hands on care schedules in your unit

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I'm curious about how other units schedule feedings and hands on care. My unit has all 3 hour feedings done at 8-11-2 and NPO stable kids are done at 8-12-4. We have some demand feedings, but not usually. So, if you have a row of three feeder/growers you're trying to help 2-3 families at the same time. We rush to get all the kids done in a timely fashion and then sit around till the next round. Criticals are on the same schedule. I think it makes much more sense to stagger cares and have one due at 8, one at 8:30, and one at 9. I have worked in units that did that and liked it for many reasons. What do you do in your units?

Specializes in NICU.

Oh my goodness you guys are making me appreciate our set up so much! We don't make parents leave the unit for report, which I do know is a little bit of a concern. We have potential for changing shifts 5 times per day as our manager has pretty flexible scheduling options. We try to take ourselves away from any nearby visitors to a nurses desk or other private place, especially with sensitive information. We aim to start all our cares prior to the hour so that you're done at the hour except with feeding if they're bottling or breastfeeding. Then if parents are there, they can work on feeding while you step away to give report. If they're not, then you can give report while bottling the baby. I really like to chart right when I'm doing things or right after, so I like that I usually have some downtime after each baby to finish charting and do miscellaneous things until the next baby. That time gets squeezed out if you have three bottlers. For Level 3 kids, we do chart HR, RR, BP if they have an art line, and isolette and skin probe temps every hour, but only do hands on vitals usually q3h or q4h, and less if your good judgement tells you to keep your hands out. The kid stays on a steady schedule so parents have consistency of knowing when to be there if they want to be involved with cares. This generally seems to work really well. Occasionally you don't get a kid on each hour if you have three, and it's a bummer if you have two on the hour you give report, but something usually works out where someone can help or on of your kids can be done a bit early.

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Specializes in OT, Palliative, ICU, NICU, Wound Care,.

We are very lucky in our unit to have an amazing Neonatal PT who has sucessfully promoted cue based cares which will often co-incide with feeds. Our care is individually tailored for each baby. I cannot understa nd there would be any benefit from scheduled feeds - reminds me of the old days when adult wards had obs rounds!! Didnt scheduled nursing care lose favour years ago. Sounds highly militant and also highly busy at certain times. What about those infants around 34-37 weeks who are learning to breastfeed and also have top ups...how do they fit in? Pretty all our babies reach a 'demand' feed state before discharge.

With our VLBW infants we try to have as little 'hands on' as possible. Sometimes we cluster care but at others they dont cope so it is done bit by bit.

As nurses it is our job to work out the best plan for the baby and how this baby copes with our interventions. If this means less hands on...or demands then we should be advocating this.

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Specializes in NICU.

As many others have stated, we stagger our feeding times. Either 8-11-2-5, 9-12-3-6, or 10-1-4-7 (with vitals being done every 6 hours at 8-2, 9-3, 10-4). We try not to have too many babies due 10-4, because feeding right before shift change isn't fun. But depending on the rest of the assignment, and on the parents, sometimes it just happens. We always try to work a baby's schedule to what will work best for the parents. If they can only come in at night for the 2100 feeding... then we adjust the schedule to make that work.

When we have q4 kids (ad lib usually), they are either 8-12-4, 9-1-5, or 10-2-6 (w/ vitals being done every 8 hours).

Staggering this way works out pretty well. Sometimes you will have 2 babies on the schedule the way the assignments work out, but it's usually not too bad. When we mix our q3 kids w/ our q4 kids you have some overlap as well, but once again, usually not too bad.

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Specializes in Level III NICU.

We pretty much schedule our own kids. There's no way you can feed 3 kids at the same time. So we usually do 0800, 0830 and 0900, ending at 0930. We don't feed Q3 kids at 10 because then they would be eating at shift change. Sometimes if you pick up from 2 nurses, you'll wind up getting report on kids that are both due at 0800. Someone gets pushed back to 0830. Not a real big deal. Sometimes we have kids that are on demand. Usually the FT 48 hour r/o sepsis kids or a baby that is nearly out the door. Never fails, they always want to eat as soon as you start to do up your other kid.

If the baby is NPO, we do Q2 vitals off the monitor and Q4 hands-on rounds. Sometimes with a micropreemie or a real sick kid, I'll do Q6 hands-on and then vitals however often required (Q1 or more frequently if on pressors, unstable vent, etc.).

