I and Os!

CathyLew · Oct 3, 2009

what I love is if someone doesn't clear a pump....and the next shift just puts in the number, even if it makes no sence at all! a KVO IV that was just put on the patient on the day shift... at midnight they will tally 3100 ccs! because that is what the pump said! gad.

I&O's are a pain, but a very important part of the overall assessment of the patient.

libbyjeanne · Oct 3, 2009

Usually my nurse aids will document my oral intake and output...but if they are too busy or I beat them to it, I will do it.

Whats an acceptable urine output for a 8-12 hour shift? Well, at least 30 cc/hr. BUT if you have given the pt a ton of fluids and they pee the minimum 30/hr, then that would not be a good output.

Yes, I clear the pumps at the end of my shift...anytime after 0500. and yeah I also clear the PCA pumps.

There is nothing more annoying than having the shift ahead of you not clear their pumps...or have their I&Os all out of whack.

chickapea · Oct 3, 2009

what I love is if someone doesn't clear a pump....and the next shift just puts in the number, even if it makes no sence at all! a KVO IV that was just put on the patient on the day shift... at midnight they will tally 3100 ccs! because that is what the pump said! gad.
I&O's are a pain, but a very important part of the overall assessment of the patient.

I'm just curious, what should you do in this instance, clear the pump take the 3100 ccs and divide by the number of shifts in the day that had not cleared the pump? Then you can add your intake correctly, but can't go back and chart the other shifts amounts that were not accounted for??

I and Os are important and so simple, but many times there are lame mistakes that make it more complicated than it should be.

Creamsoda, ASN, RN · Oct 3, 2009

I will be one to say that I do NOT clear or pay alot of attention at the volume infused on my pumps. Reason being, I usually dont look to see what infused on the pump anyway because no one ever clears it. I multiply the rate at which the pump is going x how many hrs I am at that shift and add on any piggybacks. I look to see if the pumps are cleared because I know they usually wont be anyway and I think its more accurate when I add it up myself as far as what I gave/infused on my shift. If you are going strictly by what the pump says, it think theres too much potential for error and not using common sense. Why would you record what the pump said if it said 9052 ml infused? Especially when you know it was only going 100 ml/hr.

CathyLew · Oct 3, 2009

I'm just curious, what should you do in this instance, clear the pump take the 3100 ccs and divide by the number of shifts in the day that had not cleared the pump? Then you can add your intake correctly, but can't go back and chart the other shifts amounts that were not accounted for??
I and Os are important and so simple, but many times there are lame mistakes that make it more complicated than it should be.

Sometimes a pump is put on a patient when not cleared when taken off the patient before. So the pt before may have been getting something at 150cc hr.... pump taken off, cleaned, but never cleared before put on pt #2.

In the case of a wacky number, I would use common sence, and just add up what I see in the chart and in the Dr order for the IV rate. You have a KVO bag labled #1 up.... you know they didn't get 3000ccs.... add up your rate and hrs, and chart that. clear the pump for the next person though!

mamamerlee, LPN · Oct 4, 2009

If your pumps aren't being cleared and/or reset per your hospital's policy then someone needs to bring that up to the appropriate person. Pumps are a necessary evil, and you can't just multiply 100hr x 8 hrs - what if your pump isn't actually delivering that amount? And multiple piggybacks will throw everything off. Whoever places a new pump on a line is responsible for starting the pump at zero. What is so hard about this? How many of the newer nurses out there actually had to count drops per minute with their second hand on their watch?!! I remember having to learn all the formulas - for 10, 15, 60 gtts/ml - and recalibrating everything every few hours! I am thankful for pumps!!!!

nkochrn, RN · Oct 4, 2009

I am SOOOO thankful we do NOT have to count drips, I actually did have to learn to do it, but I'm not sure I could do it right now if someone asked me too;)

If our pumps are shut off and the cassette taken out then the volume infused is automatically cleared.

We record our reports and start doing it an hour before shift change. Our aids do record the outputs, but on night shift we do not have an aid for the last half of the shift so we empty our own foleys and clear our own pumps. I do mine right before I give report.

NeoNurseTX, RN · Oct 4, 2009

We clear our pumps at 0600 only.

ChineseRN · Oct 4, 2009

I used to hate I & O's. But someone showed me their way of doing it smoothly.

Whenever hanging a bag of lets say, vanco, immediately hanging the bag, I go to my Intake and output flowsheet and record, 250mL/Vancomycin. Doing right after hanging something will prevent a headache towards the end of the shift, trying to remember who receive IV med and how much.

For my patients on continuing IV fluids, I do them toward the end of my shift right before giving report. (100cc X12, etc)

Usually my PCA's do I&O for urine/stool output, and I make sure to tell them who is on strict I&O when I give them report. However, my pca'S automatically do it. If I am in the room, and I happen to empty a urinal or foley, whoever empties it, records it.

PCA pumps are hospital policy to be cleared every 4 hours and we pass on a PCA pump flowsheet during report that lasts 24 hours. It is up to the night shift to renew the flowsheet during their shift.

I follow the rule of at least 30cc/hr. Here is where I rely on my PCA's as well. If my patient is an elderly or have CRI, I sometimes say, please watch out to see if she is giving at least 30cc/hr by the end of their shift. :yelclap: Good PCA's have reported to me that our patient have urinated less, and I report it immediately to the doctor. Urine output less than 30cc is very easy to overlook and may be critical. It is very hard to find time to do a simply check during our shift. So pray for great PCA's and urine output!!! :redpinkhe

Good luck!