Should I report this nurse for lack of obs on my baby?

[Snowflake2014]

NC for this.

I'm in hospital with my 2 week old baby, she has an infection and is on hourly observations. We've been in for days and getting out for Christmas relies on good obs to allow them to reduce o2 input until she's weaned off it completely.

At 6am I looked at her chart and saw that no obs have been recorded since 7.30pm last night. So our named nurse overnight hasn't recorded any stats. I thought I hadn't seen her much, assumed she must have popped in when I've been sleeping, which is off and on according to when the baby does.

I went back to sleep, noticed her come in at 6:30am and do obs. Not liking confrontation, I didn't wake up properly to ask her about it. I've just woke up again and checked the chart. She's put the 6:30am stats in but also one other set of data, with no time on. So she's made it look like she did two obs in 12 hours. S till nowhere near a full night of hourly obs. Still not enough for the doctor to assess when ward round starts.

Should I say something to the day nurse when she comes around? Or should I bring it up with the doctor when s/he comes? Or just leave it and hope that 2 obs instead of 12 looks bad enough?

I know they were understaffed last night and I know how much stress nurses are under due to staffing issues so I don't know if I am being fair in grassing her up?

[Lagoonablue]

You are not grassing her up. You need to tell the staff nurse or doctor. If there is dangerous practice it needs to be addressed.

[Sirzy]

She may have done the other ops but noted them elsewhere in order to not disturb you. When DS Has been in they have often missed obs if he is settled and there was nothing majorly concerning in the last lot so they didn't disturb him. Generally oxygen levels overnight drop so it's unlikely they would be able to decrease it overnight anyway.

That said please do mention your concerns and let the nurse decide if it is an issue in your particular case. Hope you are home soon

[Mouthfulofquiz]

Definitely mention this to the nurse and then also the doctor when he does the ward round today. Don't see it as confrontation - just say 'I thought we were on hourly obs and I can see that only one set was done last night, has this changed?'
Tell someone about the extra set appearing. The nurse may have done them and written them down somewhere else before popping them on the chart. But she may have not - therefore you need to know. Sorry - I know you probably don't feel like it but you will need to be a bit assertive here. Good luck!

[pullthecracker]

When I'm on nights, I sometimes do obs and write them in my handover sheet, to fill in the notes later, so that I'm not disturbing anyone. She may have noticed you sleeping and tried to be as quick as possible. Please do give her the benefit of the doubt, yes, if she genuinely hasn't done them, she is wrong. However, many of us have obs scribbled in the back of handover sheets through the night.

[BathshebaDarkstone]

You really need to report this. DS1 has c.f. and I would have gone nuts if they hadn't done his obs when they should. Your baby's health is at stake.

[Skittlekittle2]

I agree with the others here, sometimes record of obs may be wrotten elsewhere for whatever reason but generally an honest good nurse would not mind u asking if that's the case. if no one can tell you that's when I would make a complaint. Hope the little one is doing well xx

[northernlurker]

Might they be doing electronic obs recording as well? So the obs are listed but not on the sheet by the bed?

I think it would be reasonable to speak to one of the other nurses and ask if more were done and if not why not. I would suggest speaking to this nurse but I suppose she's gone off duty now.

[Arriettyborrower]

Absolutely you should say something.
Also for those saying the nurse may have documented elsewhere - still unacceptable. This is very unsafe practice - does not allow for a trend to be seen and is open to error.
Similarly, nurses should not be recording obs on handover sheets/random bits of paper as the potential for misinformation is huge.

Obs should always be recorded at the time they are due to be done on in one place (obs chart/electronic device) this is central to being able to interpret and act on the data.

Any other practice opens itself up to a potential whole world of hell for all in the coroners court.

[justkeeponsmiling]

I find it hard to believe hourly obs were ordered on your baby throughout the night tbh - only time I ever had to do hourly obs it was on patients so ill they were hooked up to monitors as they were unconscious/had just had a major heart attack/stroke etc.
Hope your baby gets better soon.

[Snowflake2014]

I did sort of wonder if the untimed set were scribbled somewhere else though I don't know why they would be when the chart is right next to the baby. However the issue still stands of only two obs being done instead if 12. Missing one or two would be okay but not 10.

I think I will try mouthful's suggestion of asking if the rate of obs has changed and broach it that way.

