#WeMDT - Tuesday 20th October 2020 8pm (GMT Standard Time)
Can vital signs monitoring in hospital be improved?
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Chat Details
fHosted by WeNurses using #WeMDT
This chat is guest hosted by @KadoorieCentre
We are researchers with multi-disciplinary expertise from Oxford, Southampton, and Portsmouth.This TwitterChat is part of our wider project addressing the limited evidence that supports early warning protocols in most hospitals.
Project Summary
Taking measurements of heart rate, blood pressure, temperature and other “vital signs” is an important part of care for nearly all hospital patients. However it can be burdensome to patients, interfering with rest and sleep, and cause more work for nursing staff. There is little current evidence to guide hospital staff on how frequently to take observations and or how much work is involved in taking observations.
The overall study aims to develop a protocol for how frequently observations should be taken. We will use retrospective patient vital signs data to assess how frequently obs need to be done to prevent deterioration. We will then find out how feasible that is in terms of staff time.
We want to understand the realities of delivering care on the general ward. This will help the analysis team This Twitter Chat is designed to collate clinical experiences of those at the frontline of vital signs observations. Specifically, we want participants in the chat to think about what is good about current early warning score protocols and also what is not so good. We know from research that there can be challenges to doing observations as dictated by early warning score schedules, and that nurses can face dilemmas in prioritising care. We are particularly keen to understand how people manage this in ‘real-life’. We also want participants to tell us about the changes they would make to the standardised protocols, and what difference this might make.
The study will result in a final study report and peer review journal outputs including online and open access journals and conference presentations. Summaries from the Twitter Chat will be used to illustrate key points. Comments will not be linked to individual Twitter handles. You can contact the research team after data analysis is complete to request a study summary if you wish.
Proposed questions
When do you think patients should be monitored more/less than the NEWS / NEWS2 suggests?
How do you prioritise patient monitoring when it is not possible to take observations when NEWS / NEWS2 suggests?
What do you tell patients about how often they will be monitored and why (if anything)?
How can we strike a balance between the patient's safety and other factors (e.g. waking from sleep)?
What can be done in the future to improve how observations are scheduled?
About our guest hosts
Julie Darbyshire (@JLDarbyshire), senior research manager based at the University of Oxford with expertise in mixed methods and qualitative research practices and lead for the ‘stakeholders’ work package within NIHR funded “Frequency of Observations” project.
Chiara Dall’Ora (@ora_dall), Registered Nurse and Senior Research Fellow in Nursing Workforce based at the University of Southampton with expertise in shift work and job performance.
Jo Hope (@_jo_hope), Lecturer at the University of Southampton with expertise in mixed methods, specialising in care provided by nursing teams in hospitals and the role of digital technologies in health work.
Chat Contributers
100 Tweets
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20000 Impressions
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Engagement Wheel
Chat Word Cloud
Participant bio cloud
Chat Summary
There were some great points made and experiences shared during this tweetchat ... here are just a few of them:
And finally ....
Post Chat Comments
After the chat you may like to add a reflection, add some questions, or maybe you've made a change from something you leant on the chat...well now you can with "post chat comments" below.
You'll need to be logged into via Twitter from the main menu, then you can share your post chat comments...
You'll need to be logged into via Twitter from the main menu, then you can share your post chat comments...
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#WeMDT transcript
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@WeNurses
20 October 2020 20:01
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Tonights #WeMDT tweetchat will collect data for a research project on the frequency of vital signs observations taken in hospital https://t.co/rfnXihvZc6 |
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@WeNurses
20 October 2020 20:01
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Hello everyone - it's great to be here for a #WeMDT tweetchat This evenings topic is "Can vital signs monitoring in hospital be improved?" and is being held in collaboration with the fab @KadoorieCentre team Please tweet us a hello if you are joining us this evening https://t.co/UfvF3XBeWG |
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@_jo_hope
20 October 2020 20:02
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RT @WeNurses: Hello everyone - it's great to be here for a #WeMDT tweetchat This evenings topic is "Can vital signs monitoring in hospita… |
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@AgencyNurse
20 October 2020 20:02
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Hi Teresa here - looking forward to tonights #WeMDT tweetchat |
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@WeAHPs
20 October 2020 20:03
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Please say Hi if you are joining #WeMDT https://twitter.com/WeNurses/status/1318628546630291456 |
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@_jo_hope
20 October 2020 20:03
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RT @WeNurses: Tonights #WeMDT tweetchat will collect data for a research project on the frequency of vital signs observations taken in hosp… |
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@WeParamedics
20 October 2020 20:03
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Hello :D #WeMDT https://twitter.com/WeNurses/status/1318628546630291456 |
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@BrianWebster18
20 October 2020 20:03
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@WeNurses @KadoorieCentre Hello #WeMDT |
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@WeStudentNurse
20 October 2020 20:03
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Starting now ... a #WeMDT tweetchat https://twitter.com/WeNurses/status/1318628546630291456 |
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@knitknitqueen
20 October 2020 20:04
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@WeNurses @KadoorieCentre Waves...!!! scoffing my dinner so that I can take part #WeMDT |
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@wehcmanagers
20 October 2020 20:04
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Head on over to #WeMDT to discuss vital signs monitoring ... starting now > https://twitter.com/WeNurses/status/1318628546630291456 |
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@WeNurses
20 October 2020 20:04
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Hi Jo great to see you here #WeMDT https://twitter.com/_jo_hope/status/1318629037208645633 |
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@knitknitqueen
20 October 2020 20:04
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RT @WeStudentNurse: Starting now ... a #WeMDT tweetchat https://twitter.com/WeNurses/status/1318628546630291456 |
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@WeNurses
20 October 2020 20:05
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Without further ado, let's get started with QUESTION 1 When do you think patients should be monitored more/less than the NEWS / NEWS2 suggests? #WeMDT https://t.co/boWZ1L0EGN |
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@AgencyNurse
20 October 2020 20:05
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@knitknitqueen @WeNurses @KadoorieCentre eek don't get indigestion ! #WeMDT |
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@rachelhenning
20 October 2020 20:05
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#WeMDT hello ?? |
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@WeLDnurses
20 October 2020 20:05
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Starting now #WeMDT on Vital Signs Monitoring https://twitter.com/WeNurses/status/1318628546630291456 |
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@WeEOLC
20 October 2020 20:05
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RT @WeNurses: Hello everyone - it's great to be here for a #WeMDT tweetchat This evenings topic is "Can vital signs monitoring in hospita… |
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@WeGPNs
20 October 2020 20:05
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RT @WeNurses: Hello everyone - it's great to be here for a #WeMDT tweetchat This evenings topic is "Can vital signs monitoring in hospita… |
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@WeLearnOutLoud
20 October 2020 20:05
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RT @WeNurses: Hello everyone - it's great to be here for a #WeMDT tweetchat This evenings topic is "Can vital signs monitoring in hospita… |
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@WeMHNurses
20 October 2020 20:05
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RT @WeNurses: Hello everyone - it's great to be here for a #WeMDT tweetchat This evenings topic is "Can vital signs monitoring in hospita… |
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@WeSchoolNurses
20 October 2020 20:05
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RT @WeNurses: Hello everyone - it's great to be here for a #WeMDT tweetchat This evenings topic is "Can vital signs monitoring in hospita… |
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@PuncnadineS
20 October 2020 20:06
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@WeStudentNurse Hello, 3rd year student nurse #WeMDT |
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@WeNurses
20 October 2020 20:06
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@rachelhenning hi Rachel - thanks for joining #wemdt this eve :) |
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@WeAHPs
20 October 2020 20:06
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Tonights Q1 #WeMDT https://twitter.com/WeNurses/status/1318629322656198657 |
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@claire_conboy
20 October 2020 20:06
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@WeNurses @WeLearnOutLoud @KadoorieCentre Hello #WeMDT from a wet Nottingham! |
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@WeParamedics
20 October 2020 20:07
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Question 1 ... please share your thoughts #WeMDT https://twitter.com/WeNurses/status/1318629322656198657 |
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@_jo_hope
20 October 2020 20:07
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RT @WeAHPs: Tonights Q1 #WeMDT https://twitter.com/WeNurses/status/1318629322656198657 |
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@wehcmanagers
20 October 2020 20:07
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Question 1 #WeMDT https://twitter.com/WeNurses/status/1318629322656198657 |
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@WeNurses
20 October 2020 20:07
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@knitknitqueen @KadoorieCentre welcome to tonights #wemdt and enjoy dinner... thats important :) |
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@WeNurses
20 October 2020 20:08
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@PuncnadineS @WeStudentNurse Hi and welcome Nadine #WeMDT |
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@knitknitqueen
20 October 2020 20:08
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@WeNurses This is interesting, we use News2 in the perioperative environment & monitor at regular intervals. I have worked on the wards and I find that some NOT all may see the 4-6 hours as a guide, but you should never ignore the gut, if you want to monitor more regularly then do #WeMDT |
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@WeNurses
20 October 2020 20:09
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Anyone else feel this way ? #WeMDT https://twitter.com/knitknitqueen/status/1318630263631523840 |
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@WePharmacists
20 October 2020 20:10
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We are tweetchatting NOW about vital signs monitoring in hospital, can they be improved? It is an MDT chat.... so we can all tweet and share ideas and learning! Use #wemdt to join or listen in :) https://t.co/FxLaHUfzzQ |
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@HeatherBain9
20 October 2020 20:10
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#weMDT is this not a good example of when professional judgement is important to monitor more frequently... https://twitter.com/wenurses/status/1318629322656198657 |
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@WeNurses
20 October 2020 20:10
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@meloncarrier Great points Bex #WeMDT |
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@_jo_hope
20 October 2020 20:10
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Intuition & gut are coming through for monitoring more - what do others think? #WeMDT https://twitter.com/Layla_Louiseee/status/1318630268031389696 |
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@Rhys_Marv
20 October 2020 20:10
