Help with organization

best tool i used was a matrix--pt names down the left (horizontally) with the long side being every hour of my shift.

i'd code blood and labs in red, meds in green, tests due in blue, special vs requirements; etc (no right or wrong way to do this)

line thru and time when done--gives you an idea of what you know will happen, allows you to plan best you can, knowing that there will be an admission or problem (or lots of both!!)

hope this "old school" tip helps some..

I am still in the learning curve as far as organization is concerned, but here are a couple of things I learned/developed.

One, before I get report, I make up a sheet (just one) that I fold so that each section is for a different patient. I put each pt's sticker on their section. I put them in order of room number.

When I take report I put their info in their section. Some hospitals/units have these printed up, which is handy but until you get to know where each tidbit goes, you spend more time looking for the place to write the info and less on getting the info. At the beginning, it is much more important to get the proper info.

The next thing I do is draw my medications. I know we are supposed to draw one patient at a time, but I have not seen that done yet and between various hospitals through different agencies, I've had the opportunity to watch a lot of "seasoned" nurses. I got a plastic tray, one of those kind that you can use to organize your drawers? Then I used the twist-tie material that comes on a spool and separated off six sections (I never had fewer than six patients--lucky you with only four or five! yea!). I used insulated coffee cups (proper term escapes me now) and wrote room numbers (not names) on the same place on each cup. The next time I worked, if I got different rooms assigned to me, I turned the cups a quarter turn and used a different color to write in those room numbers. The large-ish coffee cups make it possible to keep your meds for each patient in their own cup instead of falling all over the place and possibly getting mixed up.

Plus, when I pulled meds, I took out that patient's cup only. That way I could not make a mistake and put it in the wrong cup.

I secured my meds and went to see my patients. Introduced myself, did a once over, asked how they were, how their pain was, etc., and if there was anything they needed. I wrote on my little sheet of paper the findings of my once-over. Also put vitals on there and their pain info.

Went back, got the first patient's cup of meds and went to give them.

In between giving meds, I did my paperwork.

As I said, I am still in a major learning curve, probably will get bonked on the head by someone for telling you something that isn't right, but at least we have the discussion started!

Thanks for this thread....

best tool i used was a matrix--pt names down the left (horizontally) with the long side being every hour of my shift.

i'd code blood and labs in red, meds in green, tests due in blue, special vs requirements; etc (no right or wrong way to do this)

line thru and time when done--gives you an idea of what you know will happen, allows you to plan best you can, knowing that there will be an admission or problem (or lots of both!!)

hope this "old school" tip helps some..

what a great idea! thanks!

I am still in the learning curve as far as organization is concerned, but here are a couple of things I learned/developed.

One, before I get report, I make up a sheet (just one) that I fold so that each section is for a different patient. I put each pt's sticker on their section. I put them in order of room number.

When I take report I put their info in their section. Some hospitals/units have these printed up, which is handy but until you get to know where each tidbit goes, you spend more time looking for the place to write the info and less on getting the info. At the beginning, it is much more important to get the proper info.

The next thing I do is draw my medications. I know we are supposed to draw one patient at a time, but I have not seen that done yet and between various hospitals through different agencies, I've had the opportunity to watch a lot of "seasoned" nurses. I got a plastic tray, one of those kind that you can use to organize your drawers? Then I used the twist-tie material that comes on a spool and separated off six sections (I never had fewer than six patients--lucky you with only four or five! yea!). I used insulated coffee cups (proper term escapes me now) and wrote room numbers (not names) on the same place on each cup. The next time I worked, if I got different rooms assigned to me, I turned the cups a quarter turn and used a different color to write in those room numbers. The large-ish coffee cups make it possible to keep your meds for each patient in their own cup instead of falling all over the place and possibly getting mixed up.

Plus, when I pulled meds, I took out that patient's cup only. That way I could not make a mistake and put it in the wrong cup.

I secured my meds and went to see my patients. Introduced myself, did a once over, asked how they were, how their pain was, etc., and if there was anything they needed. I wrote on my little sheet of paper the findings of my once-over. Also put vitals on there and their pain info.

