TIMESAVERS for Med/Surg RNs

goldilocksrn · Nov 10, 2000

I think the frequent checking of PCA's is a safety issue to make sure you are in assessing pt's pain levels, resp status, and functioning of the machine itself. What you can do is do it at 2130 with the 2100 meds to save you time, and do the 0600 check with the 0600 meds, I/O's, weights, etc. Do you evening assessments as you pass meds to save time. Finding ways to combine tasks is the only way to survive these days in nursing. You know, when an MD says QD, he doesn't care what time we give it unless specified! We have got to use nursing judgment to get by. I hope this helps.

JulieW · Nov 11, 2000

Hi Sirens,

I'm an LVN so duties probably differ from your job, however, when I worked the 7p-7a shift, I found the following to be of most help- go through MARS very first thing before seeing your patients and write down the sleepers and pain meds for all- then when you make your first rounds, get their O2 sat, do a quick pain assessment, and ask them when and if they want a sleeping pill and/or pain med. Then, when you're passing 2100 meds, bring them the sleeper instead of going in and waiting for them to ask for it, then having to go back and get it, etc. If the patient is confused and non-verbal, I bring the sleeping pill with routines to avoid a long night, for them as well as me. This is sort of an obvious time saver I guess, but being new, it took me quite a few shifts to pull it all together. We clear all our pumps at 0400 and I agree that doing so at 2200 seems like a waste of time, as long as you're keeping an eye on the pump when you're in the room throughout the night.

Of course when you have two patients that share a room, it's always a time saver to pass both meds at the same time and to do finger sticks at the same time, etc.

Good topic, hope to hear more tricks of the trade-

Julie

Jo_deye_yuh · Nov 11, 2000

I agree with the above posts. The fewer times you have to retrace your steps back up the hallway for meds, etc., will save time and energy elsewhere.

Before I do my initial rounds, I take the time to go over my pts hx and MAR. I take note when their last pain med was given and how regular they are requesting PRN's. This gives me a heads up to plan for those that are q 4 h requesters. That way I am not so caught off guard by that recurrent call light while in the middle of other duties.

Preparation, materials, and forethought save much time. It took me ten times as long to do simple procedures and tasks, due to not assembling all the needed supplies. I would spend more time walking back to the SP and back again only to be out of breath, running behind for the next med pass and flustered.

"Hitting 2 birds with 1 stone"...as mentioned in the above posts, plan your cares, tx, assessments, meds, I&O's, PO checks, etc., to involve not just the one post op in room 244. Plan for all the patients in the room and move systematically up your hall and pt assignment.

For me, I can't say enough about NOTES. I am constantly jotting pt c/o's, reportable assessment findings, times PRN's were given and effectivness. This saves me when finally documenting and the shift is a blur. This also reminds me to check effectiviness of tx or meds given if I see that I did a tx or gave a med. Some nights it seems for the duration of the shift, that is all I did was give pain meds.

Time saver: When doing initial beginning of night shift rounds, I make sure each pt has his urinal at bedside, call light within reach, night light on in room, and I check the IV bags that are starting to get low and ready non refridgerated ones so the alarm does not wake pt. What fun I have had to have pts unable to find their urinal and piss all over their bed, floor and self, only to have to clean it all up. What fun I had to have pts try to get up to go to the BR with no lights on and fall, only to have to do an incident report or worse.

When I first started I used to go directly to the patients rooms and do a general walk through. Inevitably one or two would ask for a pain med and I would ask, "When did you get your last dose?", some would know and some wouldn't regardless I would have to walk back to the nurses station and check the MAR, some I could give and I would walk back to the med room and get their med and walk back to pts room to give it. Some pts were not due for meds yet and then I would have to walk back to their room to tell them, "Sorry, you are not due for another 1 1/2 hr." Only to have to be reminded by the pt to get their med 2 h later! Plus, on the key ring with med keys, a pair of scissors, O2 wrench, hemostat, and roll of tape...you always have that special tool on hand!

Best of luck!

[This message has been edited by Jo_deye_yuh (edited November 11, 2000).]

JillR · Nov 11, 2000

I to check my MAR's before I see my patients.

When I have meds at say 2100 and 2200 I give them all at 2130 as this is the time we collect I&O's and clear all the pumps. So now I have turned four different tasks into one.

I also get vitals, do all my accu checks and pass meds all at 2000. I have a system set up that allows me to save steps.

If a patient has a daily stool softener ordered for 2100, and no other meds ordered after 2000, I give it at 2000. Less steps for me and allows the patient to get some rest.

I combine the other meds for the night too. If they have something ordered for 1600 and 1700 I give them at 1630. (If they can be given together).

If a patient wants to go to the bathrrom at 1800, I get them cleaned up while on the bathroom.

Little things like this can make a huge difference.