I have been working sub acute rehab for a year now. I carry 12-15 patients, generally 14 on any given day. I have an 8 hour shift and work 6-2:30 but NEVER leave on time. Today I was called to come in and fill in holes on the pain documentation. We have to sign out the narc on the narc sheet, sign it out on the back of the MAR sheet, initial it on the front of the MAR sheet, complete the pain flow sheet and document it's effectiveness on said flow sheet and in our nursing notes. Needless to say the process is cumbersome. There's always SOMEWHERE that I miss, but I just flat out do not have time to double check every single pain med given to make sure I filled in every spot. I'm working hard to get there but right now there's undoubtably something I've missed somewhere. I can say for certain the med is always signed out on the narc sheet and documented in my nursing notes as given and the effectiveness.
If I'm lucky I can get report and hit the floor at 6:30am. I do my treatments then and then start on my 8am meds. But I never, ever, ever finish passing my morning meds before 10:30am. I then try and chart on a few patients and inhale some food before starting to get blood sugars and passing my noon meds. The noon meds predictably run into the 2pm meds, along with trying to cram in the random treatments I didn't get at 6:30am for one reason or another. Throw in a change of condition and it's all out the window. I generally give report at 2pm and then chart for an hour after my shift is over. I am not that far off the other nurses on my unit, but some of them do seem to do a better job with time management.
I'll be honest, I have tried prepouring. But I don't find it to be a huge time saver. I keep my OTCs in alphabetical order so I never have to search for something. All my breathing tx are clearly labeled to save time from pulling 4 different advairs out to find Mr Smiths. But just about every patient is on 9+ meds and many need a BP monitored before giving meds. Part of my problem may be customer service related. If I know that someone likes to sleep in or take their meds after breakfast, I always respect that desire. Time wise it would probably be easier to just go room to room and person to person and give them all their meds right away.
I need some suggestions from experienced nurses on how to streamline things and make it all faster.