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@WeNurses #WeMDT when the patient is sleeping scoring a 0 constantly yet dome wards are like 4hr obs ... why please? Hate the 2am and 6am obs when they are sleeping scored 0 all day and look OK ?? |
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@WeParamedics
20 October 2020 20:10
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RT @_jo_hope: Intuition & gut are coming through for monitoring more - what do others think? #WeMDT https://twitter.com/Layla_Louiseee/status/1318630268031389696 |
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@WeNurses
20 October 2020 20:10
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RT @_jo_hope: Intuition & gut are coming through for monitoring more - what do others think? #WeMDT https://twitter.com/Layla_Louiseee/status/1318630268031389696 |
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@WeLDnurses
20 October 2020 20:10
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RT @_jo_hope: Intuition & gut are coming through for monitoring more - what do others think? #WeMDT https://twitter.com/Layla_Louiseee/status/1318630268031389696 |
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@WeNurses
20 October 2020 20:11
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We are tweetchatting NOW about vital signs monitoring in hospital, can they be improved? It is an MDT chat.... so we can all tweet and share ideas and learning! Use #wemdt to join or listen in... https://t.co/ZR3RPjwIW2 |
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@_jo_hope
20 October 2020 20:11
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Also professional judgment... #WeMDT https://twitter.com/HeatherBain9/status/1318630608160116740 |
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@nicole_thenurse
20 October 2020 20:11
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@WeNurses On a palliative basis perhaps? Regular monitoring can be quite invasive for frail and dying patients who we know are going to score anyway #WeMDT |
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@PuncnadineS
20 October 2020 20:11
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@WeNurses I think if the patients score is 0 then waking them up just because it's been 4 hours is not good for recovery? #WeMDT |
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@Winn_on_Health
20 October 2020 20:11
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@WeNurses I suggest that obs should be taken as often as the patients acuity indicates, or if /as the clinician is concerned. NEWS & NEWS2 are good guides for appropriate frequency, but they are a guide. Clinician intuition is a valuable (tho subjective) approach #WeMDT #WeNurses |
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@claire_conboy
20 October 2020 20:11
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@WeNurses I think you should go with your gut feeling...if something seems off increase obs. Our intuition is based on knowledge & experience. Also do manual obs if the patient is deteriorating! #WeMDT |
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@_jo_hope
20 October 2020 20:12
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RT @Rhys_Marv: @WeNurses #WeMDT when the patient is sleeping scoring a 0 constantly yet dome wards are like 4hr obs ... why please? Hate th… |
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@nicole_thenurse
20 October 2020 20:12
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@WeNurses @KadoorieCentre Hello! In the midst of an ICU placement where we do them hourly as norm. #WeMDT |
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@TheTinyStN
20 October 2020 20:12
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@WeNurses If a patient has been 0 all day, I don't think it is appropriate to wake them at 2am and 6am for more obs #WeMDT |
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@AgencyNurse
20 October 2020 20:12
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I'm not quite sure we should use the terms "intuition" or "gut" ..... it's clinical judgment surely ? We are highly trained and experienced professionals ... if our clinical judgement says monitor more / less then that is what we do #WeMDT |
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@_jo_hope
20 October 2020 20:12
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RT @DeathCafePUNC: @WeNurses @KadoorieCentre Hello! In the midst of an ICU placement where we do them hourly as norm. #WeMDT |
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@ElyrithW
20 October 2020 20:13
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@WeNurses Dependent on clinical judgement. Tools like this shouldn’t override the clinicians judgement. I’ve seen patients with NEWS 2 arrest, and NEWS 5 patients stable at baseline. #wemdt |
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@knitknitqueen
20 October 2020 20:13
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@Rhys_Marv @WeNurses I agree... I wonder who decided that 2 & 6am were good times to wake a patient up! #WeMDT |
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@WeNurses
20 October 2020 20:13
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Great point ... anyone else agree ? #WeMDT https://twitter.com/Charlottehall96/status/1318631160466071560 |
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@urgentingreen
20 October 2020 20:13
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@WeNurses when a pt scores eg 5 normally [COPD for example] I will monitor more as a 1 or 2 point change could have a significant effect that may not occur at NEWS 1 and with my limited skillset it is vital to pick up changes quickly to arrange backup if needed on route #WeMDT |
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@nicole_thenurse
20 October 2020 20:13
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@_jo_hope @WeNurses Always a risky one, intuition is right a lot of the time but you can't use "just had a feeling" in a court of law as evidence #WeMDT |
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@WeNurses
20 October 2020 20:13
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Great to have you here Nicole - we hope the placement is going well ? #WeMDT https://twitter.com/DeathCafePUNC/status/1318631146872279040 |
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@WeNurses
20 October 2020 20:13
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@HeatherBain9 welcome and thanks for joining tonights #WeMDT Heather :) |
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@_jo_hope
20 October 2020 20:13
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Great point here #WeMDT https://twitter.com/AgencyNurse/status/1318631264115675139 |
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@claire_conboy
20 October 2020 20:13
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@PuncnadineS @WeNurses In that 8 hour window between 10pm & 6am how do you know what's happening with your patient? Working in an admission setting we do 4 hourly obs on everyone. #WeMDT |
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@WeNurses
20 October 2020 20:14
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RT @Rhys_Marv: @WeNurses #WeMDT when the patient is sleeping scoring a 0 constantly yet dome wards are like 4hr obs ... why please? Hate th… |
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@nicole_thenurse
20 October 2020 20:14
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@WeNurses It is an interesting one! Keeping my eyes and ears open at all times, absorbing a lot of information.... #WeMDT |
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@hannahlames1
20 October 2020 20:14
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@WeNurses It's not just the obs need to use wider assesment skills look listen and feel clinical reasoning and information gathering to support decisions on frequency of observations #WeMDT |
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@knitknitqueen
20 October 2020 20:14
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@KadoorieCentre @WeNurses When I have investigated why a patient has deteriorated, and this is not about blame at all; this may be human nature and factors.. We have to also go to basics.. how many monitors do we have on wards. This also has an impact #WeMDT |
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@WeNurses
20 October 2020 20:15
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QUESTION 2 How do you prioritise patient monitoring when it is not possible to take observations when NEWS / NEWS2 suggests? #WeMDT https://t.co/BPwSp0pFRI |
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@WeParamedics
20 October 2020 20:15
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Some really relevant points here ... do others do this ? #WeMDT https://twitter.com/urgentingreen/status/1318631368625131521 |
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@WeNurses
20 October 2020 20:16
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Yes an important point #WeMDT https://twitter.com/ElyrithG/status/1318631321162297344 |
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@AgencyNurse
20 October 2020 20:16
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Yep ... this ! #WeMDT https://twitter.com/hannahlames1/status/1318631716978917377 |
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@WeNurses
20 October 2020 20:16
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We know what you are saying @claire_conboy "But" do we think we undrming ourselves when referring to "our gut" that is an easy way of saying "Clinical Judgment" #WeMDT https://twitter.com/claire_conboy/status/1318631060520001536 |
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@WeParamedics
20 October 2020 20:17
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Question 2 #WeMDT https://twitter.com/WeNurses/status/1318631842996768771 |
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@WeEOLC
20 October 2020 20:17
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Tonights Q2 #WeMDT https://twitter.com/WeNurses/status/1318631842996768771 |
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@WeNurses
20 October 2020 20:17
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@DeathCafePUNC @KadoorieCentre thanks for joining and sharing @DeathCafePUNC #WeMDT |
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@wehcmanagers
20 October 2020 20:17
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Question 2 - incase you missed it #WeMDT https://twitter.com/WeNurses/status/1318631842996768771 |
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@TheTinyStN
20 October 2020 20:17
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@WeNurses Currently a 1st stage StN but I would ask a HCA to continue routine obs on stable patients and focus my attentions on unstable patients, attempting to get as close to the NEWS2 suggestion as I could #WeMDT |
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@WeMHNurses
20 October 2020 20:17
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Question 2 #WeMDT https://twitter.com/WeNurses/status/1318631842996768771 |
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@knitknitqueen
20 October 2020 20:18
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@Rhys_Marv @WeNurses And the last medication round of a shift. I have never had so much respect for those that are able to draw and give all their IVs before 18:00! #WeMDT |
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@AnnaDol20230332
20 October 2020 20:18
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RT @WeNurses: Hello everyone - it's great to be here for a #WeMDT tweetchat This evenings topic is "Can vital signs monitoring in hospita… |
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@claire_conboy
20 October 2020 20:18
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@WeParamedics This is why we have parameters for patients with some illnesses like COPD or CKD. Always important to get them amended or it seems like you're not acting on information #WeMDT |
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@AgencyNurse
20 October 2020 20:18
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Yes indeed .... it can also be about knowing your patient and what is normal for them #WeMDT https://twitter.com/JodyEdeOx/status/1318632596956454912 |
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@hannahlames1
20 October 2020 20:19
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@WeNurses @claire_conboy This is the process of critical thinking, clinical reasoning and clinical judgement to get to our clinical decision that the pt is unwell #WeMDT |
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@knitknitqueen
20 October 2020 20:19
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@KadoorieCentre @WeNurses I think that is it both, definitely not enough kit! I have been able to do shifts on a ward due the @hcpc regis changes due to the thing.. I have a machine o and a tympanic, turn and turn back and its gone. You spend so long to find things! #WeMDT |
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@nikkilouh
20 October 2020 20:19
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@WeNurses I think looking at the patient holistically is important and if they are with you a while like for say on an acute inpatient ward look at what is normal for them as medications etc could affect HR , BP etc . #WeMDT |
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@claire_conboy
20 October 2020 20:19
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@Charlottehall96 @WeNurses ?? this! Escalate to your senior nurse and medics. Make a plan. #WeMDT |
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@WeNurses
