Efficient assessment and med routine?

[Sjcappello]

For all of my medsurg/tele nurses, I am struggling to find a proper routine (especially at the beginning of my shifts) to be as efficient as possible. Do you like to complete all of your assessments on all your patients first and then come back to all your rooms to perform med administration, OR do you like to bring your meds in the room and perform your assessment all in one go with each patient? What's your routine like with your patients to remain as efficient as possible specifically at the beginning of your shift? 

[Been there,done that, ASN, RN]

I started my shift  by eyeballing  my peeps. Needed to make sure they were okay. Then check their labs and vital signs.  Then  AM med pass with  a full assessment . Worked for me for many years.

[mmc51264, BSN, MSN, RN]

I go in, say hi!, fix the white board and check on pain (ortho/trauma unit). I start with the pts that are awake and ready to start the day (we get some young people and they are not always early risers 🙂 ) 

Do med pass with pain assessment, check drains. After I medicate everyone, I assess later, depending on my assignment. As a day shift nurse, there's meds, breakfast, bathroom, possibly PT/OT so a lot of my "assessing" is done while working with the pt. Dressing changes are usually after noon meds, unless needed earlier. Between 1400-1600 is catch up charting b/c that seems to be nap time. 

I think your pt population will dictate your schedule somewhat. 

[Emily E]

What's your ratios? When I was on a unit with 1:6 I looked at it like I have 20 minutes per patient to get my morning meds down... that really isn't much.
I always start my day by looking at which patient will be my 'quick' one - maybe they're independent, only have oral meds, young, etc. I try to get 1-2 'quick' patients taken care of before I go to my patients that will likely have more needs/take more time. 
I look at PRNs, what have they been getting lately? It's usually easy to stop by the room to ask if they are in pain, make sure they have something to drink, etc. Having everything with you when you go into the room is key - I found I lose a lot of time going in and out of rooms to grab things. 
What does your assessment look like? Theres probably some things you can trim down on - I usually go to my pts room, start scanning meds, after I ask for pts name/DOB, then I'll ask the rest of orientation questions if it's something that's needed. For your confused 80 year old grandma, of course. Your 25 year old that's already asking about when the doctor is coming so they can be discharged? Obviously they know where they are. 
I give the meds, then do my stethoscope listening, flush IV, peek at their legs/feet. Let them know I'll be back to check on them in a bit. 
I don't do wound dressings till the afternoon. 
If you have 6 or more patients, give yourself a break, that's too many and it's the hospital that sucks, not you. 
Another thing I'll say is you should have one piece of paper that has a schedule with all your patients. I used to use seperate 'report' sheets, then grab a blank piece of paper, fold it into 4 or 6, each box gets room # meds with times and why they're there. That's what I refer to all day. LMK if you want an example I'm pretty proud of how I do mine!