Latest Comments by Mags4711

Mags4711 3,438 Views

Joined Jun 18, '04 - from 'Denton, OH'. Mags4711 is a ICU Nurse. She has '21' year(s) of experience and specializes in 'Newborn ICU, Trauma ICU, Burn ICU, Peds'. Posts: 265 (8% Liked) Likes: 32

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    LRN_RN likes this.

    Quote from bmsrn
    I only pop the top when necessary. It depends on what I'm doing and the babies size. If they are a micro-preemie I'd only open for an intubation or re-taping the ETT. I see a lot of newer nurses that open it all the time. We don't really have a policy.
    I try to dissuade them from even popping when reintubating (if it is a semi-controlled situation). The trays slide out and spin, so the lower half of the baby can remain in the warm environment. I even do tub baths in pink basins with the tops down (even on intubated babies). I admit, I may be a bit of a freak about certain things. (Hey, the first step is owning up to it, right? :-) )

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    Whoatemyburger:
    You work in a NICU where there's *high* turnover?? I don't think I've ever heard of such a place.

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    There is data that speaks to the possibility of it taking hours for the box and baby temps to stabilize after having the "top popped." I only open if ABSOLUTELY necessary. And it usually isn't.

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    Yes, there is literature that speaks to the benefits of gravity bolus feeds versus pump feeds. I'll dig through my stuff when I get a moment and post some links.
    My hospital used to use syringe pumps and we'd start feeding over an hours, then decrease to 45 mins, then 30 mins, etc. Now unless your baby is a surgical kiddo or has to be continuous for some reason (rare), or has demonstrated severe reflux that is made better by putting the feed on a pump, the baby is gravity fed. We tape up the syringes less than 10cc, for larger than that we use the soft arm posey velcro restraints and hang them from the IV pole arm on the Omnibed (using oral extension tubing).

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    Depending on the availability, often after 1-2 years you can get a day/night rotation. Our unit only rotates folks 1-3 nights/4 week schedule. But for straight days? 12's will take 26+years. Straight 8's on days? 28+ years.

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    Joe V likes this.

    Hello everyone!

    My institution (teritiary care, Level IIIc NICU) is moving to scanning for med administration soon. I have been charged with the task of polling other NICU's to find out how you all "really" do it.

    I know ideally you are to affix a barcoded ID band directly on the patient and scan that. However, we all also know that reaching scanner wands into incubators isn't the easiest thing to do, we also know the itty bitty ones generally don't have ID bands placed on their bodies, etc. Additionally you don't want to unwrap a sleeping infant to get to their ID band on their ankle.

    So what do you all *really* do?

    Do you actually scan the ID band that is on the baby's body? If so, where do you place the band? Do you always place it on the wrist?
    Do you have an extra ID that you affix to the end of the bed that you scan?
    Do you have a certain type of ID band that may have more of a "luggage tag" appearance that you make sure is hanging out of the blanket when you wrap the infant?
    Do you place your ID bands on the connector for the Pulse Ox or ECG leads?
    Do you print out some scannable sheet and tape it to the front of the bed and scan that?

    Thank you VERY much for your responses!

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    Quote from Bortaz, RN
    Are y'all talking about babies not born in your hospital, or do you test for MRSA in kids born at your facility?
    Same here, every baby that enters our unit gets swabbed on admission, every Monday (unless positive, then they are no longer screened), and on transfer or discharge.

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    Quote from smilingbig
    ...3. I don't think CHG bath wipes are to be used on neonates. It was my understanding that according to the literature and the manufacturer instructions, CHG wipes have not been tested nor approved for this use. Our doctors generally do not decolonize any of our patients (unless there is a specific situation in which it would be most beneficial to the patients care to do so)...
    We have been using CHG wipes on our neonates for a little over a year. We only decolonize if they turn positive, though (CHG wipe baths for seven days, and Bactroban Nasal Ointment 2% to nares and umbilicus for five days).
    Quote from smilingbig
    ...I don't know if you are a member of any infection prevention/control professional organizations, but there are some forums out there that have specifically addressed many of these types of practices so there may be more specific Infection Prevention/Infection Control information there.

    Good luck to you!!
    Thanks for the well wishes! I have looked through lots of forums, and rifled through just about everything I can here on allnurses, but most everything you read is not neonatal specific. I was hoping to capture exactly the kind of wonderful info given by yourself and others in this forum that is geared towards our population.

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    Hello fellow NICU folk!

    I am working on MRSA best practices and am trying to get a sense (beyond what the "Consensus Statement of the Chicago-Area Neonatal MRSA Working Group" says) of what *your* NICU's are doing re: MRSA practices.

    Could you please answer the following questions?