20 October 2020 20:20
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@AnnaDol20230332 @KadoorieCentre Hi Anna #WeMDT |
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@WeNurses
20 October 2020 20:20
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#WeMDT https://twitter.com/KadoorieCentre/status/1318632601557532681 |
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@TheTinyStN
20 October 2020 20:20
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@claire_conboy @WeNurses I think checking readings out of parameter manually is really important. Many a time the dinamap has given a wildly inaccurate reading #WeMDT |
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@katiePUNC19
20 October 2020 20:20
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@WeNurses Wider assessment using other frameworks and intuition based of knowledge and experience! ?? #WeMDT |
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@WeNurses
20 October 2020 20:21
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Anyone else feel this way ? #WeMDT https://twitter.com/23hannahh/status/1318632426260844553 |
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@nicole_thenurse
20 October 2020 20:21
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@KadoorieCentre @WeNurses I think the timing really depends on the goals of the patient and families, and whether we're within the last few days. The news chart should be replaced with a symptom obs chart...no need to monitor BP but monitoring pain, agitation, breathlessness, secretions etc. #WeMDT |
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@Winn_on_Health
20 October 2020 20:21
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@PuncnadineS @WeNurses Agree! This also applies to other nursing rituals like 2 hourly turns. IMO, Clinicians need to apply critical thinking to each patient. This has the potential to break 'ritual', replacing it with 'rationale'. #WeMDT #WeNurses |
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@knitknitqueen
20 October 2020 20:21
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@WeNurses Some places are so short, if you can do obs and make sure you document. Never forget to use your natural senses: Look, Listen and Feel! #WeMDT |
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@_jo_hope
20 October 2020 20:21
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RT @WeNurses: Anyone else feel this way ? #WeMDT https://twitter.com/23hannahh/status/1318632426260844553 |
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@AgencyNurse
20 October 2020 20:21
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Totally agree #WeMDT https://twitter.com/helen_barnowl/status/1318633091427086340 |
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@BrianWebster18
20 October 2020 20:22
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@WeNurses I don't think there should be a time when we can't do the recommendation of news. The bigger issue needs address for the sake of patient care such as staffing and the likes. But, to answer the question, appropriate delegation and collective leadership is key #WeMDT |
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@NurseMads
20 October 2020 20:22
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@WeNurses The NEWS/NEWS2 should always be used alongside clinical judgment. It’s a great tool but let’s not forget that it’s only as good as the person using it #WeMDT |
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@_jo_hope
20 October 2020 20:22
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Prioritising obs for unstable patients & delegating routine obs to HCAs - does anyone else do this? Or any other strategies? #WeMDT https://twitter.com/Charlottehall96/status/1318632550806507528 |
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@nicole_thenurse
20 October 2020 20:22
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@23hannahh @WeNurses Yes! And with all of the talk about being AKI aware...I think removing it was a mistake. #WeMDT |
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@TheTinyStN
20 October 2020 20:22
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@WeNurses Reduced urine output an important indicator of sepsis, dehydration or that something is just wrong. Strange it is not a routine observation in my opinion #WeMDT |
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@hannahlames1
20 October 2020 20:23
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@Charlottehall96 @claire_conboy @WeNurses So much more clinical information can be gathered via manual observations the strength, rhythm rate of the heart temperature of the patient are they clammy, sweaty the information we gather the better our clinical reasoning, judgement and decision making #WeMDT |
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@AgencyNurse
20 October 2020 20:23
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@Winn_on_Health @PuncnadineS @WeNurses I think that experience and confidence play an important role here ... to break a ritual and articulate rationale we need the confidence and support to do so #WeMDT |
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@knitknitqueen
20 October 2020 20:23
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@DeathCafePUNC @KadoorieCentre @WeNurses Especially when an individual has high resps, low bp and chronic pain... NEWS2 score..... #WeMDT |
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@KadoorieCentre
20 October 2020 20:23
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@claire_conboy @PuncnadineS @WeNurses Does anyone discuss overnight obs "options" with your patients? #WeMDT |
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@WeNurses
20 October 2020 20:23
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Great question ? #WeMDT https://twitter.com/_jo_hope/status/1318633804920139783 |
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@BrianWebster18
20 October 2020 20:23
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@Charlottehall96 @claire_conboy @WeNurses I think there are parameters that should always be manual such as pulse and respiratory rate as these are so much more than a number #WeMDT |
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@publicenema2
20 October 2020 20:24
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@WeNurses 4D Discharge/Delegate(as many as possible) Detoriatet(quick check,as bigger the difference to basal state ??priority) Dying(there always has to be a time to comfort and say goodbye) Differential diagnosis(especially for those who detoriatet,anything I may oversee? ) #WeMDT |
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@knitknitqueen
20 October 2020 20:24
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@NurseMads @WeNurses Do we teach about clinical judgement? #WeMDT |
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@nicole_thenurse
20 October 2020 20:24
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@WeNurses I think the NEWS is great at spotting deterioration but not necessarily in line with the tenets of palliative care. #WeMDT |
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@TheTinyStN
20 October 2020 20:24
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@BrianWebster18 @claire_conboy @WeNurses I personally always do manual resps, I was taught not to trust the machine for resps! #WeMDT |
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@WeNurses
20 October 2020 20:24
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Another fab question here > #WeMDT https://twitter.com/KadoorieCentre/status/1318634045375451136 |
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@Winn_on_Health
20 October 2020 20:24
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@claire_conboy @PuncnadineS @WeNurses All actions & interventions need to be condition & context driven. To exaggerate for illustration: 4 hourly obs in an elderly rehab unit may be unwarranted; Continuous electronically reported obs to critical patients in ITU can be life-saving #WeMDT #WeNurses |
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@WeNurses
20 October 2020 20:25
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QUESTION 3 What do you tell patients about how often they will be monitored and why (if anything)? #WeMDT https://t.co/C6Hkc1D5nI |
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@WeNurses
20 October 2020 20:25
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Do we ? #WeMDT https://twitter.com/knitknitqueen/status/1318634097506422784 |
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@NRCUK
20 October 2020 20:25
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@WeNurses Why are we not automating obs, setting baselines based on patient norms/expectations or disease expectations and letting tech count and alert some really obvious and unobtrusive stuff? We do it in banking, retail, social media billions of times a second globally??? #WeMDT |
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@alimully
20 October 2020 20:25
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@WeNurses @KadoorieCentre Oops late, sorry #wemdt |
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@nicole_thenurse
20 October 2020 20:25
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@NurseMads @WeNurses And the view from the foot of the bed! So important! #WeMDT |
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@WeParamedics
20 October 2020 20:25
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Great question ? #WeMDT https://twitter.com/knitknitqueen/status/1318634097506422784 |
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@hannahlames1
20 October 2020 20:25
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@DeathCafePUNC @KadoorieCentre @WeNurses Definitely looking at the assessment tool for the pt thinking about or centre care. NEWS is for recognition and escalation to prevent deterioration this is a different end point to palliative care needs a different tool #WeMDT |
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@wehcmanagers
20 October 2020 20:25
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Thoughts ? #WeMDT https://twitter.com/knitknitqueen/status/1318634097506422784 |
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@KadoorieCentre
20 October 2020 20:25
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@knitknitqueen @WeNurses the "feel" point is interesting. The move to electronic obs removes this connection with the patient - if you use this in your hospitals, how have you changed your practice to keep "hands on"? #wemdt |
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@WeEOLC
20 October 2020 20:26
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Question 3 #WeMDT https://twitter.com/WeNurses/status/1318634352947974146 |
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@WeAHPs
20 October 2020 20:26
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Tonights Question 3 #WeMDT https://twitter.com/WeNurses/status/1318634352947974146 |
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@WeGPNs
20 October 2020 20:26
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RT @WeNurses: QUESTION 3 What do you tell patients about how often they will be monitored and why (if anything)? #WeMDT https://t.co/C6Hk… |
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@WeLDnurses
20 October 2020 20:26
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Q3 #WeMDT https://twitter.com/WeNurses/status/1318634352947974146 |
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@_jo_hope
20 October 2020 20:26
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RT @WeEOLC: Question 3 #WeMDT https://twitter.com/WeNurses/status/1318634352947974146 |
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@WeParamedics
20 October 2020 20:26
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Question 3 #WeMDT https://twitter.com/WeNurses/status/1318634352947974146 |
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@WeStudentNurse
20 October 2020 20:26
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RT @WeNurses: QUESTION 3 What do you tell patients about how often they will be monitored and why (if anything)? #WeMDT https://t.co/C6Hk… |
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@hannahlames1
20 October 2020 20:26
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@knitknitqueen @NurseMads @WeNurses I have just finished teaching this to Nursing Associates #WeMDT |
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@WeLearnOutLoud
20 October 2020 20:26
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RT @WeNurses: QUESTION 3 What do you tell patients about how often they will be monitored and why (if anything)? #WeMDT https://t.co/C6Hk… |
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@WeMHNurses
20 October 2020 20:27
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RT @WeNurses: QUESTION 3 What do you tell patients about how often they will be monitored and why (if anything)? #WeMDT https://t.co/C6Hk… |
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@WeEOLC
20 October 2020 20:27
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RT @WeNurses: QUESTION 3 What do you tell patients about how often they will be monitored and why (if anything)? #WeMDT https://t.co/C6Hk… |
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@Winn_on_Health
20 October 2020 20:27
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@AgencyNurse @PuncnadineS @WeNurses And we need to teach, assist, and encourage confidence. Instilling critical thinking skills are one way to do this. #WeMDT #WeNurses |
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@AgencyNurse
20 October 2020 20:27
