admission process

[kaibigan]

it's me again,

i would like to know how each different hospitals or NICU from different places do their routine admission. will there be any variation on how we admit babies or everything even from different places will be of the same NICU admission care practice?do we realy do the admission assessmet from head to toe or from A,BC's prioritization? what kind of forms do we have to usually fill in? has everyone use the UOC (units of care) or do you use something else? from L&D to NICU, or from Nursery to NICU can someone tell me how he/she admits the baby?

i hope my question is not vague that you can get what i mean and be able to get answers or responses. thanks a lot!

[Gompers, BSN, RN]

I have no idea what UOC is - never heard of it before today - can you explain exactly what it is?

We do the same thing for all babies regardless of why they're being admitted - it's called a Newborn Admission Database. The first part covers things like date and time of ROM, birth, and nursery admission. Also Apgars, initial vital signs, pertinant history of mom and baby. Then there is a form for the initial assessment - it's about a page long and very detailed, but the choices are all there and you just circle them so it's very fast to fill out.

Other than that, everyone gets a MRSA swab, a foam ID band with their plastic ones are taped to the bed, and identification Polaroids taken. Everyone gets Vitamin K, of course.

Everything else depends on what the docs order as far as labs, nutrition, IV fluids, respiratory support, medications, etc.

The vast majority of our admissions are NPO, started on D5W (if under a kilo) or D10W (over a kilo), get a chest and abdominal X-ray, and have the same admission labs: type and screen, CBC, blood culture, ABG, and glucose. If the CBC shows a left shift or if the baby is clearly very premature or sick or mom had s/s of infection - then they're started on amp and gent as well.

If it's a sick baby, all we concentrate on is getting the baby stabilized. Usually with those kids first we get them stable respiratory-wise, then as soon as that happens the docs will thrown in umbilical lines and we'll start fluids. Only at that point will we worry about head-to-toe assessments and paperwork.

[BittyBabyGrower, MSN, RN]

Every admission is the same, regardless of size, age. We get the kid, check the bands, sign off the transfer note, weight the kid, put on RW and place on monitor, BP cuff, pulseox, start an IV unless the baby needs lines. We do our admission VS Q15 minutes x4, then Q30 minutes x4 then Q1 hour x2. If intubated they stay at Q1 hour x 24 hours, if not intubated, then Q2 hours. If they are feeding, then it is with their feeds (like the big kids we get from the nursery). We check glucose on admission, then 2 hours later then 4 hours later (more frequent if it warrants it). For most of our kids they get a septic workup (CBC/Diff, type and cross, blood cultures), started on Amp and Gent. Most kids get an IV, we usually start with D10 with 1.5 Ca Gluc unless they are really small and need more Ca to the bag. Full Termers usually just get D10. If they need lines, the docs place those and then we order the x-rays.

As far as paperwork, we do an admission assessment (we have a form that goes from head to toe...we just check and fill out what we need to), put down our nursing problems, make sure we do a pain check, and do a psycho-social sheet (this is when we also get the name of the SO, and visiting grandparents), this has to be down within the first 24 hours unless mom is really sick and there is no SO. We fill out the Kardex also. We have preprinted admission orders, so the docs just fill in the antibiotics (they are responsible for sending the order to pharmacy...we have to have them administered within one hour of admission), check off what we need to do. ONce we get all this settled we put the kid to bed, always in the same spot he/she is admitted to.