MD rounds w/nurses..what should I mention

Nurses General Nursing

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Specializes in cardiac rehab, medical/tele, psychiatric.

I work on a medical/tele floor and we meet w/the Hospitalists and caseworkers in the morning to discuss patients. I am new at this and some of the issues I do mention are: any changes overnight, abnormal labs, DC plan, IV fluids, anticoags.

I am trying to be more effective in my reports, as I always fel like I am missing something. Should I focus on the persons DX to try to figure out what needs I should address? Is there a checklist I should use? Any help would be appreciated from those of you who have more experience!:heartbeat

Specializes in ICU.

The SBAR communication tool is excellent for helping you organize your thoughts and keep to the point. I believe an actual SBAR form can be downloaded off the internet, but I'm sorry, I don't know of a website offhand.

S - Situation- what's the main problem?

B - Background - events of hospitalization, relevant to the present

A - Assessment - include vitals, physical assessment

R - Recommendations - what do you think the pt needs?

I've found that MDs like the facts without alot of extras, and this communication tool keeps me on track. With practice, you'll get more comfortable with it.

Specializes in Mursing.

Any links to the SBAR thing?

Specializes in med/surg, telemetry, IV therapy, mgmt.

If this is your first rounds, ask the attendees what information they what you to give. They will tell you. They usually want the info passed to be concise and to the point so things can move along.

Specializes in Med/Surg, Geriatrics.

You also need to mention issues that might be relevant to discharge that you might have noticed: will this person be safe at home? do they have mobility issues that may need to be addressed with PT prior to d/c? Are they knowledgeable about their medications and plan of care? do they have adequate support systems? These are things that should be addressed soon in the hospitalization and not on the day of discharge or worse, not all all.

Specializes in ICU.
www.ihi.org has info on the SBAR. You have to register, but it's free.
Specializes in Burn, CCU, CTICU, Trauma, SICU, MICU.

- anti coags

- ulcer prevention

- fevers, vs, last cultures, etc...

- lines that you may have, may need or may need to be changed. know when they were put int.

- pain relief, sleeping agents, anti-anxiety meds, anti-emetics, tylenol, stool softeners, etc.. prns that you may want

- pt/ot orders

- diet orders or changes, protein supplements or fiber, dietary consults...

- dc plans, help at home, medical equiptment they may need, assistance at home, placement if they can not go home, their ability to do their adl's independently as well as addressing any memory problems that may go along with that...

- family concerns, that the md may need to speak with the family. have their contact info available

- lab results over night, do they need blood, do you need electrolyte replacement orders

- skin issues, any breakdown? incisions? drains? anything look infected or need to be addressed?

- get results from any scans that were recently done for your own records and for report

- incontinence problems, do they need a foley or a condom cath, is their stool too runny and do you need to send a cdiff, can you take out a foley they may no longer need, etc...

- do you have any meds, narcs, whatever that need to be renew'd or may be ready to be dc'd? do they still need ivf? do they look dry to you and do you think they may need more fluid?

If this is your first rounds, ask the attendees what information they what you to give. They will tell you. They usually want the info passed to be concise and to the point so things can move along.

Excellent advice. I work LTC which is a whole differnt ball of wax. Some docs want everything spoon fed when they come in. Others just take the chart and go. They ask questions as needed. A few need babysat and pages turned for them, but for the most part...I go with what they want/ need.

Specializes in Psych.

Wow, after five years in NZ, I would probably keel over. I worked in one of the largest and best known ICUs in NZ and all we ever got was, "Anything out the tube?" Once I got, "This patient does not have TED house, shame on you. You know better than that!" This was in front of ten people and It was less than an hour into my shift. wish that was the worst story I had. I am envious and miss the days when I was actually expected to give some input.

On a tele unit, I would focus on BP, rhythm, rate, ectopy and responses to meds. Use of NTG and response. Weight, I/Os, lungs sounds and RR rate and characteristics, and edema. Relevant labs (electroyltes and trops) and activity tolerance. I find most docs are most concerned w/ chest pain, use of NTG and ectopics as well as activity tolerance.

This has made me think, as I said, it has been a long time since anyone asked for my input or listened when it was given.

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