How does your unit make sure tasks are done?

[pernella]

I work on a step down unit that is notoriously disorganized. We've been through multiple managers (probably a large part of the problem) and our new manager, who's new to managing, is asking the senior nurses on the floor for help getting us all on one page. Administration has been implementing/changing policies frequently, it's hard to keep everyone up to date on what's new and make sure they remember to follow through. Example: We have a new policy where if we get a transfer order but no bed is available the status changes automatically after two hours. That means we have to note all transfer orders even if they haven't left the floor. I'm totally guilty of forgetting this myself. When the patient finally gets to med/surg we get complaints that the transfer orders were never noted.

We've done weekly updates, checklists, posted signs in break room and at the station,meetings, ect but for every new task we're asked to do, we forget something. Other floors are keeping up, in fact they're the reason we're realizing how bad the problem is. Every time we forget they complain to their manager who then complains to our manager. I can't figure out what they're doing differently and I've asked nurses who work on floors who very consistent as far as keeping up with changes. I need help helping my floor.

[evolvingrn, BSN, RN]

pehaps you need a team responsible for implementation. For instance once a month that team would do audits of charts of pts that were 'overflow' to see if transfer orders were noted/released..... If the charts you get were done correctly they get a note celebrating their great charting if they don't do it you send a reminder.... if this happens more than once they sit down with a clinical documentaton specialist to review... (won't do that more than once) there are other ways to do it....but those kind of things reinforce in peoples minds the new policies....

[honeykrown, MSN, NP]

We do chart audits and all that and since our charge for the most part has no pt's, its their duties to remind the nurses what they are forgetting. Also we have a check list of duties for the charge to do which include looking at new orders for each pt and making sure they are completed.

If your unit could implement a charge nurse like this i believe things might run smoothly for teh first few months till everyone gets it.

[Sandwitch883RN]

We have a charge nures checklist that it to be completed per shift. On the checklist we assign "housekeeping" duties to each nurse on the floor such as stocking rooms, checking off crash cart ect. On of the checkoff duties for the charge nurse is also a sheet to track that care plans are implemented on each patient upon admission and updated on each shift. We started using a new charting system and we were forgetting to sign care plans. The checklist has corrected that problem because if its not done the charge nurse is "counseled". It's working great for now.

[Sandwitch883RN]

Oh and to add one more thing....Each time a new policy is presented or existing policy modified a copy is placed in the charge binder along with the checklis the charge nurse does and each staff member has to read and sign it. That way we all know of the revisions or new policies.