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RT @WeNurses: QUESTION 3 What do you tell patients about how often they will be monitored and why (if anything)? #WeMDT https://t.co/C6Hk… |
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@WeNurses
20 October 2020 20:27
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RT @hannahlames1: @knitknitqueen @NurseMads @WeNurses I have just finished teaching this to Nursing Associates #WeMDT |
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@nicole_thenurse
20 October 2020 20:28
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@WeNurses I can't say I've heard anyone tell patients how often they'll be monitored, just seeking consent each time. Sometimes nurses will explain why while they're giving the obs but I think we get a bit complacent and assume everyone knows about observations or heard it before. #WeMDT |
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@BrianWebster18
20 October 2020 20:28
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@WeNurses I am ashamed to say I only tend to do this if it's very frequent, such as hourly or less. I will start however ?? #WeMDT |
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@knitknitqueen
20 October 2020 20:28
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@KadoorieCentre @WeNurses Talk to a patient, listen and actively listen, holding a hand, watching how they eat... and feel also goes back to gut and being able to talk through a concern and not be judged #WeMDT |
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@AgencyNurse
20 October 2020 20:28
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I will often say .... i will be back at x time to do this again. Or if overnight obs are needed will say will have to wake you up at x time but will try and be as quiet as i can #WeMDT https://twitter.com/WeNurses/status/1318634352947974146 |
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@alimully
20 October 2020 20:28
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@KadoorieCentre @claire_conboy @PuncnadineS @WeNurses I used to do this in my job in bone marrow transplant, what we tried to do was bundle care ie do obs along with drugs, turns etc. #WeMDT |
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@hannahlames1
20 October 2020 20:28
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@wehcmanagers We should be teaching all parts of the decision making process I have finished delivering a module on decision making clinical judgement and clinical reasoning to Nursing Associates #WeMDT |
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@knitknitqueen
20 October 2020 20:29
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@hannahlames1 @NurseMads @WeNurses I would be interested to know how you did this as I deliver sessions to a variety of healthcare peeps #WeMDT |
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@claire_conboy
20 October 2020 20:29
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@WeNurses Yes, part of the admission process is to explain to them what you will do, how & when & discuss what might happen. Patients need to be informed fully to be able to consent. #WeMDT |
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@Winn_on_Health
20 October 2020 20:29
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@NRCUK @WeNurses And automation has been available, directly into patient electronic health records since at least 2008! #WeMDT #WeNurses |
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@_jo_hope
20 October 2020 20:29
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A few people are saying they don't tend to say how often - or maybe only if it's frequent. Is this a common experience? #WeMDT https://twitter.com/WeNurses/status/1318634352947974146 |
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@knitknitqueen
20 October 2020 20:29
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@NurseMads @WeNurses We also forget about social experience as well #WeMDT .. what part does this have to play in how we practice? |
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@WeNurses
20 October 2020 20:29
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Thoughts ? #WeMDT https://twitter.com/DeathCafePUNC/status/1318635172892463109 |
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@nicole_thenurse
20 October 2020 20:29
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@BrianWebster18 @WeNurses Same, It's something I honestly haven't thought of, and will try to do better in the future. #WeMDT |
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@WeNurses
20 October 2020 20:30
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@BrianWebster18 Great action to take away Brian :) #WeMDT |
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@TheTinyStN
20 October 2020 20:30
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@WeNurses Can't say I've ever had this conversation, unless the patient is on more frequent monitoring, however, it is something I will now integrate into my practice #WeMDT |
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@alimully
20 October 2020 20:30
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@WeNurses Yes, especially the ones where you are doing frequent observations. In my opinion the patient should be aware what you are monitoring #wemdt |
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@JFr4ser
20 October 2020 20:30
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@NRCUK @WeNurses I’d hope the same people inputing the automated criteria were the same people currently doing obs now...... which in theory does away with pre-set orders by NEWS #WeMDT |
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@AgencyNurse
20 October 2020 20:31
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@WeNursingAssocs #WeMDT we would love to know your thoughts on vital signs monitoring ? https://twitter.com/hannahlames1/status/1318635331856597008 |
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@knitknitqueen
20 October 2020 20:31
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@WeNurses I've learnt my lesson with this.. I once gave a time go so busy then the patient told me off and said I had forgotten them.. they were ok! Depending on the situation, you can gently explain you are worried, shows you care #WeMDT |
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@Winn_on_Health
20 October 2020 20:32
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@WeNurses The practitioner needs to prioritise the patient with the rest of the clinical team, after all we are #WeMDT! But I wouldn't be afraid to carry out obs more frequently, if I was worried about the patient (Confidence in action?, certainly autonomy) #WeNurses |
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@NRCUK
20 October 2020 20:32
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@Winn_on_Health @WeNurses availability, desire and value we know and not in any way connected :( 15 years trying to help many clinicians see this kind of opportunity as the route to improve clinical judgment and offer more personalised hand on care, but of course tech is there to dehumanise care :( #wemdt |
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@BrianWebster18
20 October 2020 20:32
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@DeathCafePUNC @WeNurses I've rarely heard concent gaining, unless in a outpatient type area. In inpatient areas, I don't think we do this enough and presume a patient concents. #WeMDT |
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@JLDarbyshire
20 October 2020 20:32
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@claire_conboy @WeNurses Its a tricky question to answer perhaps but how does consent work for patients with dementia? #WeMDT (sorry if this is an obvious Q, I'm one of the team who isn't clinical) |
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@TheTinyStN
20 October 2020 20:33
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@laurastunurse @WeNurses Certainly depends ward on ward, my last role I was not allowed to do obs as a HCA. Everywhere I've worked since obs, blood sugars and fluid balance charts have all been my responsibility #WeMDT |
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@_jo_hope
20 October 2020 20:33
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Interesting dilemma here - how do others manage this? #WeMDT https://twitter.com/knitknitqueen/status/1318635936993902592 |
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@WeNurses
20 October 2020 20:34
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Great point .... do we feel confident enough to do obs less frequently too ?? #WeMDT https://twitter.com/Winn_on_Health/status/1318636196784971776 |
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@knitknitqueen
20 October 2020 20:34
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@JLDarbyshire @claire_conboy @WeNurses I would always explain to any patient what I am doing, we can never assume they do not have capacity to understand what you are doing/saying regardless of the textbooks #WeMDT |
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@hannahlames1
20 October 2020 20:34
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@AgencyNurse @WeNursingAssocs Often delegated to the most junior members of staff but requires high level of critical thinking and interpretation for safe care it's never just a set of obs #WeMDT |
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@WeNurses
20 October 2020 20:35
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QUESTION 4 How can we strike a balance between the patient's safety and other factors (e.g. waking from sleep)? #WeMDT https://t.co/JWzyWfobDf |
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@alimully
20 October 2020 20:35
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@WeNurses Need to be really careful, there is much more to 'the obs' than the news or news2 score #wemdt |
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@knitknitqueen
20 October 2020 20:35
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@hannahlames1 @NurseMads @WeNurses O I do like sim... friggin Covid How did you find the engagement online? #WeMDT |
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@nicole_thenurse
20 October 2020 20:35
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@_jo_hope @WeNurses Is it because the frequency of obs is policy driven and maybe people doing them 4 hourly can't justify why they are doing it that way? Maybe if we knew the evidence behind the policy we'd be more confident to say how often and why? #WeMDT |
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@AgencyNurse
20 October 2020 20:35
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@JLDarbyshire @claire_conboy @WeNurses many people with dementia are able to understand in the here and now ... so always explain and gain consent ... if they refuse you may need to try again a few moments later or get a colleague to try #WeMDT |
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@_jo_hope
20 October 2020 20:35
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RT @WeNurses: QUESTION 4 How can we strike a balance between the patient's safety and other factors (e.g. waking from sleep)? #WeMDT http… |
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@WeNurses
20 October 2020 20:36
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Another interesting question #WeMDT https://twitter.com/KadoorieCentre/status/1318636969589702661 |
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@WeNurses
20 October 2020 20:36
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#WeMDT https://twitter.com/LuciaMuronda/status/1318637108987310084 |
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@TheTinyStN
20 October 2020 20:36
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@WeNurses Using clinical judgement to determine if a patient is stable or not. You can assess a patient just by looking at them... if they look poorly, do some obs, even if they've been stable all day. If they have been stable all day, are sleeping soundly then leave them be #WeMDT |
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@WeNurses
20 October 2020 20:36
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#WeMDT https://twitter.com/claire_conboy/status/1318637133134004225 |
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@Winn_on_Health
20 October 2020 20:36
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@BrianWebster18 @DeathCafePUNC @WeNurses Silent acquiescence is not consent, information, or voluntary compliance. Communication is king. #WeMDT #WeNurses |
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@knitknitqueen
20 October 2020 20:37
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@WeNurses Hmm this one might go back to exposure and also how much support you have. It is always a little scary to wake a patient up. I know I am not a morning person, don't wake me up at 2am, unless I am coming in from a previous night out before this 10pm thing #WeMDT |
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@claire_conboy
20 October 2020 20:37
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@Charlottehall96 @laurastunurse @WeNurses We have an EWS competency for our staff so HCA to RN can do obs. #WeMDT |
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@AgencyNurse
20 October 2020 20:37
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@hannahlames1 @WeNursingAssocs yes indeed .... and perhaps a clear example of why we need highly trained and highly skilled practitioners and safe staffing levels #WeMDT |
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@KadoorieCentre
20 October 2020 20:37
