Prioritizing

Sleepyeyes · Sep 30, 2002

Ahhh..... LTC....

:chuckle Like a challenge, eh?

I'd usually go for the ones who sound most unstable -- the brittle diabetic whose Blood sugar's running weird today because granddaughter brought her treats or something....

But I eyeball every one of them because you just never know, and check their lines as fast as I can after I get report.

longtermcarern · Sep 30, 2002

I no longer rely on what I was told in report. Last week I was told the new admit (making him pt number 41) was stable, alert and oriented, simple rehab, but I had blood running down the other hall and a person in respiratory distress on the other. I took care of the resp distress, finished up the blood transfusion and checked on a tube feeder who was vomiting. one hour later when I got to the new pt, he was cold and blue.

caliotter3 · Sep 30, 2002

The cold and blue pt one hour later is the reason you should always start your shift by walking down your hallways and peeking in doors. I did this on my own, arrived 10-15 min early, and checked on my way to the nursing station. At one LTC facility it was a rule that the oncoming and offgoing nurse do walking rounds. At least when you check you know what the pts are like at the start of the shift.

ohbet · Sep 30, 2002

All right,these are great insites,any one else? Thank you

Youda · Sep 30, 2002

I agree. Never believe what you get in report. If you don't do walking rounds with the off-going, then make it a priority to quickly walk down every hall and make sure everything is OK before you do ANYthing else. You'll save yourself a lot of hassle and extra work in the long run, and also helps you make out assignments and decide your priorities.

Dr. Kate, BSN, RN · Sep 30, 2002

And in case there is some sweet, young thing out there reading this thread, most nurses do not lie to you in report. What happens is that they're giving report based on information that may be as much as two hours old. Most don't mean to mislead you. The ones who flat our purposefully lie to you, for reasons known only to themselves in their warped and twisted minds, they're the scarey ones. I've run into one or two over the years. The good thing is you learn to hustle in getting out to see what's really going on with your patients.

Youda · Sep 30, 2002

Originally posted by Dr. Kate
And in case there is some sweet, young thing out there reading this thread, most nurses do not lie to you in report. . . snip

Absolutely! Sorry I didn't say that. If the last shift has been swamped, or tied up with someone who went bad, the last time they saw everyone could have been hours ago. A couple of nurses I've worked with were too dumb to recognize S&S, didn't care, too lazy, or didn't bother to see the residents. But, by far inaccurate reports are from just being overloaded ALL THE TIME!

globalRN · Oct 1, 2002

Yes and in another thread ohbets you asked about prioritizing when you are busy++++ and also get a new admit. That is exactly why I said you need to ASSESS the new admit before you prioritize. A good assessment by you is key because then you can be sure that your priorities are in the appropriate order...although they may change based on changing priorities over the shift.

SheilaK · Oct 1, 2002

I always start my shift off by going in and check on all of my pt's, verifing what I was told in report, is MR. So and So really on 3 L of O2, is the HL in the left forearm, are the SCD's onthe pt or just the kardex the nurse reported from. It helps me to get a better picture of what is going on. After I do my rounds I like to make a quick check through the orders, just to make sure there are no STAT orders waiting. Then I decide who and or what to do. Hope that helps.

**canoehead, BSN, RN** · Oct 1, 2002

Walk down the hall to the report room laying eyes on all your pts, see who looks scariest. Get report knowing who you are most concerned about based on that, and finding out about any others. Go to your sickiest patients (could code if something has changed that isn't picked up on) and introduce yourself and do a problem based assessment, see if they will live for the next hour (you may end up doing the whole assessment just because they are so sick or so involved). Once you've confirmed that your sickest are OK then go on with the rest of your group. On nights you may find it good to see the sickest first because you may catch the families, or can call the doc with any concerns before they go to bed. You may also get a run down on the plan of care if you call the doc early, if you wake them in the middle of the night they won't be as forthcoming.

After the sickest are seen I go to those that are least sick, just so I can do them up and cross them off the list. Then you know how much time you have to spend with middle pts, are you just going to make sure they don't die tonight or can you give them a full spa treatment? Some may want to chat, or request something extra, you will already have a good idea of what you are dealing with tonight, and whether you have time to squeeze it in.

And always listen to pt's and families if they feel something has gone very wrong and do an extra careful assessment on them. They will feel reassured and 9 times out of 10 they are right. Most of the "saves" I've made have had something to do with pts/families picking out the subtle signs, and then watching carefully.