Help getting organized?

gradRN2007, BSN, RN · Jun 13, 2007

Hi

would you be able to download a copy of your paper that you use, it sounds better than the one imade up..or PM me.

thanks

i have to buy a top opening binder to use for patients which is what most of the RN's use on the floor and at report the previous RN hands over the kardex, mas and nurses notes. i have been using the clipboard that opens up that i used in school but the binder will cover patient data better..

thanks

Bonnie Nurse · Jun 14, 2007

That is an excellent idea about the bags. Definitely appealing and probably VERY TIME SAVING!! So now that gets me thinking about the legality of it all. I do wonder if pulling meds for more than one patient at a time might prove to be against hospital or JACHO standards. If allyour meds were within your notebook, wouldn't you be taking them into different rooms? Seems as those it would be easier to give the wrong meds to wrong patient. What do you think?

anonymurse · Jun 15, 2007

Bonnie Nurse said:

That is an excellent idea about the bags. Definitely appealing and probably VERY TIME SAVING!! So now that gets me thinking about the legality of it all. I do wonder if pulling meds for more than one patient at a time might prove to be against hospital or JACHO standards. If allyour meds were within your notebook, wouldn't you be taking them into different rooms? Seems as those it would be easier to give the wrong meds to wrong patient. What do you think?

We pull meds however it best organizes our work. Everyone has a lockable drawer on their rolling med workstation. Standard practice is to use a separate clear plastic bag for each pt/time, fold the printed receipt with the pt's name outward, and put it in the bag where you can read the name.

One key to organization is to look at all my processes to see where I might end up doing something more than one way and how that might make me miss something.

For instance, pill splitting. When I pull the med I get notification, and when I administer it. However if I take the meds to the bedside and unwrap them in front of the pt, I might forget, because there's no warning at bedside.

There are many reasons to unwrap them in front of the pt. I do this the first time I meet a pt, so I can explain each med, and if the pt has problems swallowing, or is known to refuse meds (some do this after taking a pill or two).

So my solution had to be to separate the process of splitting from the process of unwrapping, because I could not force the warning to come no matter where I unwrapped. Therefore I had to split when I got the warning, but not unwrap.

As I get the first warning, I split the pill by stabbing it through the clear side on the scored line using a needle. It doesn't mess up the barcode, I can see it's split through the clear side, and when I later take the pill out of the wrapper, it comes out in 2 pieces. No way to forget. No way to be caught without a needle, because the supply is right there in the med room. No way I'll get interrupted as I would in the hall or room.

So I can deal with my organization problems by starting with the adverse consequences I want to aviod, then backtrack each consequence until I come to a fork where I can prevent them all in one move, then I put a solution in place before that fork as part of my unvarying routine in a spot where it can't be interrupted.

This is certainly a laborious way to solve problems, but just like the dimensional analysis method of figuring out dosages, it works reliably.

jjohnsanj · Jun 20, 2007

Most of the nurses on my floor use a 3 ring binder. I have a zipper pack that I keep spare pens, highlighters, sharpies, alcohol swabs, scissors, etc, in. Then I have dividers so that each pt has their own section where I keep my report sheet, patient worksheet with current orders, and MARS. On the front of the notebook, along with pictures for all to see, I put a post it not with my room numbers at the top, then med times, charting times, and other little notes to myself. Works well for me.

Nana1206 · Jul 4, 2007

crb613 said:

I use a clipboard to keep my nsg notes on (we chart by hand). As I do my initial assessment I chart right then there. When I am through seeing all my pts my charting is done. Then all I have to do is add to it as needed throught the night. I see a lot of nurses that don't even start to chart until 0200-0300....this would drive me nuts!
I have a brain sheet I keep in my pocket w/pts name,age,dnr status,admit date,room #, doctor, dx, hx ( brief) allergies, tubes, drains, lines, tx, labs, tests, sx, diet, iv sites, fluids, pca, dsg, nebs, vs w/o2 sats, accu cks, activity, on it. I have a note section at the end for things need to be done/passed on. If I need to know something through my shift I look at it & update as I go, then I give report from this. We do report face to face...I usually make a copy of my sheet & give it to the next person. This helps speed up report & keeps things from getting left out.

I look at my MAR as soon as I get report to see how heavy they are!(ours are paper & kept in a binder in the med room). I also keep a current vitals list w/my MARS. I go in at 1900 so those meds are already done...I check just in case. Then at 2100 I give my 2000, 2100, & 2200 meds & do anything else scheduled in that time frame, chart if needed. At 0000 I do the 2300, 0000, 0100 meds, chart. I do this all through the night & it keeps me on schedule & allows a little time for the unexpected things that happen. There have been a couple of days when... I could have cloned my self & that would not even have helped!:rotfl: but for most days it works great!

BTW...when I pull my meds I do them all at once...I put each pts meds w/MAR in a zip lock bag & label it. I don't open the meds until I am in the room & use the MAR to double check the med, pt & tell them what they are getting. This saves me a lot of steps!