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@Winn_on_Health @WeNurses did you also find that the regularity of the obs helped your orientation with time of day? Or did that not matter too much as long as you knew someone was looking out for you? #WeMDT |
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@WeParamedics
20 October 2020 20:38
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Question 4 #WeMDT https://twitter.com/WeNurses/status/1318636870666981377 |
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@LauragRN21
20 October 2020 20:38
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@Charlottehall96 @WeNurses I do blood sugars, food diaries, fluid balance and skin bundles. I do think however HCA should be allowed to do obs for stable patients and then hand over ( immediately) to a qualified nurse if they begin to deteriorate #WeMDT |
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@WeAHPs
20 October 2020 20:38
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RT @WeNurses: QUESTION 4 How can we strike a balance between the patient's safety and other factors (e.g. waking from sleep)? #WeMDT http… |
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@WeEOLC
20 October 2020 20:38
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RT @WeNurses: QUESTION 4 How can we strike a balance between the patient's safety and other factors (e.g. waking from sleep)? #WeMDT http… |
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@WeGPNs
20 October 2020 20:38
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RT @WeNurses: QUESTION 4 How can we strike a balance between the patient's safety and other factors (e.g. waking from sleep)? #WeMDT http… |
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@nicole_thenurse
20 October 2020 20:38
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@JLDarbyshire @WeNurses @claire_conboy Remember consent isn't a blanket, even if someone lacks capacity in one area they can still make decisions in other areas. In emergencies it becomes a best interests decision. #WeMDT |
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@wehcmanagers
20 October 2020 20:38
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q4 #WeMDT https://twitter.com/WeNurses/status/1318636870666981377 |
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@knitknitqueen
20 October 2020 20:38
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@hannahlames1 @NurseMads @WeNurses Yes, the not seeing expressions and body language has taken that element away you would have brought in as the facilitator.. #WeMDT |
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@WeLDnurses
20 October 2020 20:38
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Question 4 #WeMDT https://twitter.com/WeNurses/status/1318636870666981377 |
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@WeLearnOutLoud
20 October 2020 20:38
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Question 4 incase you missed it #WeMDT https://twitter.com/WeNurses/status/1318636870666981377 |
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@WeMHNurses
20 October 2020 20:38
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RT @WeNurses: QUESTION 4 How can we strike a balance between the patient's safety and other factors (e.g. waking from sleep)? #WeMDT http… |
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@WeSchoolNurses
20 October 2020 20:39
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RT @WeNurses: QUESTION 4 How can we strike a balance between the patient's safety and other factors (e.g. waking from sleep)? #WeMDT http… |
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@WeStudentNurse
20 October 2020 20:39
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RT @WeNurses: QUESTION 4 How can we strike a balance between the patient's safety and other factors (e.g. waking from sleep)? #WeMDT http… |
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@Winn_on_Health
20 October 2020 20:39
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@JLDarbyshire @WeNurses Did you assess this in different departments/specialities, and with patients of varying age? Context often has an influence over response. And there have been studies on patients telling us what they think we want to hear. #WeMDT #WeNurses |
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@WeNurses
20 October 2020 20:39
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RT @alimully: @WeNurses Need to be really careful, there is much more to 'the obs' than the news or news2 score #wemdt |
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@TheTinyStN
20 October 2020 20:39
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@laurastunurse @WeNurses Yes so long as they have completed training and been signed off as competent I agree #WeMDT |
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@nicole_thenurse
20 October 2020 20:39
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@JLDarbyshire @WeNurses @claire_conboy Also not an obvious question....mental capacity is a minefield and difficult for a lot of people to get their head around. #WeMDT |
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@hannahlames1
20 October 2020 20:39
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@WeNurses As a neuro nurse have definitely found this difficult are they a sleep or has their GCS dropped due to worsening neurology, head injury #WeMDT you can always hear the neuro nurse doing the GSC and so does the rest of the ward ?? |
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@AgencyNurse
20 October 2020 20:40
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Clinical judgement #WeMDT https://twitter.com/WeNurses/status/1318636870666981377 |
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@knitknitqueen
20 October 2020 20:40
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@Charlottehall96 @laurastunurse @WeNurses Hmm now I am putting a spanner in the works.. how can we know we are truly competent? who decides... then who decides on them.... #WeMDT |
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@WeNurses
20 October 2020 20:40
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#WeMDT https://twitter.com/Winn_on_Health/status/1318636884587925505 |
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@WeNursingAssocs
20 October 2020 20:40
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RT @AgencyNurse: @WeNursingAssocs #WeMDT we would love to know your thoughts on vital signs monitoring ? |
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@_jo_hope
20 October 2020 20:40
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RT @WeNurses: #WeMDT https://twitter.com/Winn_on_Health/status/1318636884587925505 |
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@Winn_on_Health
20 October 2020 20:41
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@KadoorieCentre @WeNurses My day-time orientation was completely missing. E.g. When I was discharged from ED I thought I'd been there about half an hour ... not the 5 hours my wide reported. #WeMDT #WeNurses |
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@WeNurses
20 October 2020 20:41
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Great to have your perspective Hannah #WeMDT https://twitter.com/hannahlames1/status/1318638096641122310 |
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@hannahlames1
20 October 2020 20:41
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@AgencyNurse @WeNursingAssocs Absolutely one of the many benefits of the nursing associate role have been so impressed with their level of knowledge and critical thinking in the module I have just ran they will be only a positive for patient care #WeMDT |
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@_jo_hope
20 October 2020 20:41
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#WeMDT https://twitter.com/claire_conboy/status/1318637993972895746 |
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@knitknitqueen
20 October 2020 20:42
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@AgencyNurse It is a shame we cannot also document all the times we have powerful conversations with the patients.. you can learn so much from them apart from vital signs #WeMDT |
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@AgencyNurse
20 October 2020 20:42
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Thats really fab to hear #WeMDT https://twitter.com/hannahlames1/status/1318638487785082881 |
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@TheTinyStN
20 October 2020 20:42
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@knitknitqueen @laurastunurse @WeNurses Tricky! I think in this case it that someone can prove they can carry out the procedure and have an understanding of the result. Equally, I can understand as a nurse being reluctant to trust someone you don't know to take over that monitoring. Pin is on the line #WeMDT |
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@sawherry
20 October 2020 20:42
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RT @AgencyNurse: @WeNursingAssocs #WeMDT we would love to know your thoughts on vital signs monitoring ? https://twitter.com/hannahlames1/status/1318635331856597008 |
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@alimully
20 October 2020 20:42
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@knitknitqueen @Charlottehall96 @laurastunurse @WeNurses Grear question. it's true, competency doesn't end at sign off of competency document #WeMDT |
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@AgencyNurse
20 October 2020 20:42
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@knitknitqueen yes indeed - every interaction is an opportunity to assess that patient #WeMDT |
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@nicole_thenurse
20 October 2020 20:43
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@Charlottehall96 @WeNurses Some people look completely golden and then their measured obs will give you a complete fright! I agree that obs should be holistic and cover look as well as measurements, but can you have one to have one without the other all night? #WeMDT |
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@JLDarbyshire
20 October 2020 20:43
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@knitknitqueen @Charlottehall96 @laurastunurse @WeNurses really interesting point! Can anyone else offer thoughts on this and who can/can't take obs? #WeMDT |
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@WeNurses
20 October 2020 20:43
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#WeMDT https://twitter.com/KarenShovelton/status/1318638757977952265 |
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@WeNurses
20 October 2020 20:44
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Really interesting point and question #WeMDT https://twitter.com/DeathCafePUNC/status/1318638894359916546 |
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@TheTinyStN
20 October 2020 20:44
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@DeathCafePUNC @WeNurses This is true! Part of me thinks frequent waking is part and parcel of being in hospital, the other part of me knows that if I was being woken every 4 hours I would be utterly miserable #WeMDT |
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@WeNurses
20 October 2020 20:44
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#WeMDT https://twitter.com/DeathCafePUNC/status/1318639149268803589 |
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@hannahlames1
20 October 2020 20:44
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@WeNurses Can you justify and support you decision and what you are doing and why what knowledge can you draw on to inform you judgement if the answer is no then should most probably not be doing it and the pt most probably does gain any benefit from it #WeMDT |
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@_jo_hope
20 October 2020 20:44
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Another interesting dilemma here - what do others think? #WeMDT https://twitter.com/DeathCafePUNC/status/1318638894359916546 |
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@LauragRN21
20 October 2020 20:44
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@knitknitqueen @Charlottehall96 @WeNurses as a student im trusted to use my common sense and training to understand when concerns need to be escalated. we need to put that trust in everyone in our team regardless of job title #WeMDT |
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@WeParamedics
20 October 2020 20:44
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RT @_jo_hope: Another interesting dilemma here - what do others think? #WeMDT https://twitter.com/DeathCafePUNC/status/1318638894359916546 |
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@wehcmanagers
20 October 2020 20:45
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RT @_jo_hope: Another interesting dilemma here - what do others think? #WeMDT https://twitter.com/DeathCafePUNC/status/1318638894359916546 |
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@WeNurses
20 October 2020 20:45
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QUESTION 5 What can be done to improve how observations are scheduled? #WeMDT https://t.co/vPBOpP47i7 |
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@WeLDnurses
20 October 2020 20:45
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RT @_jo_hope: Another interesting dilemma here - what do others think? #WeMDT https://twitter.com/DeathCafePUNC/status/1318638894359916546 |
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@WeNurses
20 October 2020 20:45
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RT @_jo_hope: Another interesting dilemma here - what do others think? #WeMDT https://twitter.com/DeathCafePUNC/status/1318638894359916546 |
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@reboverend_RNc
