Looking for Flow Sheet Ideas

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Hello,

I am a in line for promotion to Unit Nurse Manager on our sub-acute/rehab floor. There are a few things right off the bat that need attention; INR Flow charting as well as Diabetes Monitoring. Does anyone have any good templates I could take a look at?

Right now on our floor the labs are all done my the nurse manager! This is because the previous NM was on a power trip and di not let her nurses fax/call the MD for anything even INRs! This will change. Also right now CBGs are just marked on the MAR and and coverage given is marked on the MAR in a seperate place. I would like a flow chart where you can see the patients sliding scale, NPH orders (if any) as well as any given dy's CBGs and amt of insulin given.

I am alos curious if anyone can post up their units system for documenting I&O's. At this point out CNA's fill in daily I&O sheets that almost alwasy come back blank because they have never been help accountable. The 11-7 nurse is then supposed to take this information and transfer it to the 24hr I&O sheet in the MAR. New Admits for the first 72hrs, pt with caths, GT/NGT and pt on IV therapy of any kind are required to have documented I&O at our facility.

Thanks for any input

Steve

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Steve....my boss came up with a 72 hour flow sheet for s/p incidents/admissions/etc. I will have to "fix up" a copy and send it to you, so give me time. We also have a Flow Sheet for ABT's....again, give me a bit of time. Maybe these could inspire you? :idea:

Suebird :p

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I would love to have any and all flow sheets so I can review them and get ideas for my own. Thanbks for responding!

Steve

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No problem! ;) :mad: ;)

Suebird :p

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First off, try not to reinvent the wheel. Are you a corporate facility? Maybe another facility has a form that you can borrow? Have you looked at Briggs? They have tons of forms.

As far as the accuchecks and sliding scales...all of this is done on the MAR in the same place. We put the order down as follows. "Accu checks BID with sliding scale coverage using Humulin R insulin sub Q as follows.....The Blocks are for inital, result, coverage,site.

We just started a new form that goes in the MAR weekly, its more for the docs FYI. On it goes a recording of the accuchecks and if the MD needed called and it also lists the sliding scale, and their dx. The mds are supposed to review these records and make any changes in orders if needed (HA, Ha) I think its a liitle waste of paper and time. Why can't the nurses look at the numbers and say....hey, so and so has been high every day at 4pm, maybe I'll let the doc know and see if he wants to adjust the NPH in the am..." Or "we've been doing qid checks and so and so has been way below or wNL, maybe we can get these cut to BID"...

As far as I&O...we really don't do it on anyone unless we have an order for it. The CNAs do keep track of fluid intake on thier food consumption sheets in the ADL books. That is it! Personally, I don't like this policy.

I would look at your policy and evaluate it. Do you really need to have that many on I/O? Do all the tube feeders really need it? Or the caths?

I would look at trying to combine some of the documentation and making it more central. That way it is mroe likely to get done. You can ask your pharmacy what type of forms they have or what can be added to the MARs and TARs.

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Thanks for the response! I am not looking to re-invent the wheel just organize a chaotic place. I fee that we need a a seperate CBG monitoring sheet in the MAR so you can see it all at one glance and more clearly see trends.

As far as I&Os they are very important!!! Yes if you are on a GT you should have an I&O. Same for catheters, to me that is basic nursing and it your responsibilty. I am on a sub-acute floor and the GT feeds we have are s/p major MVAs. My wife has worked for a major corporate Rehab hospital up in the Boston area and they used a seperate flow sheet for INRs, CBGs as well as Heparin. I am looking to adpot such a system because right now all the nurses are zombies because the previous NM was control freak but at the same time got nothing done herself.

If anyone has any links or wants to snail mail me any copies that would be great.

Steve

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I forgot you said sub acute:idea:

Try looking at the Briggs site. http://www.briggscorp.com/e2wShoppingCatalog.aspx?functionId=009000007&parentID=008328983&parentLink=012000014:008002480:008002485:008328743:008328983

They have tons of forms and you can see what they look like before you order. What are the other units doing? The only reason I ask is because in one place I worked......everyone had to be on the same page and use the same forms....corporate forms. Gosh forbid you wanted to eliminate or add an easy form :nono: Can your wife get some copies from her place?

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Briggs forms are very good for flow sheets. As for coumadin flow sheets, i know there was a posting on that not to long ago. We also keep the cbs on the med sheets with the insulin orders, we dont use seperate flow sheets for those. The 24hr I&O's we keep in a bright orange notebook that the nurses are responsible to document in every shift. As a manager, i check the books weekly to be sure they are being filled out. It helps to keep the importance of the completion of I&O's a priority. Good luck!

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