Kardex for shift report?

[KatRNC]

I think I asked this question a while ago, but I didn't get too much back from members, so I figure I'll ask again. What kind of "kardex" to you use in report, if any, and what types of specific information is on it? I was used to the kardex being used for charge nurse to charge nurse report in my former facility, and the nurses used their own ways of looking at orders, and flow sheets and lab results, etc to give shift to shift report.

My current facility uses the Kardex for shift to shift report. Things like the TPN rate are written there, as well as cycling CPAP to NC timings, and feeding amounts, which change daily (or sometimes more often than that) can be erased and rewritten. My feeling is that if I'm giving report at the bedside, I can look at the tpn rate, and compare it to the orders and don't need to "update" the Kardex with that information. Also, the flowsheet, is looked at, and the Order sheets, and the MAR, so why do we need to be so specific on the kardex? Don't we have enough paperwork to do?

With all the "specifics" on our Kardex, there are never any lab values. I took report a few weeks ago on an infant who had been transfused, and when I asked what the HCT was, I was told the nurse didn't know! I would think that the latest lab values are important to include on a kardex? (and in shift to shift report?) My previous facility had that information on the flow sheet. The facility I'm currently at is trying to come up with a new Kardex, and after months, we seem to be no closer to finding what works for us. Any suggestions or examples would be greatly appreciated!

Thanks!

Kathy

[Julie Basilio]

Kardex is just a summary and guide of our patient's progress. In our unit, charge nurses use Kardex for their endorsement (consisting of latest treatment, medications, TPN, feeding and investigations. Yes, you are right latest lab results should be there, too.) Bed side nurses are not encourage to endorse to the next shift by Kardex alone. We encourage them to use the MAR, Order sheets and the actual results of any investigations. Kardex is useful for quick reference. They will just use the kardex as their guide, not to miss anything during endorsement. In our Kardex, we we simply write the name of Medication without dose, frequency ..etc. So that nurse will not be encourage to use it to medicate from - thus avoiding medication error.

[KatRNC]

So, do I understand that you have 2 Kardexes or do the charge nurses go from bedside to bedside for shift report?

[Julie Basilio]

We have to Kardexes. One on the bedside and one with the charge nurse. Actually it is of 2 different format. The kardex with charge nurse is more informative and more detailed. The bedside kardex is just a "skeleton" of the the entire treatment of the baby to encourage the staff to go over the whole file every shift.

[chescat58, RNC-NIC]

We use the computer, we haven't had a paper kardex in years. In the clinical summary we have the history that crosses over from mother's chart (if born in house, if not put in manually), significant events, current meds, current orders, labs results, VS, I & O. We review the variances charted on the assessment and intervention flowsheet (computer), review orders in computer, review of the worklist (computer), review patient goals and shift summary (computer)

[ICURN_20]

In our ICU, we have a template in our clipboard of a head to foot assessment. After the report, it seems like you have a much better idea of the patient you are about to meet and their family. It is updated daily. If you rather want a thorough knowledge of the patient, you can log on online to see his previous labs and test. But in telemetry, they just give you a kardex, MAR and chart to read on then the outgoing nurse will just say, 'oh I fed him already', like you already met the patient so you need to come in like 30 minutes before your shift to write your own notes otherwise you will forget if you have like 5 patients. One patient arrived an hour ago and still need to carry out doctor's orders and your other patient is just being wheeled in to the unit right at the beginning of your shift. Blek! it happens all the time and you are wondering what kind of dance you will be doing for the next 12 hours shift and hoping none of your patients will fall or complain before you have the chance to see or assess them ;(

[dawnebeth]

So, do I understand that you have 2 Kardexes or do the charge nurses go from bedside to bedside for shift report?

Our kardexes stay at the bedside and the charge nurse goes from bed to bed to get end of shift report. She and the next shift charge nurse meet together at the nurses station while the bedside nurses do report at the bedside. We check over the mar together and give a 'star' report, which has a specific order from neuro, respiratiory, cardiac, etc, using the Kardex as a starting point. The bedside nurse transcribes any new lab orders, IV orders, radiology, feeding orders, etc onto the Kardex (aka rand card) but we don't keep the most recent lab values there. Those are just on the computer and can be printed out if needed.

[iteams]

Is there anywhere you can see a sample Kardex online? I'm actually looking for a sample of the old-style paper Kardexes that were used for reporting.

[dawnebeth]

I believe ours was adapted and changed to meet the needs of our unit, since we've had many versions over the years since I worked there. On the front are columns, on the left for lab draws and necessary tests each day with the date. In the middle are regularly scheduled lab tests--either daily or weekly. On the right are x-rays and other tests like eeg or ultra sound. Below that are spaces for all vaccines, eye and hearing exams as well as a small space for baby's and mom's history.

Open up and on the top of the page on the left is a section for all IVs and IV fluids. on the right, opposite is the transfusion section with the feeding area right below that. Under is special instructions for not only feeding, but skin care or any specific care that baby needs--with info on how often to weigh, and head circumference and girth measurements.

Under the IV section is a place listing all vents or machines the baby might have (ET, head cooling, nitric oxide, etc.) and how often to do vitals. Below that is ventilator settings and whether the baby has chest tubes, that sort of thing.

Below that is the baby's diagnosis, parents names, baby's birth weight, birthdate, name, etc, as well as primary nurse, what team the baby is on and doctor's names. There's other stuff, too on the kardex, but I don't remember everything.

[iteams]

Does it have a problem list?

[dawnebeth]

No, our problem list is separate, which we use at the end of shift to identify what needs to be done or was done during the shift and write out a small paragraph on the end of shift section of the nursing notes.

[iteams]

Thanks a ton!