that alcohol may even be more effective than oral zofran, or at least a useful adjuct.

Scientists don’t exactly know why this works. Some think it’s purely due to “olfactory distraction” – distraction while following the instructions, taking deep breaths, and relaxing the body.

Pseudoseizure Nursing Hack

In the ER, the nurses frequently experience patients who have not-so-believable “seizures”. These “fake” seizures are termed pseudoseizures, and the patient might not even know that they are “faking”. Typically when this happens, we bust out an ammonia salt and place it underneath the patient’s nose. This tends to stop their “seizures” pretty much immediately. But what do you do if you don’t have an ammonia inhalant on hand?

Not every ER utilizes ammonia salts, and sometimes they can be hard to find. If you experience a patient with what you believe to be a pseudoseizure, try opening an alcohol pad and placing it directly beneath their nose. This may distract them and bring them out of their “seizure”. Please note this is anecdotal and is not in the literature. 

Save your Senses (ER Nursing Hack)

Clostridium Difficile (C-Diff) is a common diarrheal infection which can make people pretty sick. We often see these patients in the ER and hospitals. Unfortunately, C-diff is very contagious and tends to run rampant in nursing homes and hospitals. As we all know, C-Diff has a pretty distinct and powerful smell which can be hard to erase from our noses!

Before going into a C-diff patient’s room, add a mask to your PPE. Break open an alcohol swab and place it inside the mask. This way, the isopropyl alcohol overpowers the C-diff smell and you save your senses – or at least make it more tolerable.

If alcohol swabs are too strong for you, you can try rubbing toothpaste or Vix rub inside a double-layered mask. This nursing hack works well for C-diff, but also for other smelly situations including I&Ds, rotting flesh, nasty wounds, and fungal infections.

7 IV Stick Trick

Putting in IVs is super common in hospitals, especially within the emergency department. If one thing is sure – patients hate getting stuck! Some tense up, others look away, and then there’s those who shake, cry, and even syncopize. Ironically, the latter is usually buffed up guys with tattoos all over their bodies! People don’t like needle sticks because the needles hurt. But what if I were to tell you that there’s a way you can decrease pain, without any medication or extra equipment?

This ER nursing hack will help your IV insertions go more smoothly! After you clean the IV site, place the needle flush with the skin right where you are going to poke. Press the needle into the cleansed skin with the bevel up for 3-5 seconds before you puncture the skin. The longer you wait – the more desensitized their pain receptors will become – this should decrease the pain felt.

ER Nursing Hack: IV desensitization

With less perceived pain, the patient may tell you “is that it?!” or “I could barely feel it!”. It also takes away the “shock” factor, making the patient less likely to jump! For most patients, this technique will be effective, however, some patients still will have a high amount of perceived pain, especially if you dig.

Related Article:

8 BP not Enough? Use the Bedside Cuff

Vital signs are an important aspect of nursing care and patient monitoring. Blood pressures have a tendency in the ER to be very high or very low. When very low, we give large amounts of fluids as fast as we can. While pressure-bags are a great option and ensure fast infusion, they are not always available.

Many ER rooms have bedside manual blood pressure sphygmomanometers. In place of a pressure-bag, use the blood pressure cuff around the middle to top of the bolus and pump it up until it flows nicely. Like the pressure bag – you will have to occasionally pump in more air as the bag empties.

Related Articles: “5 Vital Sign Errors to Avoid”

9 Neb-wick Air Freshener

After a particularly smelly patient leaves, sometimes the aroma sticks around in the air. Unfortunately, Lysol sprays don’t always cut it. Now I personally am not a huge believer in the essential oil craze, but this nursing hack requires someone on staff to have essential oils or strong smelling lotion.

Take a used nebulizer adapter and squirt some water or saline in the medication chamber. Next, add a few drops of an essential oil of your choice. Turn the oxygen on high and viola. This nursing hack will have the room smelling Glade-scented fresh in no time. Talk about Oxy-Clean!

ER Nursing Hacks 9: Neb-wick

10 The Dependable Bedpan Nursing Hack

Many patients cannot or should not ambulate while they are in the ED. This is fine until they have to use the bathroom. Bedpans can be successfully used for both #1 and #2, but unfortunately, they have a tendency to cause messes. Whether you are using a fracture pan or a regular bedpan, line the pan with an adult diaper or absorbable pad. Secure it with tape or rubber bands. You can also use a large pull-up inverted inside-out and secure it over the bedpan. Place the bedpan underneath the patient as normal.

This way, any urine or liquid stools are absorbed in the material and do not splash, spill, or cause messes. It also allows for easy cleanup! If you need to collect a urine or liquid stool sample – this method should not be used.

Related Articles: “Comprehensive Urinalysis Interpretation”

Hopefully, you found these 10 ER nursing hacks to be useful. Implementing them in our everyday shifts should help save our senses and our sanity, not to mention our time! As a nurse, we are pulled in so many different directions at once and expected to always be on top of our patient care. Utilizing these hacks will hopefully help.

What are your personal nursing hacks which help save you time and make you a more efficient nurse? Let me know in the comments below, and share this article with your nursing friends!

Check out more general nursing hacks over at FRESHRN here!

ER Nursing Hacks: Pin 2