Any suggestions for establishing a "routine" way of doing things in the ICU? For ex) Assess both patients, chart immediately, punch out the a.m. meds, handle probs as they arise. It seems like very often, something comes up before I can even chart my assessment, and then I end up playing catch up on stuff.
Nov 1, '07
You have the right idea.
Really push to do assessments and chart immediately after each assessment. You don't really know your patients until they have been assessed. Don't rush, but do not focus and get it done.
Go ahead and give the first round of meds if it is within the window of time for it to be given. For example, I start gathering my 1000 meds at 0930.
Sometimes, you cannot avoid the doctors on rounds, Xray needing a hand with the pCXR, the phone call from the lab, or early visitors.
Nov 2, '07
what do you mean by "do not focus and get it done" and "avoid the doctors during rounds?" Don't you want to be there during rounds so you hear what they have to say and can provide your input?
Nov 2, '07
Biggest tip that I was told get everything done as soon as you can. It is an ICU and things will happen! If you have all of your work done the problems that arise will not stress you out! I never waited to get my bath done I did it in the first 4 hours ect...
Nov 3, '07
Chart as soon as you can. Make sure you get that initial assessment done right away-what you find there sets the plan for the day in motion.
I agree about rounding with Drs. This is the time to collaborate and ask for what you need...
Nov 4, '07
I try my hardest to have my note, assessments, vitals, I/O's for 1900 done and charted before 2000 hits. Sometimes it's easier said than done but I just get in there and bust my butt the first hour or so. Makes for a much more controlled evening with things get chaotic.
Nov 4, '07
Are you asking specifically for daytime?
For days, (I only spent 2 months on icu days) start with report, look at labs in case report left you with a question. Grab flowsheet and put VS on it for 0700. If either of your pt's has missed a night shift bath, get 'em bathed and do assessment at same time. Pass breakfast trays if they are eating. Chart assessments; if you have to bump someone off the computer to do so, okay.
If it's a slow rounding morning for docs you may have assessments done and charted when they get in; if not it will just screw up your morning. If someone's on the computer after you hand out breakfast then go ahead and do AM meds. Round with docs and answer questions. Let visitors in and grab a snack.
I try to catch up on computer charting at two specific times of the day: noon and 1700. From my preceptor when I was a brand new nurse, at 5 pm each day she'd say "okaaay it's time to grab some coffee and chart, chart, chart!" After I went to nights I could still hear her voice at 0500 and it drove me nuts if I couldn't get the charting done then. Other times to chart are when you're not busy, or if you just know the crap is about to hit the fan for any reason.
Between 4p and 6p I'd start looking at I's and O's (if the patient wasn't so critical that I had it added up all along as the day went) and making sure all the crap is in the computer. One last round of visitors around 6 that can go back to the waiting room at 6:30 so we can get ready for report. Then oh wait, you gotta find time to pee in there somewhere.
Nights are a bit different, but it sounded like you were asking about days.
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