20 October 2020 20:45
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@JLDarbyshire @knitknitqueen @Charlottehall96 @laurastunurse @WeNurses Hello! Anyone can take observations- it is the interpretation of that assessment that matters. Competencies simply provide the behaviour- we teach parents to preform safely. But it take longer to learn the WHY behind alterations...and that is what should be assessed #WeMDT |
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@WeLDnurses
20 October 2020 20:45
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Question 5 #WeMDT https://twitter.com/WeNurses/status/1318639393868042243 |
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@wehcmanagers
20 October 2020 20:45
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RT @WeNurses: QUESTION 5 What can be done to improve how observations are scheduled? #WeMDT https://t.co/vPBOpP47i7 |
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@_jo_hope
20 October 2020 20:45
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RT @WeNurses: QUESTION 5 What can be done to improve how observations are scheduled? #WeMDT https://t.co/vPBOpP47i7 |
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@WeNursingAssocs
20 October 2020 20:45
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RT @WeNurses: QUESTION 4 How can we strike a balance between the patient's safety and other factors (e.g. waking from sleep)? #WeMDT http… |
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@WeNursingAssocs
20 October 2020 20:45
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RT @WeNurses: QUESTION 5 What can be done to improve how observations are scheduled? #WeMDT https://t.co/vPBOpP47i7 |
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@WeParamedics
20 October 2020 20:45
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Question 5 #WeMDT https://twitter.com/WeNurses/status/1318639393868042243 |
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@AgencyNurse
20 October 2020 20:46
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RT @WeNurses: QUESTION 5 What can be done to improve how observations are scheduled? #WeMDT https://t.co/vPBOpP47i7 |
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@KadoorieCentre
20 October 2020 20:46
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@DeathCafePUNC @WeNurses @_jo_hope interesting point here. Is the evidence behind the policy shared through your hospitals? #WeMDT |
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@WeAHPs
20 October 2020 20:46
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RT @WeNurses: QUESTION 5 What can be done to improve how observations are scheduled? #WeMDT https://t.co/vPBOpP47i7 |
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@WeEOLC
20 October 2020 20:46
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RT @WeNurses: QUESTION 5 What can be done to improve how observations are scheduled? #WeMDT https://t.co/vPBOpP47i7 |
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@TheTinyStN
20 October 2020 20:46
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@laurastunurse @knitknitqueen @WeNurses We do but as a student you are working with another nurse, a HCA is not. I have worked with some people who did a set of obs and didn't even blink at a systolic of 65. Yes there's trust, and I'm inclined to trust, equally I'm inclined to protect my pin if I'm unsure #WeMDT |
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@WeGPNs
20 October 2020 20:46
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RT @WeNurses: QUESTION 5 What can be done to improve how observations are scheduled? #WeMDT https://t.co/vPBOpP47i7 |
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@nicole_thenurse
20 October 2020 20:46
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@Charlottehall96 @WeNurses It's like, here's some melatonin to help you sleep and get time oriented, but also, we will be hitting you up with that blood pressure cuff at 4 am....#WeMDT |
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@WeMHNurses
20 October 2020 20:46
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RT @WeNurses: QUESTION 5 What can be done to improve how observations are scheduled? #WeMDT https://t.co/vPBOpP47i7 |
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@WeLearnOutLoud
20 October 2020 20:46
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RT @WeNurses: QUESTION 5 What can be done to improve how observations are scheduled? #WeMDT https://t.co/vPBOpP47i7 |
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@alimully
20 October 2020 20:46
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@JLDarbyshire @knitknitqueen @Charlottehall96 @laurastunurse @WeNurses So you can train anyone to 'do the obs' the part that is important is the clinical decision making. That's the problem with reducing nursing to a series of tasks when it isnt, its complex and needs highly skilled practitioners #WeMDT |
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@OlshanskyJohn
20 October 2020 20:46
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RT @WeParamedics: Question 5 #WeMDT |
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@TheTinyStN
20 October 2020 20:47
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@DeathCafePUNC @WeNurses Haha exactly, and then we wonder why people are confused or agitated #WeMDT |
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@knitknitqueen
20 October 2020 20:47
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@WeLDnurses Give more autonomous judgement and not to focus on the number of obs but the quality! #WeMDT |
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@Winn_on_Health
20 October 2020 20:47
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@JLDarbyshire @claire_conboy @WeNurses Agree. And in clinical staff also need to consider mental capacity, for patients defined as having dementia, & other psychiatric diagnoses/problems. #WeMDT #WeNurses https://twitter.com/AgencyNurse/status/1318637072236818432 |
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@_jo_hope
20 October 2020 20:47
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RT @knitknitqueen: @WeLDnurses Give more autonomous judgement and not to focus on the number of obs but the quality! #WeMDT |
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@hannahlames1
20 October 2020 20:47
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@WeNurses Break traditional ward routines - everyone needs their obs doing at 6am ?? think why are you doing it what is it going to tell you, is there clinical need #WeMDT |
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@KadoorieCentre
20 October 2020 20:47
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@_jo_hope @WeNurses We've seen some comments about patients with naturally low/high O2 and BP tonight. Does anyone have a gut feeling for the "type" of patient where this is particularly prevalent? #WeMDT |
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@TheTinyStN
20 October 2020 20:48
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@alimully @JLDarbyshire @knitknitqueen @laurastunurse @WeNurses Indeed.. which leads us to we delegate obs when we are busy and there's no time, but it is assessment, and should be done by an RN. So it goes back to not enough RNs for patients #WeMDT |
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@WeNurses
20 October 2020 20:48
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excellent points #WeMDT https://twitter.com/hannahlames1/status/1318640092559396864 |
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@claire_conboy
20 October 2020 20:48
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@WeNurses Ours are based on admission time so although 4 hourly the patient in bed 1 may be due at 9, bed 2 at 10 and bed 3 at 11. Chaotic at times but also based on pt needs & not what suits us as nurses. #WeMDT |
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@karendownsy
20 October 2020 20:48
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@WeNurses Banging on about tracking your patients trend ...but knowing which direction your patient is heading by collaterally looking at obs, bloods, fluid stewardship, continuous medication infusions etc should help inform your decision to balance well being against monitoring? #WeMDT |
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@reboverend_RNc
20 October 2020 20:49
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We need more spanners! Competence is the beginning not the end....doing the fans of observations is not the same as the interpretation. Why communication between RN and those who support them know when and how to escalate- that is what we should be concentrating on #WeMDT https://twitter.com/knitknitqueen/status/1318638175338795008 |
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@KadoorieCentre
20 October 2020 20:49
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@hannahlames1 @WeNurses The 'obs round' seems common. How many here have set times for taking patient obs? #WeMDT |
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@knitknitqueen
20 October 2020 20:49
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@Charlottehall96 @alimully @JLDarbyshire @laurastunurse @WeNurses Don't forget the other professions that also come to the ward, you can gain a lot from the AHPs as well x #WeMDT |
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@NRCUK
20 October 2020 20:49
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@WeNurses Use technology to help steer you to where and when you need to be... it's how every other industry and customer service has been doing it for 20 years, offering better leaner engagement and output at a lower cost :) #WeMDT |
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@nicole_thenurse
20 October 2020 20:49
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@WeNurses Evidence + discussion with patient. We need to talk more to patients about observations so they can make informed choices. #WeMDT |
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@_jo_hope
20 October 2020 20:49
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RT @KadoorieCentre: @hannahlames1 @WeNurses The 'obs round' seems common. How many here have set times for taking patient obs? #WeMDT |
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@Winn_on_Health
20 October 2020 20:50
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@DeathCafePUNC @JLDarbyshire @WeNurses @claire_conboy But it's important to become familiar with the Mental Capacity Act 2005, or know who to go to for assistance, insight, and advice #WeMDT #WeNurses |
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@AgencyNurse
20 October 2020 20:50
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Nursing is not merely a set of tasks to be completed ... as professionals we need to have reasoning behind every action and omission ... and this also needs to be understood and recognised by managers #WeMDT https://twitter.com/hannahlames1/status/1318640092559396864 |
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@WeNurses
20 October 2020 20:50
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Great question #WeMDT https://twitter.com/KadoorieCentre/status/1318640449272336384 |
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@WeParamedics
20 October 2020 20:50
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RT @KadoorieCentre: @hannahlames1 @WeNurses The 'obs round' seems common. How many here have set times for taking patient obs? #WeMDT |
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@WeLearnOutLoud
20 October 2020 20:50
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RT @KadoorieCentre: @hannahlames1 @WeNurses The 'obs round' seems common. How many here have set times for taking patient obs? #WeMDT |
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@WeLDnurses
20 October 2020 20:50
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RT @KadoorieCentre: @hannahlames1 @WeNurses The 'obs round' seems common. How many here have set times for taking patient obs? #WeMDT |
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@reboverend_RNc
20 October 2020 20:50
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@Winn_on_Health @WeNurses What an interesting perspective Julian thanks for sharing ?? #WeMDT |
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@knitknitqueen
20 October 2020 20:51
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@laurastunurse @Charlottehall96 @WeNurses This is not about blame, there are a lot of factors that go into reasons why escalation does not take place or perhaps delayed #WeMDT |
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@hannahlames1
20 October 2020 20:51
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@knitknitqueen @Charlottehall96 @laurastunurse @WeNurses Interesting point would I assess the same as you what level of knowledge would you expect it can be very subjective and dependant on the assessors level of knowledge and experience #WeMDT |
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@TheTinyStN
20 October 2020 20:51
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@laurastunurse @knitknitqueen @WeNurses Agree but the code states you have to ensure someone is competent to delegate to... if you as a nurse make that decision, and then that person doesn't do as they're asked, a patient comes to harm, ultimately it is your pin on the line #WeMDT |
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@WeNurses
20 October 2020 20:51
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#WeMDT https://twitter.com/NickyThomasHyd4/status/1318640634731769856 |
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@nicole_thenurse
20 October 2020 20:51
