Better communication, Better Approach to Overall Care...I need idea's/examples

[abbaking]

Any idea's you have - Please let me know. I am a floor nurse on a 26 bed Tele/Med/Surg unit.

I emailed my boss about a significant issue on my unit. There seems to be a backward way of doing things and it really slows things down and puts patients in danger. My boss asked me to consider all things and email her any idea's for improving communication/care. Thats why I need some help.

I work Night shift (1830-0700). Shift change is 30 minutes from 1830-1900. Both RN and PCA staff recieve report at these times but RN to RN and PCA to PCA. I would like to have the PCA recieve report from me (just a basic overview) rather than have them get report from eachother. Having information straight from the horse's mouth is better than possible misinformation from a float PCA or a registry CNA.

Call lights during shift change is a big issue with us - My idea is to restrict visiting hours during shift changes (Honestly, its the visitors that impeed and disrupt the ability to get information). Also have the PCA staff from both shifts available to answer call lights and the unit secretary to assist aswell. We also need to have a sign in the rooms so that patient can see - maybe something in bold red that alerts them to make their wants (not needs) known BEFORE shift change. That would also mean trying as best as possible to medicate for pain, reposition, potty, etc before shift change. Basically to inform the patient to use the call light only if ABSOLUTELY needed during change of shift times (Shortness of breath, chest pain, etc.)

Another issue is vital signs. Currently our PCA does all the routine vital signs Q4. But we only have 1 PCA for 20+ patients. If she is busy with cleaning up an incontinent patients, answering call lights and so on she sometimes forgets to inform me of a patients high BP.

I think it would be safer and easier if, as a part of our initial assessments, that we (RN's) just do the first set of vitals along with everything else - It would be quicker than hunting sown for the PCA. I am not blaming the PCA (I used to be one) but they have told me that they DO look for me or ANY nurse if a patients vital are abnormal but that they get called in another room, or a call light is goiung off, or a patient needs to be cleaned, or a meal tray needs to get picked up, etc.

Dayshift uses cisco cell phones - perhaps we could use them on night shift with RN/PCA staff.

Currently the charge nurses give a private report to eachother in an office. I want to see that change. I want to see them give report on the unit inside the nurses station. An extra set of eyes and hands will greatly help.

Sorry this was long but I needed to describe in detail my ideas.

Any other idea's?

[kcksk]

On our floor the pcas work 8 hr shifts so they aren't getting report when we do shift change. Also, our RNs tape report so we are available to clean up anything, help with lights, etc while nurses are listening to report. Then we are there to answer any questions they may have. We only do vitals q8h unless they are ordered differently on our floor. Hope that helps.

[Nurse Kyles, BSN, RN]

I gather from your message that you do not do bedside report. I am a student nurse, so take everything I say with a gain of salt. Perhaps bedside report would be helpful for you if call lights are an issue. All of the facilities I have had clinical at do bedside (or directly outside the patients room)report. If you implemented this, you might be able minimize your call light issue. You and the other staff (RNs & PCAs) would be on the floor and be able to take care of whatever issue presents. Personally, I think it is rude and not good practice to put a sign in the patients room that they should not call you from such and such time. Hope you can get it figured out!

[clemoi]

Bedside report seems to work really well in the clinical sites I've seen it used. I'm a PCA on a large med/surg floor and the nurses don't do bedside report but I think it would help. I think it's important for a PCA to get report from a PCA because the information they report is different than a nursing report. Also, if the PCA has 20+ patients then they would have to get report from all the different nurses rather than the one PCA he/she is taking over for. I can tell you that at work, I write all my important information on the rounding sheet hanging in the patient's room. That way the nurse never has to call or find me when he/she needs a BP reading or glucose level, it's always written inside the room.