Isolation Rooms and Organizing

[Tolle_lege]

I have recently started working at an LTAC hospital and I am still considered a new grad because I have worked for just under a year. I love the hospital and in fact my preceptor is a great nurse who is very balanced about helping me out and letting me fly on my own. One thing that I am having a lot of difficultly with is working and organizing my time in isolation rooms.

I took three patients today, one was a vent who was being weaned on CPAP for the first time, and one on trach mist with frequent desats and a weaned patient with a healing trach wound, both taking some meds still through the G-tube. Each one was an isolation, two with AC/HS accuchecks with Levemir and sliding scale insulin and two on Q 6 hour vitals, which nurses are asked to do, not CNAs.

I find it very difficult to get my vitals, accuchecks, insulin and 730 meds(and everyone has them!) done before 8:00! My day is filled with daily wound changes and meds and my beeper going off every time someone has a decrease in HR or SaO2! How do I organize my time? We do not do charting by exception and everything must be checked or filled out and by 9:00 I can't remember who is who, and when I try to stop and gather my thoughts, alarms start going off and my pockets are buzzing and I feel like I just can't stop and think, I have to go react!

I know it will get better with time, but right now I feel so disorganized! Any helpful tips?

[nygirl1986]

i'm a new grad too, and i am totally with you on this time management thing!! it feels like it's impossible to find time to get everything done (much less find time for "breaks"...whatever those are, or even time to pee!! lol)....but honestly, the amount of things you think are going to get done before 8am seems a little unrealistic ! when you say you need to get vitals, meds, check blood sugars and give insulin, and do a full assessment by 8am...i'm assuming you start at 7?! i don't think it's possible to get all that done before 8, i don't care how good you are!! granted some days are going to be better than others...but i work on a step down unit and we take 4-5 pts on the day shift (i work 7am-7pm for now).....we don't do our own vitals or accuchecks and i am still lucky if get all that stuff done on time! esp through in pts on isolation...forget it. by the time i gown up, wash my hands, wipe down any equipment we have no choice but to bring in because they don't have their own personal one....i dunno. i just think that it seems like you're putting too much pressure on yourself to get a ton completed in a short period of time!

[Tolle_lege]

I've given up on the full assessment by 8! I try to get as much info in report as possible (have a great cheat sheet) confirm things as I go in and out. I try to listen to lungs and heart while doing vitals and check radial and pedal pulses, look at skin and capillary refill and grip, look at their eyes for pupil reaction, etc. But I will think I am having a great morning and then blink and its 9:20 and I still have 9 meds on 2 more patients- and then the alarms start going off! Oy vey

[Virgo_RN, BSN, RN]

Do you have a good worksheet? That would be the first step. Write down all of your meds and treatments on your worksheet, and try to cluster your care so that you are doing as many things as possible for each patient with only one trip into the room. Make sure your worksheet has space to jot notes so that if you cannot chart as you go, you can go back and chart later and still remember what you need to chart.

Don't get caught up in planning your entire shift ahead of time. Keep things general enough that you can be flexible when things happen that throw you off track.

Triage your care. Assign priority levels to everything that you need to do. For example, things that absolutely must happen at specific times, put a star next to. Things that should happen, but can happen within a time range, put a check mark next to. Things that you should do, but the world won't end if you have to pass it on to the next shift, put an X next to.

Take time once hourly to just stop. Finish up whatever task you are in the middle of, and go somewhere quiet for a moment to just review where you are; what's been done and what needs to be done, what you are behind on, what your priorities are, and what you might need to let go of.

[CABG patch kid, BSN, RN]

I agree with the person who said do as much as possible when you go in a room. When I worked on a tele floor and juggled more pts than I do now, I would first look and see who had meds due before I went in a room. Gather your accucheck supplies if one is due along with meds that can be given. Go in, do vitals, full assessment, check blood sugar and give the meds that you can. Then go get your sliding scale coverage if needed, then move on to the next one! Always prioritize who you will see first (most sick pt, newest admit or pt that you did not have the previous day and don't know yet, etc.)

Things will come up that throw you off kilter, that's a given in nursing! You may not get all your stuff done on time or you may not be able to sit down and chart right away (I don't chart until I see all my pts, do their assessments and all the major "to-dos" like stat labs are done). Oh, and isolation rooms will ALWAYS take up more of your time, I don't care who you are! Just the act of gowning, gloving, etc before going in and taking time to really wash up good on the way out will take up more time. Make sure you have everything you need before you go in and always try to cluster your activities as much as possible; actually that will save you time, iso pt or not, lol.

Good luck to you, it will get easier with time and practice, have fun out there!

[aCRNAhopeful]

Everyones ideas are great so far. One thing that has helped me to better my time mgt has been to get the assessment charted ASAP. Now that may or may not make sense for you based on what demands are placed on you by your specific unit but for me when I have 3 patients thats has been the best. Usually go see the sickest pt, ensure all is OK, assess and check outputs, etc. and then chart it. I will have also laid my eyes on my other patients to make sure theyre OK. I then work my way to the next and repeat the process and by the last patient its time to give the morning meds. Then I give the meds to that patient and work my way back. After that its time to see what the docs have had to say and just keep running and prioritizing. But, if I would try to do all AM meds and assessments, and whatever else pops up while I'm doing that then I wouldnt remember who is who by the time I went to chart. So that may be another option for you to try to chart the biggest stuff right away so that you cant fall as behind when something new comes up.