Table 2 . Example of dedicated times for each ward at the author ’ s hospital .
Surgical ward and ICU
Even hours
BID ( q12h ) TID ( q8h ) QID ( q6h ) Flush IV
10 am and 10 pm Including cold packing = 10 am , 6 pm , 2 am 10 am , 4 pm , 10 pm , 4 am 10 am , 4 pm , 10 pm , 4 am Walking 10 am , 4 pm , 10 pm , 4 am ( if not asleep ) Routine ( T ) PR PR 10 am , PR 10 pm ( T if needed ) Weigh
Feeding ( 3 – 4 meals alongside appropriate medications )
Physiotherapy times ( TID ) Bladder management ( express / empty u + cath )
4 am after walk
10 am , 4 / 6 pm , 10 pm , 2 am . Follow fasting flow chart overnight
Utilise quiet time after 10 am , 4 pm and 10 pm checks 10 am , 4 pm , 10 pm , 4 am
Medical ward and cattery
Odd hours
BID ( q12h ) TID ( q8h ) QID ( q6h ) Flush IV
11 am and 11 pm 11 am , 7 pm , 3 am 11 am , 5 pm , 11 pm , 5 am 11 am , 5 pm , 11 am , 5 am Walking 11 am , 5 pm , 11 am , 5 am ( if not asleep ) Routine ( T ) PR PR 11 am , PR 11 pm ( T if needed ) Weigh
Feeding ( 3 – 4 meals alongside appropriate medications )
Bladder management ( express / empty u + cath )
T , temperature ; P , pulse rate ; R , respiratory rate ; u + cath , urinary catheter
5 am after walk
11 am , 5 / 7 pm , 11 pm , 5 am . Follow fasting flow chart overnight
11 am , 5 pm , 11 am , 5 am could continue to administer the treatments to a high standard . However , it should be noted that this solution may not work as effectively in hospitals with adjoined wards .
A second concern was that the standardised treatments , particularly those at 10 am and 4 am , would not suit the routine of many working clients , who would be expected to continue treatment when the patient was discharged from hospital . However , it was noted on the practice ' s reporting system ( Vetsafe , VDS ) that medication errors frequently occurred at times when staff handovers took place , that is , 8 am or 9 pm , which were the times likely to be most suitable for clients to provide medication to the patient at home . VNs attributed the medication errors to working under pressure and delivering care while handing over to the next team . This raised an interesting debate about whether to prioritise patient safety in the hospital over client compliance with a treatment plan on discharge .
The compliance of clients with treatment plans can vary greatly , with each client having their own routine , so it was pertinent to question the likelihood of clients complying with the suggested treatment times following discharge . It was therefore decided to focus on patient safety in hospital , by restricting routine treatment administration around 8 – 9 am and 8 – 9 pm .
Overnight rest
During the review , the VNs stated that ‘ patients are woken up for non-essential checks ’, there were ‘ too many checks overnight ’ and they felt that ‘ walking them overnight is unnecessary ’.
Obtaining vital signs in the middle of the night is disruptive to sleep and is not founded on evidence-based medicine [ 12 ] . In human medicine , monitoring vital signs and blood withdrawal were noted to interrupt sleep [ 13 ] . A human study using a randomised placebo group
24 Veterinary Nursing Journal