Brain sheet for ED?

[SR8811]

Hey friends,

I am in an LPN2RN program, and my preceptorship is in an ED, and I was hoping to get a few of your "brain sheets" to either use or create my own based on them. By brain sheets, I mean the sheets you basically write the patient's info out on during reports and notes throughout the shift.

Also, open for any tips and advice!

The ED is what I am most interested in department-wise, so I am hoping having the ED down as my preceptorship experience will help when it comes to applying for ED jobs. Unfortunately, my preceptorship experience is 1.5 hours away from home, so there is no chance of working there.

Thanks!

[HarleyGrandma, RN, EMT-B]

I don't use a brain sheet; things move too fast. I document in real-time (or within minutes) because traumas come in, and staff gets shifted around. Multiple departments are involved in care at the same time and need information from each other. At shift change, we do a brief verbal bedside report. So much of the ED is gathering information while performing tasks (hooking to the monitor, starting IV) and then quickly typing it all into the computer from memory.

[Wuzzie]

Yeah, I never used a brain sheet in the ED unless you count a strip of 2" tape on my leg with things written on it as a brain sheet.

[SR8811]

Fair enough, thanks Wuzzie and HarleyGrandma.

[JKL33]

Agreeing with those above, "brain sheets" aren't very common at all in the ED. Generally speaking, the pace is too fast for them to be of much benefit.

The report you receive is going to be very concise.

You will frequently reference your ED assignment (e.g., your individual patients' charts) in the EMR in order to keep your workflow going.

Maybe we can help more if you describe specifically what you envision you would put on a brain sheet. Remember, though, there's very little of "X is due at 2100" where having a brain sheet for what you do at hourly times could help you. All ED orders are STAT; they are generally to be completed ASAP in conjunction with the following related policies.

[CTFD_RN, BSN]

Ditto to all of the above. The only time I use paper is either for an SBAR printed on my admitted pts that I use to stay organized on admitting orders or the paper towel I write VS on in my pts room so I don't have to log on to the computer.

[Wuzzie]

Beware the paper towel. I can’t tell you how many times a well-meaning co-worker “helped” me by cleaning up and throwing away all of my documentation. I learned the tape trick during my first round of flight nursing and found it works just as well in the ED.

[Lunah, MSN, RN]

Yep, tape! Don't write on a glove, LOL. I had a bad habit of writing on my arm. But charting in real time is essential! We also used SBAR for hands-off; it's a good format.

[amyjm333, RN]

As a new RN in the ED, I made my own "cheat sheet" - it included all the things I needed to know in order to enter the info into my triage without getting any "hard stops" or things we MUST know to complete the triage screens in our EMR (first net). I would then document on the back of the sheet any meds or whatever else I needed to remember to chart. This is basically what I used. I am now able to recall all of the triage info and just write down VS & any verbal orders the MD gives me when we are both at the bedside. Or I chart at the bedside in real time. It gets easier with experience, but my cheat sheet helped when I was a brand new RN in the ED?

[SR8811]

amyjm333 said:

As a new RN in the ED, I made my own "cheat sheet" - it included all the things I needed to know in order to enter the info into my triage without getting any "hard stops" or things we MUST know to complete the triage screens in our EMR (first net). I would then document on the back of the sheet any meds or whatever else I needed to remember to chart. This is basically what I used. I am now able to recall all of the triage info and write down VS & any verbal orders the MD gives me when we are both at the bedside. Or I chart at the bedside in real time. It gets easier with experience, but my cheat sheet helped when I was a brand new RN in the ED?

Fantastic, thank you! I am well out of my preceptorship now and an RN, but I am now applying to EDs in my area, so this will be helpful once I start! Thanks again!

[Guest219794]

I would strongly recommend not writing down things that can be easily found in the EHR. If you train yourself to look at the paper rather than the computer, it will slow you down and may not be accurate. At least start weaning off the paper.

Most ER nurses don't use them, but when giving a report to a floor nurse using a brain sheet, it is agonizingly slow as I read stuff off the EHR she has access to, and she handwrites it. Also, it is guaranteed to, in the long run, have errors.

[MotoMonkey, BSN, RN]

As a new ER nurse, I do not use a brain sheet when caring for patients, but when giving report to the floor, I find it really helpful to take five minutes (if I have the time) to write out some information in an organized way so that I can give a more complete and coherent report to the floor.

When I write out the info, I use sort of a modified SBAR format. I start with what brought the PT to the ER in the first place, then discuss pertinent medical history or recent events.

Next, I discuss what has been done for the patient; this includes their last set of vitals, the findings of any imaging, labs (focusing on abnormal and pertinent findings), medications I have given during their stay and their response, IV locations if they are on oxygen, and if they will be coming to the floor with an IV infusion continuing. In this section, I will also try to mention how the patient ambulates and transfers.

Lastly, I go over the admitting diagnosis and whether the hospitalist has been in to see the patient (At my hospital, our hospitalists almost always do their initial assessment in the ED and then let us know that the patient is OKed to go upstairs.) In the end, I also like to make mention of any family or friends at the bedside and if they will be accompanying the patient upstairs.

I don't actually have any printed brain sheet to capture this information, but I will start jotting down notes on scrap paper when our ED provider makes the decision to move toward admission.