Published Jan 28, 2003
Our facility is getting ready to break ground this summer for a brand new hospital. The one we have now has been around since Moses disembarked off the ark.... Anyway, administration has been going around asking nursing what needs we have and such...our nurse manager has decided that in the new hospital we will do bedside charting. Also she wants a cabinet in each pt's room (which all will be private :)) for the pt's meds. She says that she had this system at another facility and we need to get this at our new facility. The way she explains it that there will be a cabinet in each room that will contain the nurses' notes, MARS, and the patient's meds. The cabinet will be locked and each nurse will have a key to unlock the cabinet. Our manager thinks this system is the best thing since the round wheel and sliced bread. She said it actually easier to chart at the patient's bedside and to have all the meds there and not have to run to the nurses' station for our meds. Of course, the floor staff is kicking like a mule on this idea...we just don't see how this can work. Anyone out there on the boards have a system similar to what I am trying to describe? If so, can you tell me the advantages and disadvantages of such a set-up like bedside charting? Not one of our staff nurses wants this system, but the management is basically cramming it down our throats...
One of the major disadvantages I see with the bedside charting is when the heck I am going to have a few moments to put my feet up? Not in the patients' rooms. We will supposedly have a pull down shelf to put the chart on in the room to chart. At least now when I chart I can usually get off my feet for 5 or 10 minutes at a time (I do 12's). When I mentioned this little fact to my manager her reply was "Well, it isn't a sit down job anyway."
Plus at medpass time, I find it hard enough now to concentrate on the MARS and I am not even in the room, I can't imagine trying to check meds and listen to family members and/or pts while pulling up 10 or 15 meds that some patients have in the morning. Plus when I have to have drugs double checked with a nurse such as insulin, heparin, and so on. I will have to look for another nurse who will probably be in a room....but all this is falling on deaf ears....
I would like to hear from nurses who have worked with a system like this or a situation similar. Our staff just has a ton of doubts that this will fly but our manager is bound and determined this is what is best for us.....(though she works the floor once in a great while) this is what she WANTS. Tell me about the pros and cons...
We do it this way (everything in the pts room) except the injectable drugs -- & I find it works quite well.....
....fantastic opportunity for pt education re drugs they have been commenced on - gives them a chance to see the packet, identify drugs, & ask questions about their drugs
....I don't have a problem with sitting down to do my notes in the pts room -- again, gives you a great opportunity for interaction with the pt when you are not "busy" doing other things
....I'm sure there must be other reasons, but the boys have just got home after their first day at school, & it is stinking, so I must go for a swim -- will post more as I think of them
Ruth, I have some questions for you when you get a chance.
How many patients do you typically have assigned to you?
What area do you work? Med/Surg, Onc, Telemetry, etc?
If the nurses are in the rooms most of the time, how do you keep an eye on the ones who tend to climb out of bed, the chair or wander off?
About the meds in the room, do you have a drug reference book at each room that you can look up drugs you are not familiar with or need to check some potential interactions? Or do you have to run out to the main desk and get that information?
How much time do you think you spend with a pt on an average? (I know that every pt and family is different but just a rough average on your run of the mill 60 y/o with pneumonia....
This is all I can think for now. I am way too tired to think about any more questions. Thanks again. You have been a great help.
Originally posted by deespoohbear Our facility is getting ready to break ground this summer for a brand new hospital. The one we have now has been around since Moses disembarked off the ark....
Our facility is getting ready to break ground this summer for a brand new hospital. The one we have now has been around since Moses disembarked off the ark....
Oh my...you don't really think Moses was on that ark, do you? :imbar It was Noah, his three sons, and their four wives. And a whole lot of animals...
I don't have any experience with the type of hospital you describe. I think it initially sounds good in theory. But like you said, a central location for charting and meds is more practical. It makes it easier to double check meds with a co-worker, or to look up a med, or to ask a co-worker a question about a med. If I was unsure about a dosage or had a question about a med, I wouldn't want to be looking it up right there next to my patient. And I'm sorry, but the fact that nursing isn't a sit-down job is EXACTLY why I want to sit down while I do my charting, and maybe even have a cup of coffee. And I think it would bother me to have my patient right there next to me, probably talking, while I was trying to do my charting. Just my 2 cents worth.
We had this system at a long-term care hospital during my clinicals (lots of vent patients). Worked well THERE -- but you had to stand to chart at the computer (yuck) because of the height it was when you pulled it down. No interference from family since visits were not as frequent as a short-term care hospital. It was especially handy in the isolation rooms. You do wind up feeling a little isolated from your co-workers, though.
I really have not tried the medication in the room practice, however when I first started to work the floor I found that I had trouble keeping up with charting, coming from home health I was use to visiting and getting to know my patients which is a hard habit to break. Our house supervisor suggested I chart while in the room. This was great, I was able to visit with my patients and their family, chart what I see, (did not have to depend on my often undependable memory) and keep my charting up to date. There are some rooms I would love to leave quickly due to the unpleasantness of the patient, however you take the good with the bad. When patients ask what I am writing, I am tell them I am writing what I see so that the Doctor would know as I am His/Her eyes and ears when they are not available. (only in the mythical perfect hospital) As far as the medications in the room, well, what about the missing medications, narcotics, and prn medications. it doesn't take that long to pass medications (I usually have about 7-8 patients) once the initial assessment is done and my chart is opened everything falls into place, even for this new to the floor but not new to nursing nurse.