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Specializes in NICU.
Our care is individually tailored for each baby.

Haaaahahaha, imagine basing care on what the baby needs! Heeeeheeehee! ::wipes away tears of mirth:: That's funny.

Sorry. I'm not, uh, bitter about the state of developmental care on my unit. Not even a little bit.

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Specializes in NICU.

omg I would hate it if someone told me that a baby HAD to eat on a 8-11-2-5 schedule! or 9-12-3-6....seriously? What about devoting time to do a GOOD assessment? You can't assess two kids at the same time and feed them appropriately!

Basically in our unit we have q2hr feeders, q3hr feeders and then in the "level 2" part we have q3hr and demanders...it doesn't matter if they are PO, PO/NG or strictly PO.

My kids are staggered so that I have at least a 1/2 hour to devote to each of my two or three patients.

Full assessments are done q6hrs. For an "demander" they are done every other feed, and we don't let babies go more than 4-5hrs w/o eating.

Yes, first thing in the morning I do a "safety check" for each of my babies. I hardly ever make my schedule out so that I (or the next nurse) get stuck with at 7 o'clock feeding. And usually you follow the schedule the previous nurse had!

Today for example, I had an NPO, and two q3hrs.

My NPO assessment was 8 and 1400 with "off monitor vitals" q2 between.

My other two kiddos ate at 8:30 and 9 schedule.

At 1700 practicioners decided NPO kiddo could eat again, so she got back on her q3hr schedule starting feeds at 1700. I did a quick assessment, but she go t afull assessment at 2000 and now that assignement has a 8, 8:30, 9 feeding/assessment schedule!

Hope I didn't ramble, but this is how it was done where i work now and at the two hospitals prior to this.

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Specializes in NICU, PICU, educator.

You don't do them all on the same time, you couldn't do that....that is a guideline, we start earlier and have plenty of time to work with the kids. So our 8-11 etc kids are just like your on the half hour kids.

For our ngers, we only wake them up every other feed, NPO's are every 4-6, depending on what they are NPO for.

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Specializes in Level II & III NICU, Mother-Baby Unit.

No schedules where I work either. We just try to not have the babies eating during shift changes so we can give them our full attention as they eat. I like it this way much more than scheduled feedings. More developmentally friendly for the babies and for the parents too.

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Specializes in Neonatal ICU (Cardiothoracic).

So for those of you who have no set schedules, how do you determine whether your baby is receiving the correct TFL/caloric intake?

And does your management/policy back you up on this?

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Specializes in NICU.

I like the schedule for a lot of reasons, but my big two - #1 being that it's the way I can monitor/assure intake, especially across shifts, and a HUGE #2 being that my parents know when things are happening for the babies, so they can make sure to be there for kangaroo, hands-on help, etc.

We do have ad lib/demand feeders, but those kids are usually pretty close to going home. Some of my smaller babes would go all day without intake, if I waited for them to act like they wanted to eat.

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Specializes in NICU, PICU, educator.

I think that wires are getting crossed....we aren't just talking about kids that are on the way out, these are still under fullterm kids that need x amount of fluids/cals, right?

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Specializes in NICU.
We are very lucky in our unit to have an amazing Neonatal PT who has sucessfully promoted cue based cares which will often co-incide with feeds. Our care is individually tailored for each baby. I cannot understa nd there would be any benefit from scheduled feeds - reminds me of the old days when adult wards had obs rounds!! Didnt scheduled nursing care lose favour years ago. Sounds highly militant and also highly busy at certain times. What about those infants around 34-37 weeks who are learning to breastfeed and also have top ups...how do they fit in? Pretty all our babies reach a 'demand' feed state before discharge.

With our VLBW infants we try to have as little 'hands on' as possible. Sometimes we cluster care but at others they dont cope so it is done bit by bit.

As nurses it is our job to work out the best plan for the baby and how this baby copes with our interventions. If this means less hands on...or demands then we should be advocating this.

How do you deal with infants who are too sleepy, sick, or preemie to waken on their own to give cues that they are hungry? Many gavage feeder are like that. How do you manage their cals and fluids?? I'm very supportive of developmental care and feel we disturb infants way too much, which interrupts HCG and growth, and I would love more info on how you make this work in your unit.

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