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@KadoorieCentre @_jo_hope @WeNurses If I get a small person or a fit person, I assume they will have a low bp until I take the obs. #WeMDT |
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@WeNurses
20 October 2020 20:51
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#WeMDT great point https://twitter.com/eggerstweet/status/1318640763207667712 |
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@WeNurses
20 October 2020 20:52
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#WeMDT https://twitter.com/JLDarbyshire/status/1318641084038336517 |
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@WeNurses
20 October 2020 20:52
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#WeMDT https://twitter.com/eggerstweet/status/1318641175507701760 |
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@WeNurses
20 October 2020 20:52
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#WeMDT https://twitter.com/KarenShovelton/status/1318641225801543680 |
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@JLDarbyshire
20 October 2020 20:52
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@KarenShovelton @WeNurses Picking up on a comment elsewhere, do people here feel that manual/paper recording or electronic systems are better? #WeMDT |
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@claire_conboy
20 October 2020 20:52
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@knitknitqueen @laurastunurse @Charlottehall96 @WeNurses We have eobs which automatically escalate to NIC & medic team depending on NEWS2 score but think there is some element of alarm fatigue & the feeling of constantly looking at a device & not as much time actually looking at the patient #WeMDT |
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@puncabigail53
20 October 2020 20:53
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@WeNurses @KadoorieCentre Hello, I'm Abbie: a third year student mental health nurse???? - joining very late and just gunna try and blitz through the questions! #wemdt |
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@WeNurses
20 October 2020 20:53
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#WeMDT https://twitter.com/alimully/status/1318641347390328832 |
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@knitknitqueen
20 October 2020 20:53
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@Charlottehall96 @laurastunurse @WeNurses Hmm not necessarily, the code is there as year something you follow but when you are investigating you are not just looking at the individuals. I would like to get away from the blame game. I have been involved in investigations and it breaks my heart when peeps blame #WeMDT |
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@WeNurses
20 October 2020 20:53
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Thoughts ? #WeMDT https://twitter.com/JLDarbyshire/status/1318641369934680064 |
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@WeParamedics
20 October 2020 20:53
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#WeMDT https://twitter.com/JLDarbyshire/status/1318641369934680064 |
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@nicole_thenurse
20 October 2020 20:53
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@KadoorieCentre @WeNurses @_jo_hope I'm sure the evidence is there if you look, but I've always been told like "so we do obs this often here unless..." Would have to hunt for the evidence! #WeMDT |
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@knitknitqueen
20 October 2020 20:54
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@hannahlames1 @Charlottehall96 @laurastunurse @WeNurses That is why I like to have practitioner self assessment before they are assessed. This way you are, as the assessor, mentor, supervisor know the level to start the pitch #WeMDT |
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@WeNurses
20 October 2020 20:55
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With just 5 minutes left to tonights #WeMDT tweetchat please share any final thoughts on "Can vital signs monitoring in hospital be improved?" https://t.co/mUC4y7olYp |
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@hannahlames1
20 October 2020 20:55
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@NRCUK @WeNurses Or does this de-skill us even more the less tasks we do and the more we automate the less we engage in critically thinking and interpretation we will loose this skill #WeMDT |
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@nicole_thenurse
20 October 2020 20:55
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@helen_barnowl @Charlottehall96 @WeNurses Sitting and drinking their cup of tea and you take the glucose and wonder how they are still upright #WeMDT |
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@_jo_hope
20 October 2020 20:55
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Is it easier or harder to track trends on an electronic or paper obs system? #WeMDT https://twitter.com/WeNurses/status/1318641350670155776 |
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@claire_conboy
20 October 2020 20:55
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@JLDarbyshire @KarenShovelton @WeNurses Both open to mistakes & both have positives & negatives. Personally I prefer paper as I like to view a trend & i find the devices a bit awkward to do that. Maybe the younger generation prefer electronic? #WeMDT |
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@AgencyNurse
20 October 2020 20:55
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Depends on the system tbh ... but some e-systems don't give an easy overall view of whats happening .. eg you don't automatically see historical data plotted on a graph like you do with manual charts ... this can be rather annoying #WeMDT https://twitter.com/JLDarbyshire/status/1318641369934680064 |
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@WeParamedics
20 October 2020 20:55
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RT @WeNurses: With just 5 minutes left to tonights #WeMDT tweetchat please share any final thoughts on "Can vital signs monitoring in hospi… |
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@WeAHPs
20 October 2020 20:56
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RT @WeNurses: With just 5 minutes left to tonights #WeMDT tweetchat please share any final thoughts on "Can vital signs monitoring in hospi… |
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@JFr4ser
20 October 2020 20:56
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@WeNurses Habitual practice is the biggest barrier to critical thinking #WeMDT |
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@AgencyNurse
20 October 2020 20:56
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RT @WeNurses: With just 5 minutes left to tonights #WeMDT tweetchat please share any final thoughts on "Can vital signs monitoring in hospi… |
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@WeLDnurses
20 October 2020 20:56
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RT @WeNurses: With just 5 minutes left to tonights #WeMDT tweetchat please share any final thoughts on "Can vital signs monitoring in hospi… |
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@wehcmanagers
20 October 2020 20:56
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RT @WeNurses: With just 5 minutes left to tonights #WeMDT tweetchat please share any final thoughts on "Can vital signs monitoring in hospi… |
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@puncabigail53
20 October 2020 20:56
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@WeNurses When a patients score shows as 'nornal' but it is actually not normal for them, or if they have a change in medication/when prescribed a medication which can dramatically change their obs as the day progresses - then I think that they should be monitored more often! #wemdt |
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@KadoorieCentre
20 October 2020 20:56
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@WeNurses We are collecting data for a research project on frequency of vital signs observations taken in hospital (IRAS ref: 19/SC/0190). By taking part tonight we assume your consent to include your comments in our data. Comments will not be linked to your Twitter handles. #WeMDT |
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@WeNurses
20 October 2020 20:56
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RT @_jo_hope: Is it easier or harder to track trends on an electronic or paper obs system? #WeMDT https://twitter.com/WeNurses/status/1318641350670155776 |
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@AgencyNurse
20 October 2020 20:56
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RT @_jo_hope: Is it easier or harder to track trends on an electronic or paper obs system? #WeMDT https://twitter.com/WeNurses/status/1318641350670155776 |
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@knitknitqueen
20 October 2020 20:56
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@WeNurses YES, use the same monitoring equipment throughout the hospital! #WeMDT I have never met so many types of monitoring just in theatres and then on the wards... all leads are incompatible.. ???? |
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@WeNurses
20 October 2020 20:56
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RT @JFr4ser: @WeNurses Habitual practice is the biggest barrier to critical thinking #WeMDT |
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@_jo_hope
20 October 2020 20:57
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Yes, have seen this on wards - harder to 'find' the trend graphs on electronic devices. Is this something everyone finds or does it vary? #WeMDT https://twitter.com/claire_conboy/status/1318642024107618305 |
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@knitknitqueen
20 October 2020 20:57
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@hannahlames1 @Charlottehall96 @laurastunurse @WeNurses And also makes them accountable also and not just on you #WeMDT |
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@hannahlames1
20 October 2020 20:57
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@JLDarbyshire @KarenShovelton @WeNurses I love a bit of technology but there is a process of learning and thinking when we put pen to paper which does not occur with electronic and automatic systems #WeMDT |
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@reboverend_RNc
20 October 2020 20:57
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@WeNurses When acutely unwell you need frequency in obs. When they are recuperating watching for change reduces missing deterioration. Convalescence allows patient to learn to monitor own level of wellness- sometimes obs can reassure or by saying ‘I’m ok’ we trust their judgement #WeMDT |
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@sawherry
20 October 2020 20:57
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RT @WeNurses: Hello everyone - it's great to be here for a #WeMDT tweetchat This evenings topic is "Can vital signs monitoring in hospita… |
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@knitknitqueen
20 October 2020 20:57
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@WeNurses I cannot believe an hour has gone already! #WeMDT |
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@NRCUK
20 October 2020 20:58
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@Winn_on_Health @JLDarbyshire @WeNurses that's the #wemdt issue.... everyone thinks you need something new in tech when in fact stuff has been around for ages, but there is always suspicion about the impact on the role not the recognition of the value to it and patients. |
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@hannahlames1
20 October 2020 20:58
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@JFr4ser @WeNurses Absolutely #WeMDT |
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@puncabigail53
20 October 2020 20:58
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@WeNurses If unable due to the patient declining, then non contact obs must be done to ensure that you are still monitoring them even if not ideal... #wemdt |
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@AgencyNurse
20 October 2020 20:58
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@knitknitqueen @WeNurses Its flown by this evening !!! #WeMDT #wheredidthathourgo ! |
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@WeNurses
20 October 2020 20:59
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#WeMDT https://twitter.com/CatherineHughe7/status/1318642953888333825 |
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@reboverend_RNc
20 October 2020 20:59
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@hannahlames1 @knitknitqueen @Charlottehall96 @laurastunurse @WeNurses Nice!! Self-assessment is underused in healthcare- so impregnate for developing self-awareness, confidence and insight too #WeMDT |
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@alimully
20 October 2020 21:00
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@_jo_hope Our system can show them as they would look on paper, quite helpful. #WeMDT |
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@NRCUK
20 October 2020 21:00
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@marysgal87 @hannahlames1 @WeNurses NOOOOOOO!!! More contact when and where it is needed and less repetitive wasted time for those that don't, come on, let's get over this human contact nonsense when tech saves us all so much wasted time and repetition in every role and our own lives #wemdt |
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@nicole_thenurse
20 October 2020 21:00