Went back, got the first patient's cup of meds and went to give them.

In between giving meds, I did my paperwork.

As I said, I am still in a major learning curve, probably will get bonked on the head by someone for telling you something that isn't right, but at least we have the discussion started!

Thanks for this thread....

I'm horrified that you are allowed to dispense medication like this!!The potential for med errors is huge.

I'm horrified that you are allowed to dispense medication like this!!The potential for med errors is huge.

I believe I predicted a bonk on the head, didn't I? I certainly hope you can be a little more detailed, nightmare, giving support, encouragement and ideas, instead of useless emotional criticism? Afterall, one new nurse and one fairly new nurse, open and admitting that we need help, and talking about how we are doing things now.... I cannot think of a less useful response! But I am willing to give you another shot at it, if you would be kind enough to share how you do things.

This is the way I was taught (once out of school), this is the way I have seen nurses administer medications in every single setting.

Except they use the little cups, carry them in their hands or pockets, and, IMHO, that makes it pretty dangerous unless they go med by med according to the MAR. I have seen nurses open medications in the med room instead of the patients' rooms, administer without the MAR in front of them. I figured I was improving on their systems.

I neglected to mention that (I thought it was obvious), meds are administered at the beside, with the MAR open and available to be referred to, after checking the patient's ID and the medication, dose, route, time, etc. on the MAR.

Also, again, I thought it would be obvious, but let me add that I never open a medication dose pack until I am with the patient, I say the name of the med out loud and I engage the patient in a discussion of the medication's purpose, side effects, dosage, etc. at the time of administration.

I cannot imagine why there is "horror" unless you thought any of us took the med to the bedside outside of a labeled sealed container. In the US (maybe there too, I don't know) meds come out of the pyxis in individually sealed and labeled packets.

Actually, I think the potential for med errors is minimized with my method of the cups, MAR, etc. The only way that I have seen that is safer is using a COW (computer on wheels) with the drawers underneath, one drawer per patient--which is a lot like my one-big-cup-per-patient, and scanning the patient's bar code with the bar code on the med.

Horrified? Seems not only a little strong but inching toward being offensive....

Can you find a more constructive way to respond? Maybe with your suggestion of how meds can be given more safely, given the situation here which is one pyxis for six to ten (or more) nurses, and all the patients' meds due at roughly the same times? And don't forget the time involved in verifying, teaching at the bedside, etc.

Thanks, nightmare....

I also use a grid with all my patients down the left side and a column for each hour. I am less likely to forget to do things this way. At the beginning of my shift I put in meds, blood sugars, vitals, dressing changes etc along with a box next to them to check off when completed. I also use this method to make notes of things that happen. If I call a doctor about something or take a blood pressure or dc a foley etc. That way if I get busy and have to do my charting later, I can remember times that things occured. You could also use a spreadsheet program to make up a customized one. If all patients on your floor get q4 vitals, you could put that on there for example.

I use the matrix like BLUERIDGEHOMERN describes. Caution: Be sure to discard in appropriate HIPAA receptacle when done with shift.

i use the matrix like blueridgehomern describes. caution: be sure to discard in appropriate hipaa receptacle when done with shift.

great point-pre-hipaa we just tore them up and trashed them--a big :nono: now!!

i believe i predicted a bonk on the head, didn't i? i certainly hope you can be a little more detailed, nightmare, giving support, encouragement and ideas, instead of useless emotional criticism? afterall, one new nurse and one fairly new nurse, open and admitting that we need help, and talking about how we are doing things now.... i cannot think of a less useful response! but i am willing to give you another shot at it, if you would be kind enough to share how you do things.

this is the way i was taught (once out of school), this is the way i have seen nurses administer medications in every single setting.

except they use the little cups, carry them in their hands or pockets, and, imho, that makes it pretty dangerous unless they go med by med according to the mar. i have seen nurses open medications in the med room instead of the patients' rooms, administer without the mar in front of them. i figured i was improving on their systems.

