Any Rad nurses out there??

Editorial Team / Admin · Feb 29, 2004

Does your new IR have any suggestions for you, such as how "they" organized the day at his previous facility? (possibly not, as some of them don't tend to notice the details of HOW things get organized, but only notice if things are NOT organized! :))

Re: missing orders: I don't know what your hospital practice is, but ours was for the ordering MD to write the procedure order in the chart. We tried to remind the Rad (who had to approve all procedures) to request the order be written in the chart at the time he/she spoke with the ordering MD. Most of the time the order was there when the pt arrived, but sometimes we'd have to delay the case to page the ordering MD to come down and write the order for us. You MUST have the order written before you may proceed with the procedure. You could have the ward clerk or RN check for the order before sending the pt, to save yourself some "dead" room time.

Do you have any resource materials for detailed overview of basic procedures? Example: Handbook of Interventional Radiology Procedures, edited by Kandarpa and Aruny is a GREAT resource. ARNA (American Radiological Nurses Ass'n) has some good nursing-focussed materials for purchase. The above handbook is more MD-focussed but is still VERY helpful.

List common procedures and what is needed for each: name, MR#, location (out-pt or floor/room #), ordering MD, HIS OR HER PAGER #, what procedure is being requested, which Radiologist approved the procedure, what labs are needed/what labs are available, and date of most recent labs, special requests/problems (i.e., nephro tube placement on pregnant pt!). Devise a form you can fill in the spaces for the pertinent information. The items listed will jog your memory as to what needs to be checked on prior to the procedure.

If the schedule is pretty well known the afternoon before, can you delegate someone to prepare the procedure sheets for all the known cases? The sheets can be available in each room so as procedure requests come in during the day, both nurses and techs can fill out the sheets. If someone happens to leave, or someone takes over in a room, the sheets are there for communication to the oncoming person. Our Rads had to approve any cases, so they had access to the sheets too, and would fill them out and place add-ons (even for the next day) in a central location, near their reading room. We'd swing by and retrieve them periodically during the day.

We also devised a supplies needed/billing sheet combo. Each procedure was listed on one sheet, with routine supplies to be pulled for it (and special instructions, i.e., placement of electrodes, antibiotics etc), as well as a "may also be used" section, for supplies for unusual anatomy, etc. Following each supply item was its ordering number and billing number. We'd check-mark which supplies we used, so billing was easier after each case. We also noted (by circling the item and writing how many were needed) which supplies needed to be re-stocked. (but don't get me started on stocking supplies, we NEEDED a computerized inventory system but they were "too expensive." )

As you work more with the procedures and with each other you'll probably develop a smoother routine. Standardizing how the data is gathered for the cases, and which supplies are pulled for each case, may help.

PM me if you have any questions; I know this is stabbing in the dark here, just thought I might offer some suggestions to what I perceived as the problem, and I thought I'd start with some basics. Good luck! -- Diana

RadRN2 · Mar 3, 2004

Very good ideas, dianah. I definitely agree to prepare the day before as much as you can for tomorrow's cases. Developing some sort of check list may be helpful to remind you of everything that needs to be done. We prepare a "chart" of sorts, even on the inpatients, so that we know everything is done before the pt gets to the dept. Includes printed copies of all needed labs, H &P, allergies, etc, even though all of this should be on their chart. I know this kills more trees, but we want to know everything is done AND all abnormalities are known and addressed BEFORE the pt comes to the angio suite! (although surprises are always fun!) All our outpatients, of course, also have charts that are made up the day before they come. We also have standing orders for the majority of things we do, so we can automatically go from there. Much easier! Also, experience will be your greatest tool in helping you all decide what will work and what won't work in your specific circumstances. Every place is a little different. Don't be afraid to try a system and if it doesn't work, throw it out or redesign it. That's how everybody's systems started. And don't let the IR intimidate you. Dianah's right -- they want things to work but generally don't have the slightest idea how you organized it! Good luck