Brain Sheet - Page 3

There is a nursing iPhone and iPad app to make it easier for nurses life and it ibased on the brain sheet. You can also keep track of completed tasks are completed and shift information too. App is called myShift and check it out in Apple app store.

I use plain 8 x 11 paper. I write as follows


Name Chief Complaint

Allergies

Abnormal labs IV location

I underline tasks that have been done and "circle" tasks that need to be completed.

Hourly labs on a rule out ACS patient? Maybe I'm misunderstanding you. Even most of my ICU patients don't need labs hourly.

Our obs patients admitted to r/o ACS get 2 additional sets of cardiac enzymes drawn q4 or q8 ... and a stress and/or echo done in the meantime ... and discharged.

When I float to the ER, I use paper towels, scrap pieces of paper....even alcohol swabs (writing on the outside package) if I don't have anything to write on. I just write notes. I have brain sheets when I'm on my own floor (or ICU or wherever they decide to send me) but I find in the ER it can kind of slow you down...probably because you usually only have these patients for a few hours vs. a whole 12-hour shift. Jotting down quick notes on what needs to be done seems to be more efficient, in my opinion.

Yes hourly labs or hourly someting are a distinct, frequent possibility. Think outside of the ICU and having 2, maybe 3 patients. On CDU's (clinical decision units) with a potential for 6-8 patients per nurse (depending on the shift) and the size of the unit there is a distinct possibility that there will be someone getting a lab almost every hour.

These are HIGH yeild, HIGH overturn/transfer units. They are admitting, discharging transferring patients several times a shift. You might start off with 6 patients but with admissions, transfers to ICU, Cath Lab, Telemetry, or another facility when their pain becomes active.....there is every potential (on bad nights) to have multiple patients in those same 6 beds.

These units are VERY busy when used correctly....even on good days these are VERY busy units and have tho potential for very high acuity when that rule out develops chest pain with stat EKG's and labs who needs to be bolused with heparin, nitro started and the patient transferred to the ICU/telemetry with another patient in the ED waiting for that bed. These units are no joke.

The CDU's (clinical decision unit) I have seen (grant it I have only seen 2) require highly skilled, highly motivated, extremely organized individuals for them to run smoothly. While some sort of hourly something going on is a very busy night....it does occur.

Esme, I have to say ... in my experience in multiple EDs -- where I am often guiding emergency, medicine and other specialty residents through the admission decision process ... if a patient was requiring hourly labs they would by definition be considered inappropriate for an obs / CDU admit. Obs/CDU patients in my experience are fairly low acuity - those requiring some hours to rule out a condition or get a non-life threatening symptom under control. If a ACS r/o patient goes to the obs unit, but then develops rhythm changes/worsening symptoms/an upward trend in cardiac enzymes ... they become a full admission and are transferred to tele or ICU. And I have not ever seen cardiac enzymes checked hourly.

I absolutely agree with you that the similarity between the ED and a CDU/obs unit is the turnover and the constant coming/going from various diagnostics. I'm noticing an incremental increase in the number of posts related to obs units here in the ED forum because of that similarity.

I don't mean to unnecessarily belabor a point ... but IMHO "hourly labs" are generally not part of an obs unit environment.

Altra -

From my understanding of Esme's post, she was referring to the point of between the 6-8 patients on a CDU floor, you are likely to be running labs every hour. Not for each patient per-say, but between the bunch of them

-emerjensee