Justkeepsmiling, we've been here since Thursday and they've done hourly obs day and night since then. She's two weeks old and struggling to breathe, I can only assume that's why.

[TooHasty]

won't it be obvious when the doctor comes round that she has only done 2 obs in 12 hours?

[Theorientcalf]

I'm a paeds nurse and I wonder if she's recording electronically as some places do now or if she's wrote them down on a bit of paper and not filled it in yet.

If she really has done one set of obs overnight on a baby on O2, then that is really not very good. I assume your baby was on a sats monitor all night so doing obs wouldn't have been a challenge like on some wriggly children.

I would have a word with the nurse in charge. The doctors will want to see the obs on ward round anyway.

If I had a baby on oxygen I'd be doing hourly obs.

[R4roger]

are you sure she doesnt have an electric dvice? that's what they use where I was an in patient recenlty.

[PiperIsTerrysChoclateOrange]

I would just ask the staff nurse.

No way would a nurse not record any data.

[GretnaGreen]

One of the most common disciplinary/ regulatory offences in nursing is not recording contemporaneously. I don't entirely understand not wanting to disturb people given that the notes are at the end of the bed and any disturbance is likely to be caused by you coming in in the first place. But even if you note them down to put on later, you're putting the patient at risk - what if something happens with that patient and you're not on the ward or can't be found when the people dealing with whatever has happened need to know what's been going on?

You are also putting yourself at risk of disciplinary action and your employer at risk of legal action if you can't prove that you did the obs at all/when they should have been done.

I have done some work in the regulatory sphere and believe me when I say it's better to risk disturbing the patient than to not record what you do as you do it.

[GretnaGreen]

OP, I think you should clarify this with someone unless the notes clearly state that obs were reduced overnight.

[MiddleAgedandConfused]

You should report her. This time it may not be critical to the health of your child, but in another case it could be.
When I was in hospital a couple of years ago they did exactly the same thing.

[elspethmcgillicuddy]

Justkeepsmiling- I find it hard to believe you have so rarely had to do hourly obs. Baby on oxygen should definitely be on that. Appropriate for many adults on oxygen too throughout the night.

[Theorientcalf]

Justkeepsmiling, a baby on oxygen would always be on regular obs. Children go down hill in seconds, unlike adults.

[SoggyOldBiscuit]

I hope your baby gets much better soon. You must be so tired

[Gileswithachainsaw]

Yes you should definitely ask.

babies on oxygen are meant to be checked regularly.

not recording it on the chart is dangerous surely as when Dr does rounds s/he hasn't got the relevant information to make a decision regarding treatment.

night is just as vital if not more so because sats dip in sleep.

If she's not coming in s/he could well loss something. If your waiting for an alarm to sound.its a bit late by then surely?

[Gileswithachainsaw]

loss?

miss.

[livingzuid]

Sorry you and your baby are in hospital OP. When my newborn was in icu it was all done electronically, including oxygen and they monitor from the desk as well as popping over to have a look very regularly. No baby was out of sight on the ward. If your baby is hooked up to the monitors they will check her remotely - and ours had pagers too even once she was moved to a medium care ward.

No matter what, ask. Don't be shy when it comes to your baby's health. You are perfectly entitled to enquire what the procedure is.

Hope she gets better soon and you make it home for Xmas.

[Snowflake2014]

Thanks everyone. I mentioned to the day nurse that there weren't many obs done in the night and she looked at the chart and took it to a senior nurse. I'm not sure what the outcome was because I've been a bit upset today and just focused on that.

To those who said a nurse wouldn't not record things, of course they would. Nurses aren't special snowflakes, they are a mixture of good, bad, conscientious, lazy, kind, harsh etc. That's why there are disciplinary procedures because not all nurses do as they should.

Fortunately my little one is looking a lot better today. And hourly obs have resumed with the shift change.

[Snowflake2014]

Thanks everyone. I mentioned to the day nurse that there weren't many obs done in the night and she looked at the chart and took it to a senior nurse. I'm not sure what the outcome was because I've been a bit upset today and just focused on that.

To those who said a nurse wouldn't not record things, of course they would. Nurses aren't special snowflakes, they are a mixture of good, bad, conscientious, lazy, kind, harsh etc. That's why there are disciplinary procedures because not all nurses do as they should.

Fortunately my little one is looking a lot better today. And hourly obs have resumed with the shift change.