Learning to manage 2 patients?

Specialties MICU

Published

Hey all! I am orienting to ICU with a few years of Med-Surg/PACU under my belt. This is going to sound silly, but so far I have only ever taken care of 1 patient at a time. Now, I will have to start taking care of 2 patients at a time in order to progress in my orientation. I know all of you routinely take care of 2-3 patients, but I am still slower with my patient care and worried about one of them crashing while I am with the other one; as well as prioritizing two patients' needs. Any tips or tricks that help you keep track of 2 patients? I figured having good, organized report sheets is a given.

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Specializes in Med-Surg Nursing.

You just have to figure out a system to manage your time. And become really good at multi-tasking. If I'm with one patient, I have in the back of my mind thinking what I need to do for the other patient when I'm finished doing what I'm doing with the other. It's gonna take time. And sometimes, the patients crash with NO warning. That's why they're on monitors so if YOU are busy with 1 pt and the other one crashes, your coworkers will intervene on your behalf until you can come take over. At least that's how it works where I am.

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Specializes in CVICU.

If your hospital does not have a walking report element to shift change, I would get in the habit of going into your room and meeting the patient/family and checking your lines and placement of suction, etc. (do this with the nurse from previous shift). This will give you a chance to have a quick visual assessment of the patient and location of supplies and equipment in that room. If the patient is awake/alert or family is present you then have the opportunity to introduce yourself and determine their most immediate needs.

I like to do this because if I get caught up in another room I have peace of mind knowing I already visually assessed both or all three of my patients before I really dive into work. This will help you prioritize care and usually will help get the first hour or so organized a little better.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

A few brain sheets.....

doc.gif mtpmedsurg.doc

doc.gif 1 patient float.doc‎

doc.gif 5 pt. shift.doc‎

doc.gif finalgraduateshiftreport.doc‎

doc.gif horshiftsheet.doc‎

doc.gif report sheet.doc‎

doc.gif day sheet 2 doc.doc

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Thanks for your suggestions! In my facility they do walking report and at first I thought it was awkward but I guess at least you know they're alive and in no acute distress. I really appreciate all the help and encouragement I get here.

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Specializes in Trauma Surgical ICU.

Since you have med/surg and PACU experience this will be easier than you think. The scary part is just taking them on. It will take you longer at first but you will get a flexible system down that works for you. I say flexible because things change and some tasks, interventions need to be done now while others can wait. I tend to get report, eye ball my pts and then get my meds wrote down for each pt and when. I will either assess the most critical first if I have one if not I will assess the pt that would be the fastest, then go to the other. By this time, I can take my 9p meds in and do that with my second assessment. Once finished with this one I will go pull my meds for the other pt and be done for a few, chart both assessments, sign my care plans, check orders then give baths if I need too..

Esme gave great sheets for keeping organized. I don't use those, never have been able too. I take a sheet of paper and fold in half. One half is for one pt and the other side is for the other pt. I write what I need to do, JP drains, dsg changes etc on that and nothing more except the meds and times due. Everything else I need is on the kardex, so no need to write it out..For my urine, I&O's etc I write on a paper towel with the time and room number, when I sit, I chart it and then throw it away.. Strange but it works for me..

You will good at bouncing between rooms. Try to keep things in perspective and prioritize. Don't be afraid to ask for help if one of your pts are crashing or for help in general. Taking 2 pts now will help work out your kinks while you have a preceptor by your side :)

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Specializes in Telemetry, Cath Lab, Critical Care, PACU.

How my day starts when I have multiple patients.

1. Get report and do walking rounds. When I'm on walking rounds I do a quick eyeball assessment of the patient and the enviornment - Airway, vent settings, infusions and rate checks, monitor and alarm limits, safety check for siderails and bed alarm, restraints, etc. Once you get good at it, this can literally take a minute or two.

2. After report and putting eyes quickly on each patient, I look up my labs and write down an initial set of vitals on all of my patients.

3. Now I prioritize who I'm going to medicate and assess first, usually starting with the most unstable. If I have two patients, sometimes one is vented, or both are vented. If I have three patients, the third is almost always awaiting a transfer to step down, so they are always seen last by me for medications.

4. After everyone is medicated and assessed, I begin trying to chart as much as I possibly can to get it out of the way. Usually by now physicians are rounding and almost always interrupt you for their own bedside rounds or with questions on how the previous shift went, so that's why I've made sure to already know my labs and any critical values and have an initial set of vitals documented. Also be able to speak to your assessment that you've done, especially if it relates to neurologic changes, and how it compares to the previous findings.

From there you just have to be flexible because as you already know things can change quickly in critical care!

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