When I worked Agency, I worked at a hospital that had that system, except the box was right outside the door. it had a drop down so you could write any notes. Also, you don't have to worry about getting into the med cart along with everyone else who has meds to pass the same time you do. I worked on med/surg with 8-9 patients and it really worked out well. It actually saved me from walking to the med room everytime I needed to give meds.
Originally posted by melissa24 Oh my...you don't really think Moses was on that ark, do you? :imbar It was Noah, his three sons, and their four wives. And a whole lot of animals...
:imbar :imbar :imbar
OMG!! I am so embarrassed. I was really tired last night when I posted that....yes I know it was Noah, his wife, their sons and wives and the animals (two by two)....oh, what a goof....If my pastor found out I would have to go back to confirmation class.... Moses was given the Ten Commandants at Mt. Sinai and broke them when he saw Aaron and the other Israelites worshipping the golden calf.....my Grandmother is probably turning in her grave over that post....:chair:
Now that I have totally embarrassed myself in the cyber world, thanks for replying.....I didn't think about the part about being somewhat isolated from my co-workers.....another point I can bring up to my manager...
Originally posted by deespoohbear Plus at medpass time, I find it hard enough now to concentrate on the MARS and I am not even in the room, I can't imagine trying to check meds and listen to family members and/or pts while pulling up 10 or 15 meds that some patients have in the morning. Plus when I have to have drugs double checked with a nurse such as insulin, heparin, and so on. I will have to look for another nurse who will probably be in a room....but all this is falling on deaf ears....
In one of the hospitals I do clinical rotations in they are trying this on some of their floors. What you stated above is the major complaint of the nurses I have worked with on the floors that have this system. Too many disruptions from pts, family, friends in the rooms. The benefit was supposed to be less time waiting at the med cart for someone else to finish getting their meds, but in some cases (You know how some pts/families can be) it takes more time because of interruptions. And also having to go to the room to draw insulins, then leave the room to find someone to verify, then return to administer. These are on med/surg floors.
And although the majority of the nurses hate this system, the powers that be like it, so it will soon be implemented throughout the hospital.
See that is what we think, but the management who have "sit" down jobs think this is best. Give me a break. I am seriously considering looking for another job because the idea of this just makes me sick. Yesterday morning, I had 50 po meds to pass to 6 patients....(general med/surg/tele floor). I started at 7:30 am and did not get finished until almost 9 am. I don't know whether to be depressed or angry over this idea....
We do what you describe as well, but it's a large ICU and we are always in the patient's room, at the bedside. Aside from the private rooms, each "suite" has 4 beds with a sliding glass door seperating the suite in half into two rooms with two beds each. Our assignments are usually 1:1 or 1:2 depending on acuity. There are always at least two nurses per suite, sometimes 3, sometimes 4. Each 4 bed suite has a pixis and each 2 bed room has a locked drawer for meds not found in pixis (piggyback abx's, IV drip bags, etc.). The drawers are not always kept locked because there is always (99.9% of the time) a nurse in the room (we've gone round and round with this with the state). Next to each bed is a supply cart with everything from finger nail polish remover to IV fluids and tubing to needles and the nuts and bolts of ICU nursing. In theory, this supply cart is also to remain locked, but hardly ever is. The charts and order books are not locked and are kept together in a desk in each room. Each bed has a computer next to it for charting and each computer has a chair. There is also a chair at the desk where the charts are kept. The nurses use their own drug books, the medication profiles in pixis, or the internet to look up drug info (yep...we have unlimited internet access x2 in each room). We NEVER have to leave the room unless we go for a break, use the bathroom, or get supplies that are not kept in the room--and even in this case, we have a supply person on the unit to bring us stuff. We have our share of patients who try and crawl out of bed or try to pull out any one of their numerous lines or tubes. It's good that we're right there--ALL THE TIME, but that's the nature of ICU nursing--to be there ALL THE TIME.
In the very early 70's when our unit was designed and built, it was at the time, an innovative approach to patient care...a vision by a famous cardiac surgeon. I would say one of the downfalls about the setup is that sometimes I don't even know that a co-worker is working on the same night as me unless I run into them in the breakroom (on most nights we use 16-20 nurses). It certainly isn't setup for midnight socializing except for with the nurse in the other half of my suite. But that's really not the idea anyway.
I have absolutely no idea what this setup would be like on a floor unit with heavier patient loads. Our stepdowns or other floors are not setup like this so I don't know if this helps you or not, but I'd just thought I'd share!
Good luck and keep an open mind...are there any committees you could become involved in regarding the change? Maybe your knowledge seeking here can be instrumental in the huge change that will take place in your hospital.
CANRN, MSN, RN
At the hospital I work at, we have our charts, meds, linens, syringes, IV tubing, tape, alcohol swabs, etc all in a cabinet just inside the room, a sink etc is also right there with a stool and a desk. We can chart, in the room but out of site of the patient, get our meds, etc and it's great! They call them "nurse servers" they are stocked daily by our unit hostess. Blank physcian orders, nurses notes, and other chart items and the entire chart are kept in this locked area. Sure saves on the feet! I love it.
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