Organization when busy?

When I get out of shift report, I look first at meds and treatments and things that have a scheduled time. I have a report sheet that I made for myself that has a chart at the bottom of the page with 12 columns, one for each hour of my shift. I write down things that need to be done in the corresponding time column on each patient's page. Then I can easily flip thorough my sheets to see if I have anything scheduled to do. I put a square bedside anything that I want to chart later, and put a checkmark in the box after I charted it. We ahve computer charting, and knowing that I charted something is improtant, as you can't always get a computer terminal when you need to. Another thing that I TRY to do is make hourly rounds on patients. Depending upon what is going on, it may be 1 1/2- 2 hours between rounds, but I still try to poke my head in to see if they need anything, how the IV fluid level is, etc... (Our hospital tried to implement mandatory hourly rounds, and it flopped.) Sometimes, I ahve days where my zone phone rings practically every time I step out of a patient's room, and I have to adjust my priorities on the fly as I walk to the next room. I give it a good attempt at being organized and most of the time I am, but you always have shifts that do not allow you to be organized, as you jump from one event to another.

this last weekend in the ed we were very very busy w/ 3-4 deep in the waiting room most of the shift. i was wondering if anyone has tips on how to stay more organized when it's sooooo busy. we don't have computerized charting yet and i try to keep notes on my pt's but we have to chart everything that's going on w/ the pt such as when docs in w/ pt, when lab is in w/ pt, rad charts when they take pt and when they return so i can look that up but it's like a guessing game as to when the rest of the stuff occured. if i'm in w/ another pt i don't know when the doc was there or lab, resp, ect. it's also hard to check in on pts when you have to keep going to the waiting room to get people checked in. i asked some of the girls i worked with how to be more organized and they said when it's this busy there really is no way to be organized.

is there anything that works for you when your busy to keep good tabs & documentation on your pts? any advice would be appreciated.

it seems unrealistic that you should know and then chart when the physician or any other person was "in the room" seeing a patient. in the er setting, at least where i work....you are in and out of not only rooms assigned to you but in others when helping the team. seems like they want you charting instead of providing care. perhaps asking your supervisor if she has any ideas on how to provide safe, effective care while charting others whereabouts at any given time. question: why aren't the allied health services charting themselves???? i shouldn't have to chart that i saw a respiratory technician enter the room...... they should be charting that.

Sometimes there is no organization-when you are are drowning in really sick patients, sometimes all you can do is pick the most important thing and do it, then go to the next most important thing. If you have time later, then you can guess the times that pts were seen, went to xray, and all the other stupid things they expect us to chart.

What is your nurse to patient ratio? With us, it just depends on what is going on with your patient. We are lucky to have computerized charting and the physicians have to enter all of the orders in the computer. Why do you have to document when the doc is at the patient's bedside? Don't your physician's write their own progress notes on what they have done with that particular patient? Charting every single little thing when you are that busy is unrealistic and should be discussed with your nurse manager. How many beds does your ED have? I feel very blessed to work in the ED that I work in. Yes we are understaffed like everyone else, but when things are that busy and patients are really sick we do what we can to get them stable, then send them to the floor or one of the ICU's. It sounds like you are doing the best you possibly can, and that is all that you can do in an ER.

We have timeclocks on our computer charting that tells us when it's time to chart something about the patient. If the doc is at the bedside, we chart that. If labs/xray or treatments are pending or in progress we chart that. For us it's a click of a button, check a box and you are done. Our techs have access to our clocks too, so they are pretty good at charting or making a note. We have another timer that tells us when vitals are due as well, which is another contact with the patient. By P&P, we are supposed to chart something about a patient every 15 mins. Do we, oh goodness gracious no.

The object is for it look like our patients had something gone on or pending the entire time they were there or at least we are acknowledging the patients are there. The powers that be really hate the idea of patients sitting in our ER for 4 hours with nothing pending or no contact of any kind with healthcare professionals. It happens though from time to time and there is just nothing we can do about it.

If we are swamped, we just simply chart what we can when we can. Over time I've gotten pretty good at keeping a mental clock of what's been going with most of the patients so charting when I get a min is getting easier. I'm sure my times aren't perfect, but they are getting better. My arm makes a great dry erase board when necessary too.

I'm sorry to say this, but my documetation goes on the back burner. I absolutely skip through flu and immunization screening when possible, I only do a focused asessment on uncomplicated cases. If I have a 25 year old with abdominal pain without any other medical history I will absoutely not check her pedal pulses, when I have 8 patients of which 4 are chest pains.

I try to shift my focus on the sick ones and have their documentation up to par. Another thing we do is my collegues and I collaborate on who will take what. We all see what types of patients we have and the nurse with less critical patients will take on the next sick one. We also keep the charge nurse updated on what's going on.

Nat