Hey Dude, Where’s the Assessment?

It was the usual story when I got report from — I’ll call her Cherry — the RN going off-duty: patient from a retirement home, gradual decline, increased weakness, not eating, not drinking, family not coping. So when I reviewed the chart, Cherry RN had written in her initial assessment:

From retirement home. FTT, V/S as per triage.

That was all. Nary another word. No up-to-date vitals.  No chest auscultation, no neuro checks, no assessment of cardivascular status. No nursely hands palpated the abdomen, or checked the feet for edema or pedal pulses. No medical history, list of current medications, or allergies. I honestly didn’t believe it at first and flipped through the chart repeatedly, looking for a proper nursing assessment.

Sadly, there was none.

For you, Cherry RN, there are lessons. First, be accountable, provide good patient care, a sound assessment and adequate charting. In short, do your job. Because now that I’m charge nurse, I will need to speak to you about it, and document something to give to the educator. Neither of these chores will make me very happy, and really, you don’t want me unhappy. And if you think I’m crustilacious, the educator is a bit of stickler, if you know what I mean.

It’s probably unnecessary to add that also you will be fodder for a snarky blog post and be (anonymously) subject to worldwide ridicule.

Second lesson: FTT — Failure To Thrive — is not an observation, or assessment: like its cousin, Failure To Cope; FFT has become a label or catch-all for elderly patients who seem to be unwell or declining for nonspecific reasons. The danger for nurses (or any health professional, for that matter) is that we are really treating the term and the stereotype, not the patient.

Or to put it another way, Failure To Thrive is a a specific diagnosis which requires a careful and thorough assessment of the patient for physical or cognitive impairment, such as new onset confusion or depression, medication changes and conflicts, malnutrition and dehydration and underlying chronic or acute disease processes. It requires a thoughtful nursing assessment and response. The literature suggests early intervention — and nurses in the Emergency Department are well placed to strongly advocate with family, physicians, home care, physiotherapists, and social work — will halt or even reverse the effects of FTT. If you don’t do your initial assessment properly, how can credibly you do any of this?

The benefits should be obvious: fewer patients in the emergency, fewer admissions, less cost to the health care system. And satisfaction, that as a nurse, you actually made a difference.

So please don’t write  “FTT, V/S as per triage.” Treat the patient, not the label. Assess. Advocate. Please.

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  1. #1 by LK on Wednesday 05 May 2010 - 0927

    Thank you, from one who reports to nurses, while being attendant to seniors in a retirement-nursing home. We often observe the reasons for FTT.

  2. #2 by DreamingTree on Wednesday 05 May 2010 - 1149

    WOW…just wow…

  3. #3 by wilomis on Wednesday 05 May 2010 - 2225

    Send her ass back to Nursing 101… or I’ll come up to the great North and let her borrow my Principles of Nursing textbook…

    • #4 by wilomis on Wednesday 05 May 2010 - 2226

      Sorry if I seem snarky… I still have the sweet smell of C Diff in my olfactory nerve…

      • #5 by torontoemerg on Wednesday 05 May 2010 - 2231

        Ah lovely C. diff. Did you feel like showering, like, for ten hours?

        • #6 by wilomis on Wednesday 05 May 2010 - 2321

          I have never showered as much as I do now… Nursing school has made me a cleaner person than I ever was before.

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