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@reboverend_RNc @WeNurses Yes...such a good point about patients own judgement as part of their convalescence. For many of them, this isn't their first rodeo and they know when they're "not right" #WeMDT |
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@hannahlames1
20 October 2020 21:00
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@WeNurses It's only as good as the person performing the task, education, is key critical thinking, clinical judgement patient centred assessment, are key #WeMDT |
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@AgencyNurse
20 October 2020 21:00
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@alimully @_jo_hope That sounds like a fab system #WeMDT .. ours is so well hidden it takes a degree in computing to find it !!! |
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@Winn_on_Health
20 October 2020 21:00
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@JLDarbyshire @NRCUK @WeNurses I also worry about #AI bias (see my Tweets on this!!). Last, if a patient needs someone by their bedside, I would prefer it was me!; No matter how good a robot might be, humans are (IMO) better. Care is a personal, & person-centred activity. Rant over ... #WeMDT #WeNurses |
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@KadoorieCentre
20 October 2020 21:01
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@AgencyNurse @knitknitqueen @WeNurses Quick reminder: This Twitter chat is part of a research project on frequency of vital signs observations (IRAS ref: 19/SC/0190). By taking part tonight we assume your consent to include your comments in our data. Comments will not be linked to your Twitter handles. #WeMDT |
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@knitknitqueen
20 October 2020 21:01
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@reboverend_RNc @hannahlames1 @Charlottehall96 @laurastunurse @WeNurses Thank you! I have used it in the competency documents I have produced. Best thing ever and good for accountability.. #WeMDT #closethatloophole |
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@WeNurses
20 October 2020 21:01
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That's a wrap for tonights #WeMDT tweetchat ... thank you to everyone who took the time to share their thoughts and tweets this evening https://t.co/ewVLzRy4yR |
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@nicole_thenurse
20 October 2020 21:01
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RT @JFr4ser: @WeNurses Habitual practice is the biggest barrier to critical thinking #WeMDT |
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@AgencyNurse
20 October 2020 21:01
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@KadoorieCentre @knitknitqueen @WeNurses lots of fab points from very different perspectives ... have fun unravelling all the different threads :D #WeMDT |
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@nicole_thenurse
20 October 2020 21:02
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@WeNurses Thank you! It's been great discussion and I have a lot to think about! #WeMDT |
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@WeNurses
20 October 2020 21:02
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Don't forget >> #WeMDT https://twitter.com/KadoorieCentre/status/1318643473034215425 |
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@_jo_hope
20 October 2020 21:02
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Thanks all. Really interesting chat. #WeMDT https://twitter.com/WeNurses/status/1318643489949757440 |
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@knitknitqueen
20 October 2020 21:02
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@reboverend_RNc @hannahlames1 @Charlottehall96 @laurastunurse @WeNurses We are all passionate so at times the fingers cannot go as fast as the mind.. #WeMDT |
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@KadoorieCentre
20 October 2020 21:02
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@knitknitqueen @WeNurses From an ergonomics/human factors point of view the equipment use in hospitals is terrible! #WeMDT |
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@AgencyNurse
20 October 2020 21:02
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Wise words #WeMDT https://twitter.com/hannahlames1/status/1318643342868172802 |
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@AgencyNurse
20 October 2020 21:02
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Thank you all for such an interesting discussion #WeMDT https://twitter.com/WeNurses/status/1318643489949757440 |
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@Winn_on_Health
20 October 2020 21:03
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@NRCUK @JLDarbyshire @WeNurses Perhaps we should share papers, information, and sales bumph ... there's a great deal of it available, ask Dr Google! #WeMDT #WeNurses |
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@hannahlames1
20 October 2020 21:03
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@NRCUK @marysgal87 @WeNurses Tech does save time but I feel observations are viewed as just numbers that a machine can take when it is so much more involved in full assessment and we risk loosing these skills #WeMDT |
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@JFr4ser
20 October 2020 21:03
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@WeNurses Given nursing staff autonomy to make decisions. And the leadership to ensure they make safe decisions. Trust the largest safety critical profession in the world #WeMDT |
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@hannahlames1
20 October 2020 21:04
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@WeNurses Thank you great discussion glad I stumbled upon it #WeMDT |
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@claire_conboy
20 October 2020 21:04
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@WeNurses Great discussion! Lots to think about #WeMDT |
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@WeNurses
20 October 2020 21:05
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A big thank you goes out to the @KadoorieCentre team ... for being such brilliant experts in the room and for developing such an interesting tweetchat ... we can't wait to read the findings of your research ! #WeMDT https://t.co/cyuJxcMHiW |
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@knitknitqueen
20 October 2020 21:05
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@WeNurses Thank you! #WeMDT |
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@NRCUK
20 October 2020 21:06
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@Winn_on_Health @JLDarbyshire @WeNurses I agree.... but we don't have a nurse at every bed but all beds have a call bell, so automated monitoring simply alerts to change, we seem to be OK with screening for cancer at a population level but object to ward-based equivalents, unless in ICU etc who love it #WeMDT |
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@WeNurses
20 October 2020 21:06
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#WeMDT https://twitter.com/bekirostron/status/1318644640304738304 |
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@KadoorieCentre
20 October 2020 21:06
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@hannahlames1 @WeNurses ^^ is a good argument for not deploying Pepper (other vaguely humanoid robots are available) on the obs round #weMDT |
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@reboverend_RNc
20 October 2020 21:07
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@WeNurses Only wish I’d been able to join from the beginning!! Always love learning from you all #NurseTwitter and many thanks #WeMDT |
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@NRCUK
20 October 2020 21:08
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@hannahlames1 @marysgal87 @WeNurses agreed, but a machine is watching 24/7 and a lot of this chat has been about more bodies to do it, not enough time, it isn't about just numbers, it's about when they change and how quickly a live process nows that v's obs, like you credit score that's 20yrs old :) #WeMDT |
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@Winn_on_Health
20 October 2020 21:08
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@NRCUK @WeNurses This is a good place to start thinking about eObs. Remote GP consultations take place using remote devices. Wearable devices are sending data to GPs, Comm hospitals, hospital records, specialists ... #WeMDT #WeNurses https://www.jmir.org/2020/6/e18636/ |
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@WeNurses
20 October 2020 21:09
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#WeMDT https://twitter.com/NathanSInclai10/status/1318644981775671303 |
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@WeNurses
20 October 2020 21:10
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#WeMDT https://twitter.com/JulieJolley7/status/1318645798431870977 |
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@NRCUK
20 October 2020 21:11
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@Winn_on_Health @JLDarbyshire @WeNurses I only have an interest in improving care, selfishly for the future me and all the current me's too, and as a tax payer and as an exhausted nurse's husband, there's only one reason NHS is so far behind in tech and processes and we know it isn't money :) #wemdt |
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@Winn_on_Health
20 October 2020 21:12
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@WeNurses Yes they can. The tech is available today. Context, the p'ts condition, the #WeMDT, & the clinicians critical thinking are essential to appropriate (obs) decision-making #WeNurses |
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@NRCUK
20 October 2020 21:12
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@Winn_on_Health @WeNurses I have 5 years of obs on my wrist :) not that any HCP would ever be interested in it #wemdt |
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@LauragRN21
20 October 2020 21:12
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thank you #WeMDT only joined towards the end but as a student I learn so much from these tweetchats, I was even brave enough to comment tonight, even if what I say might not be 'right' I will get there! @WeNurses |
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@knitknitqueen
20 October 2020 21:12
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@JulieJolley7 @WeNurses we need to teach about that as well, #airwaymatters #WeMDT |
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@NRCUK
20 October 2020 21:13
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@ph_wilson1 @WeNurses You don't need evidence for the blindingly obvious all the time :) #wemdt |
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@NRCUK
20 October 2020 21:16
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Interesting conclusion... so another apathy casualty then? thanks for sharing @Winn_on_Health #wemdt https://twitter.com/Winn_on_Health/status/1318645389717798912 |
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@KadoorieCentre
20 October 2020 21:18
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@Winn_on_Health @JLDarbyshire @WeNurses Context always important to recognise. Yes to different depts/specialties. Age less varied (but was a bit). Key thing was these were engaged patients already part of hospital 'quality improvement' groups so may be "more interested" than average. #WeMDT |
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@Shaun_LDNurse
20 October 2020 21:22
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Did I miss tonight’s @WeNurses #WeMDT chat?.. ????? #StudentNurse #Nursing |
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@KadoorieCentre
20 October 2020 21:23
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@NRCUK @Winn_on_Health @WeNurses The FOBS project (http://www.isrctn.com/ISRCTN10863045) is looking to see if tech can help ?? #WeMDT |
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@KadoorieCentre
20 October 2020 21:32
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@WeNurses Mainly thank you to everyone who participated! If we didn't manage to respond to you directly in real-time please know it wasn't personal??It was incredibly hard tracking all the threads that were all so varied and interesting - we could easily have had an hour per Q! #WeMDT |
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@SherringtonJean
20 October 2020 21:38
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RT @WeNurses: QUESTION 5 What can be done to improve how observations are scheduled? #WeMDT https://t.co/vPBOpP47i7 |
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@KadoorieCentre
20 October 2020 21:52
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@Shaun_LDNurse @WeNurses Oh boo! You did. ?? It was super-busy. Check out @WeNurses and #WeMDT to catch up on the conversation ?? |
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@Misses_BadGuy
20 October 2020 21:53
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RT @WeNurses: Don't forget >> #WeMDT |
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@Winn_on_Health
20 October 2020 21:59
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@WeNurses I was challenged on 'critical thinking' (below). My reply: No, I don't agree. Critical thinking (CT) means making reasoned judgments; failure to think things thru can cost lives, & put p'ts at harm. Nursing has been advocating CT for years. #WeMDT https://nursejournal.org/community/the-value-of-critical-thinking-in-nursing/ https://t.co/PBknDtrchE |
Stats
Total contributers:
47
Total tweets:
361
Total reach:
8,663,677