i neglected to mention that (i thought it was obvious), meds are administered at the beside, with the mar open and available to be referred to, after checking the patient's id and the medication, dose, route, time, etc. on the mar.

also, again, i thought it would be obvious, but let me add that i never open a medication dose pack until i am with the patient, i say the name of the med out loud and i engage the patient in a discussion of the medication's purpose, side effects, dosage, etc. at the time of administration.

i cannot imagine why there is "horror" unless you thought any of us took the med to the bedside outside of a labeled sealed container. in the us (maybe there too, i don't know) meds come out of the pyxis in individually sealed and labeled packets.

actually, i think the potential for med errors is minimized with my method of the cups, mar, etc. the only way that i have seen that is safer is using a cow (computer on wheels) with the drawers underneath, one drawer per patient--which is a lot like my one-big-cup-per-patient, and scanning the patient's bar code with the bar code on the med.

horrified? seems not only a little strong but inching toward being offensive....

can you find a more constructive way to respond? maybe with your suggestion of how meds can be given more safely, given the situation here which is one pyxis for six to ten (or more) nurses, and all the patients' meds due at roughly the same times? and don't forget the time involved in verifying, teaching at the bedside, etc.

thanks, nightmare....

my apologies chris. i got the impression that you were dispensing the meds into the cups then taking them to the bedside. not having the same drug dispensing system as yours,all of ours are in the original prescription packets,i jumped to conclusions!!

it is very difficult to do a 30+ med round in time and i've been at it for

17 years! the predispensing of meds is a big no,no here as i'm sure it

is with you..again my apologies for forming the wrong conclusion.we just have to dispense them room by room as we have no other system in use.

I use the matrix like BLUERIDGEHOMERN describes. Caution: Be sure to discard in appropriate HIPAA receptacle when done with shift.

That's why God made the shred box, right? :wink2:

my apologies,chris. i got the impression that you were dispensing the meds into the cups then taking them to the bedside.not having the same drug dispensing system as yours i jumped to conclusions!!it is very difficult to do a 30+ med round in time and i've been at it for 17 years!the predispensing of meds is a big no,no here as i'm sure it is with you..again my apologies for forming the wrong conclusion.we just have to dispense them room by room as we have no other system in use.

apology accepted.

i cannot imagine medications being dispensed without having them in labeled individual packets. some of our medications come that way from the pharmaceutical companies, but most of them are dispensed by our pharmacists into little plastic bubble packs with the name of the drug printed on the paper backing. i think this is cheap insurance considering how much safer it makes giving medications.

still, i have caught the wrong med dose written on the backing, the wrong medication in a particular pocket (not sure how it is in scotland, but here the pyxis tells you what drawer number and what pocket number and then ideally you also read the name of the drug when you remove it from that little pocket; not everybody does). i caught these things because i check the name and dose of the med before i accept it into my patient's "cup."

I work on an ortho floor w/ critical care pathways in place for each type of patient we see. This made organizing much easier for me, but what I did was: I typed up a list of things that most patients needed per shift, including meds, therapies and personal care type items, leaving space for name, room number, diagnosis, etc. Then, at report time each day I make note of the time that scheduled things are due (next IV bag hung, pain med due, etc.) and cross off the list things that do not need to been done for that patient (either already completed or not relevant to their dx). I also add to my list additional assessments or scheduled meds/events that are unique to a specific pt's treatment. Then as the shift progresses, I check things off my list as they are completed, making a note of the time if relevant (and not otherwise already documented on the MAR, etc.) This sheet of paper also make a handy place to quick write down a set of vitals or I&O's if I quickly stop in a room w/o a chart. I have the list condensed to 4 pt/ half sheet of paper (2 front and 2 back) but can use a whole sheet if need be for shifts w/ 5 or 6 pts. The PP who mentioned using the pre-printed pt stickers had a great suggestion, I'll be considering if I can place those on my sheet - Thanks!

Hope this is helpful to someone!