    1. Do you routinely screen for MRSA? If so, who and when/how often? (for example, we screen ALL on admission, then once a week thereafter unless positive)
    2. If someone is positive, do they get retested? Can they come off precautions?
    3. Do you Universally Decolonize ALL patients (MRSA+ or not) with CHG bath?
    4. Do you cohort nursing or patients or both (i.e. one nurse has only MRSA patients, or do they care for a MRSA+ and non-MRSA patient; do the MRSA+ patients get moved together?)? If only one patient on the unit is positive, is that patient made a 1:1?
    5. How is your unit configured? (Single Patient Rooms, wards, etc.)
    6. How do you handle visitors? Do they (parents included) have to gown and glove? What about multiples? Kangarooing?


    Hello ID folk!

    I am working on MRSA best practices for our neonatal ICU and am trying to get a sense of what your institutions in general are doing re: MRSA practices.

    Could you please answer the following questions?

    1. Do you routinely screen for MRSA? If so, who and when/how often? (for example, we screen ALL on admission, then once a week thereafter unless positive)
    2. If someone is positive, do they get retested? Can they come off precautions?
    3. Do you Universally Decolonize ALL patients (MRSA+ or not) with CHG bath?
    4. Do you cohort nursing or patients or both (i.e. one nurse has only MRSA patients, or do they care for a MRSA+ and non-MRSA patient; do the MRSA+ patients get moved together?)? If only one patient on the unit is positive, is that patient made a 1:1?
    5. How do you handle visitors? Do they have to gown and glove?

    Thank you all in advance!

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    We are all private rooms (Level IIIc) and visitors are allowed at all times. We have now also moved to bedside report (standing in the patient room, parents and visitors present!) to allow parents to feel more a part of the process, and to force double checking of pumps/drips.
    Our legal eagles also call it "incidental disclosures."

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    Quote from spacey
    Thanks for the replies so far.... and overwhelmingly in favor of keeping work life and personal life separate. Now I feel like less of an oddity. We have soooo many people doing this....probably 90% of our staff.

    Another similar situation, giving out cell phone numbers. We had a nurse who had parents texting with her during the shift about their baby and how the shift was going... and their baby wasn't even her patient! Yet they didn't call and speak to the nurse assigned to their baby. It seems crazy and I feel like I'm the only one who has a problem with it.

    ...People are very very possessive of their "special relationships" with the families..... It's going to be a tough battle.

    thanks for the input... please post more!
    I would say about 40% of our staff are friends are with current patients, probably close to 60% are friends with previous patients and families. I do have a problem with it. I won't do it. I have four former patient families that are friends with me on FB, we didn't become "friends" until 1-4 years later. This is out of about 550 friends. I have denied many friend requests as well. I do not baby-sit, I have gone to one birthday party. Work is work, personal life should be personal life.

    Many of my co-workers will babysit or go to birthday parties, it makes me very uncomfortable.

    Also, we have a couple of RN's who take pics of babies and text them to the parents or text moms about how the baby is doing that day. Again, makes me VERY uncomfortable. Lines are blurred and crossed and then what happens if the unthinkable (death) takes place with that child?

    I **NEVER** give a family my personal contact information. One mom was texting one "primary" nurse and complaining about another, then after discharge she was texting questions to the nurses. Not good.

    My mother was a nurse and she taught me that there are distinct lines and boundaries and life is so much simpler when those are not crossed. She was right.

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    If you've ever had an art stick, you'd understand why I am about to say what I'm going to say. I HATE THEM!!!!! Lots of our RN's will do them to get "larger" samples of blood (and not even try a venous). It makes me nutty! To me an arterial poke is a last resort, or it sure as snot should be. The pain is *incredible* and yes, you run the risk of losing that artery. I also only occasionally see anyone doing the Allen's test. Which should be an absolute MUST.
    Sure, I understand that sometimes, you simply have to get an arterial sample. But I do think they are performed too often.

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    I work across the state from you, Kalamazoo, and we have open visitation 24/7. We have been that way for at least six years and I still dislike it. Only the parents are allowed to stay in the rooms for the half hour at shift change, though. But anyone can be at the bedside during rounds, which IMHO is *ridiculous*! We have 9 to 13 babies in each room and "try" to give report away from the bedside, but...it is *very* limited space. When I contacted our HIPPA attorneys about this, I was told it's considered "incidental disclosure" which is covered. I disagree, it is not "incidental." we could ask them to step out and voila! It's not an issue. But we do this "Patient and Family Centered care" stuff and it's parents first, parents first, parents first.
    I mention the rounds thing because there are occasions when a family member or grandparent may be visiting and hear something or a plan for the baby before mom and dad do. I personally think only parents should be allowed at the bedside during rounds as well.
    Later this year we'll be in a new facility and all the rooms will be private, so the HIPPA thing won't be a huge issue. But then they'll be able to room in 24/7...

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    We send cards after death, six months, and then at a year out. We order our cards (and a nice natural paper box) from Memories Unlimited, Inc http://www.memoriesunlimited.com/

    Our transporters take the baby down in a basinette to the morgue.

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    My hospital just paid for us to take the NICU review course that Dr. Verklan gives. It was quite thorough and good.

    Seriously, vent changes??? That's not even in my scope of practice! How can they ask what vent changes should be made?


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