hands on care schedules in your unit

[iyqyqr]

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?

[iyqyqr]

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.).

If you schedule your own kids, it sounds to me like their feeding times would vary from day to day. How do parents know when to come in to breast feed or nipple or even just help with cares a bit for the sicker babies???

[RainDreamer, BSN, RN]

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.

That's pretty much what we do too. I can't imagine having 3 kiddos all due at the same time.

Our feeders are usually Q3 or Q4, depending on what works best for them ..... some kiddos need to eat more often, some need an extra hour in there, just depends on what works for them. If we have a Q3 kid and a Q4 kid ..... and they're both due on the hour, then one of their hours will overlap. So I just start one of them early .... for one care/feed, it's not too bad.

Our NPO kids are Q4.

All of our micros are Q6. We don't mess with them unless we need to.

Sometimes on our gut/cardiac/neuro kids (i.e. the real crab monsters) we'll have orders to "round when awake".

We chart vitals (click the hour on the computer and it's interfaced to come up from their monitor) Q1 hour, for ALL kids.

We know the kids get the right intake for the shifts because we don't take out a feed .... we just move a time around here and there if we need to. So all the Q3 kids get 4 rounds of cares/feeds each shift, all the Q4 kids get 3 rounds of cares/feeds each shift, etc.

As far as how the parents know when to come in ..... that's never been a problem. Usually if we move a time it's not more than a half hour. And it's not like we move them daily ..... usually they'll be on the same schedule for a while. The only time we move their time is if they change up the assignments and we get report from 2 different nurses and have 2 kids due at the same time.

[texas2007, BSN, RN]

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

USUALLY for the ad lib on demand crowd, they will set a minimum amount to take per feed (based on the amount of feeds they usually take) and you have to wake them up after they've gone 4 hours between feeds. If they don't take the minimum the rest goes thru the NG. However, the babies that do get the ad lib on demand status are like 37 weekers who came in for grunting or something not a big deal and since resolved.

[preemieRNkate, RN]

If you schedule your own kids, it sounds to me like their feeding times would vary from day to day. How do parents know when to come in to breast feed or nipple or even just help with cares a bit for the sicker babies???

Well, like someone else said a few posts above, the feeding times don't change to more than a 1/2 hour or so. And many times, the parents will call in the morning and I will let them know that the baby is eating at whatever time. If they come in and the baby is due at 0830, but they want to start them up a early at 0800 it's not a big deal. And we only change the times if we have 2 babies that overlap. I just can't feed 2 kids at once.

[RNin2007]

Ours are staggered...such as 0730, 0800, 0830. I can't imagine having them all due at the same time. It would seem that you would be rushing and could miss something, not to mention like was said above about having time to help a mom breastfeed etc.

[BittyBabyGrower, MSN, RN]

Okay, we say they are on the A schedule which is 8-11-2-5, but if we have 3 on the same schedule then one is done at 730, the next at 8 and the last at 830, so it is the same as you all are doing, but we just say they are all due at 8. We'll just say early A or late A. But, we don't move times around at all. The kids that are due at 11 then you just deal with it being change of shift and finish up while giving report.