[RN28MD]

new nurse has a post op patient who is running a fever, she/he gives patient tylenol for it. But experience nurses say a blood culture should be drawn. Why are the new nurses not doing this. Does this happen at your hospital that new nurse are forgetting to do. But not only new nurses I have seen this happening with experience nurses too.

[Lucy4]

I & O. I haven't found very many that know how to calculate intake for IVFs. When I get report and ask how much is left, the response I get is "well I think...." When I ask how much they took credit for at 10PM - can't tell me. I go in and check patients with them and we look at the IVs together now. Even at that, they cannot enter the correct amounts in EMR. Asking to clear volumes on the infusion pump so I can accurately record how much I can credit - too complicated. Some will multiply the hourly rate x 8 (100/hr - 800 cc infused). Doesn't matter that the patient's IV came out and time lost in starting a new line or was recieving blood for 3 hours and IVFs were held for transfusion. Same with enterals. Clearing the pump at end of shift is too complicatd for them. No record of how much water used for meds and flushes.

[RN28MD]

You make a areally good point. We should make a list of stuff that are not being done right to see what we should be checking off during their orientation.

[RN1989]

Originally Posted by RN28MD

new nurse has a post op patient who is running a fever, she/he gives patient tylenol for it. But experience nurses say a blood culture should be drawn. Why are the new nurses not doing this. Does this happen at your hospital that new nurse are forgetting to do. But not only new nurses I have seen this happening with experience nurses too.

Not every postop pt with a fever requires blood cultures. I see many nurses who do not understand that pts need to use their IS and TCDB a MINIMUM of Q2H. The nurses forget how important these tools are and they do not require a doctors order or an RT to perform them. Vigorous use of an IS and TCDB can assist with postop fevers. An infection in a postop pt is generally not going to rear its head for 3-4 days or more unless they had a dirty wound or known infection prior to OR. Thus the average 1-2 day postop pt does not need the added pain or expense of running BC. Tell your colleagues to stop forgetting the little things and remember that TCDB and getting your pt's buns OOB ASAP is a cheap and easy way to provide good care while also saving money!

[Longhorn Mama]

I absolutely agree with RN1989 - most post-op fevers will be pulmonary related. We've got to get them moving and breathing.

How about filling water pitchers? When did it become OK to have water sit in a pitcher for 24 hours - no ice, etc.

And I agree with the I&O post. You think people would also remember to document the I&O from the operating room.

[Lucy4]

My observations are a general lack of attention to details. As I stated before, I & O is a big pet peeve of mine - especially on a cardiac floor. I have seen some of the new nurses turn off an IV pump that is beeping rather than fix the problem - leaving a PICC or central line to clot off. Leaving TED hose on for days even when they are obviously dirty - stained with blood, etc. Not changing dressing - leaving for the next shift who leaves them for the next shift and on and on.

[RNperdiem]

A fever in a transplant patient, even a low grade fever needs to be reported right away; expect to get an order for cultures.
For other post-op patients, IS and mobility is in order as the above posters noted.
Nursing is full of neglected basics. On a good day, I can do a lot. On a bad day it seems that little more than assessments and meds get done.

[veronica butterfly]

I & O's definitely a pet peave of mine, no hats in the toilets or urinals in sight for the guys.... Dinner trays whisked off and never recorded what people ate and drank.

Stool and urine samples that never get collected, just passed on shift to shift...

Not treating pain adequately also. I hear so often, "they didn't ask for pain meds, so I didn't offer."

[Drysolong]

Originally Posted by RN28MD

new nurse has a post op patient who is running a fever, she/he gives patient tylenol for it. But experience nurses say a blood culture should be drawn. Why are the new nurses not doing this. Does this happen at your hospital that new nurse are forgetting to do. But not only new nurses I have seen this happening with experience nurses too.

In my facility, blood cultures are drawn if temps >101.

[Drysolong]

Originally Posted by Lucy4

I & O. I haven't found very many that know how to calculate intake for IVFs. When I get report and ask how much is left, the response I get is "well I think...." When I ask how much they took credit for at 10PM - can't tell me. I go in and check patients with them and we look at the IVs together now. Even at that, they cannot enter the correct amounts in EMR. Asking to clear volumes on the infusion pump so I can accurately record how much I can credit - too complicated. Some will multiply the hourly rate x 8 (100/hr - 800 cc infused). Doesn't matter that the patient's IV came out and time lost in starting a new line or was recieving blood for 3 hours and IVFs were held for transfusion. Same with enterals. Clearing the pump at end of shift is too complicatd for them. No record of how much water used for meds and flushes.

Where I work, this is a PCT function. I verify this is done.