Hi,

I am a' new RN, 3 months out, and feeling totally overwhelmed. Some days it appears that I have the 'worst' patient load on unit for that shift. I usually am able to get through it (and pass out later), but I still have lots of paperwork to complete and am late getting off. I am hating that part so, right now. I have tried to make different plans for organization, and have not found one that works for me. Your organization plan you mentioned in this post sounds like one that may benefit me. Thanks so much for posting and thanks to all of you on allnurses.com for you advice and help.

LPN MAN · Oct 6, 2007

Thanks for the ideas!

SCnurse2be2008 · Jan 16, 2008

Hi! I just graduated in Dec. 2007 with my BSN. I did an externship this Summer and had to do a presentation on one thing that hospital could change (nursing related, of course). So, I made a report sheet that I think could be pretty universally used. I have coped one right here:

Nursing Report Sheet

RM:

Diet:

Activity:

PT Name/Age/Sex:

MD:

O2:

Precautions: Contact / Droplet / Airborne / Restraints / Fall

Adm. Date/Dx:

IV Site/Soln./Rate:

Input:

Output:

Drains:

PT Hx:

Labs/Tests:

Medication Times:

FSBS (Insulin):

CODE:

Last BM:

D/C Plans:

Allergies:

Urination (Foley, etc.):

Consults :

Assessment done/changes: _____________________________________________________

Other Data: _______________________________________

socalpca · Jan 17, 2008

There are nurses on my medical-oncology floor who use clipboards and some who don't. As a new nurse(7 months), I have tried a lot of different things. Here's what I've come up with that has worked so far:

-Get to work early. My shift is 1900-0730 and I will get on the floor at 1800 and start to gather info on my patient team for that night. This way I can get all my information gathered and claim a computer terminal before the rush begins. I have also been able to start my assessments earlier.

-I have a computerized print-out of my patient. Each patient is on a separate sheet of paper, and the labs are printed out with the name of the test, the value and whether the value is low, high or critical. I highlight any abnormal value for easy reference. This sheet also has plenty or room for notes. The pre-printed sheet also has spaces for diet, meds, IVs, activity, skin condition and isolation status.

-Ask your fellow nurses. There are a lot of good ideas out there. Find out what they are and try them out. Some will work, some won't.

Redeemed98 · Jan 25, 2008

Hello all! I have 1 more day of orientation and then on my own. I'm feeling very nervous about it, and have been trying to get myself organized. I like being organized as much as possible, and at my hospital, we report on tape recorder for the oncoming shift, which I don't really like, but I've put together a sheet to help me during my day as well as when I report, even though it needs to be tweeked a little. Maybe it will help someone here.

Room- / Name- / Age- / Dr.- / Dx-

Allergy-

Diet-

IV-

VS: q

VS: B/P- P- R- T-

8-

12-

4-

Tylem 7, 11, 3

Accu √____ _____ ______

O2 @___L/min per_________

Activity-

Other-

Labs-

samdombek · Jan 26, 2008

Geez, I, too have trouble getting things done efficiently . . .I LOVE the idea of pulling all of a patient's meds at once and putting them into invidually labeled zip-lock bags--what a tremendous time-saver that would be, but . . .I can't imagine that this practice would be acceptable to the almighty JACHO. I tried looking this up on the JACHO site, but I didn't get anywhere. Does anybody have a definitive answer? thanks!

gradRN2007, BSN, RN · Jan 26, 2008

We are very alike, I have been an RN since April of 2007 and do almost the exact same thing. We have 5 ring binders that most RN's use and we have our nursing notes, mars, insulin dosing scale, copy of h/p and any other pertinent info we need to pass on to the next RN.

Instead of post it notes which I did use) but when one fell off I changed to one sheet of paper divided into 4 sections that I put on top of my cover under 2 rubberbands and I put the following info on each section: green on left, red in middle and blue on right...Couldn't figure out how to make the columns..Sorry

intials of pt misc. info in middle accucheck

vs 2000_______________ * 2100 0500

0400______________ * bs bs

input 1900-0700 _______ * _units _units

output ___________

daily weight ______ medications

2100 0000 0400

ekg *I write in the times when glancing at mars

am labs-cbc,chm7 etc (specifics like vanco, antibiotic etc)

Misc. Might be 1 more cardiac enzyme due at 0200, or occult blood, etc...Just anything that needs flagged, usually helps with documenting.

I also make a copy of the telemetry sheet (cardiac imcu) and have that and my top sheet in front of me when I give report.

After report (sometimes before) if I know my assignment (usually work 3 nights in a row and get same patients then just need update from previous RN), I go into room introduce myself or say hi I am back and can I get you anything while I fill out the dry erase board on wall with my name and phone # (carry phone so I can be reached)

Charge RN name, pca name, etc..Make sure the date and pertinent info is on board....And if the pt. Needs blannket, pain meds, water, whatever I can bring it with me when I go back to assess and give meds. We do pull our meds and put in plastic bags and lock in our cart 2x a shift. I also find when I pull say lopressor and I need to give 12.5 and its a 25 mg I write on the package with a sharpie right when I pull it and also when I reconsile the mars for the next day I write 1/2 tab for the next shift in red. We also have kardex's that we get each shift and if its neat then I just highlight new info and hand off everything for the next RN...Pending order, labs, etc.

Hope this helps, everyone develops there own system that's for sure