capnnikkiRN

I am wondering if there are any hospitals out there that use Restricitive Resuscitation orders/Limited Resuscitations orders. Such as check boxes to select yes or no for: CPR, defibrillation, intubation, ACLS Drugs, etc. If you have restrictive resuscitation orders, how does that work in your facility? How is it operationalized?

My organization is in the process of implementing a blood and blood products physician order form. The order form requires physicians to provide the rationale for the transfusion. The goal is to gain better control of the limited supply of blood and blood products, while ensuring patients that meet clincial criteria receive the needed products. The order form will also serve as the form used to request blood (like a request slip). We are finalizing the process for this form and I am just curious what the practice is at other facilities? Does the physician just write the order? Is there an order form for blood/blood products? How do nursing staff obtain blood from the blood bank? Thanks!

For those of you who are doing hourly rounding, how are you documenting your rounds? Do you use a check sheet placed by the door or do you document in computer charting? We are thinking about changing the documentation in my facility from the checklist to the computer documentation. I am curious to know if anyone else documents rounding int he computer, how they do it, and if there are any issues. Thanks!

I work at a facility that does hourly rounding and many of the nurses expressed the same concerns that you have. I work as an educator on that unit and did some research to rework the process. Here was my suggestion, we follow the 4 P's (pain, potty, position, placement) and the nursing staff assess these needs at least once during the hour for their patients. The goal is that rounding isn't a special event, but the concepts of rounding are carried out on a routine basis. The nurses on my unit have a better outlook about rounding and our patient satisfaction scores are going up. Good luck with rounding, I think it gets better when we focus on the patient needs and not a piece of paper and from the sound of it so do you.

I agree, it is yuck. (The canister stays with the same patient. Still, yuck)

In all the places I have worked, we have always marked the canister and once the canister was full, we would make sure it was sealed and dispose of it in a red box. I have never opened a canister and empties fluid at the end of the shift. One place I worked at had this stuff we put in the canister through one of the holes up top and it turned the fluids into a gel. I think it puts us at risk for exposure to fluid. I also think it would be cheaper to replace the canister, then to have to pay for the supplies for me to use gloves, gowns, and eye protection to prevent an exposure from fluid splashing.

Hello all! I am working at a facility where the nurses are emptying suction canisters (connected to an NGT) at least once every shift.Many of the places I have worked at did not want us to open the canisters. I would like to know the practices at other facilities? Does anyone know where to find research on this matter? Thanks for your input.

I think everyone has said the same thing, that interpersonal skills can be learned or rather acquired. At first I was uncomfortable, but luckily I had a purpose for the transaction with my patient. I was armed with a set of questions and information. I didn't have to offer more unless it was asked. The longer I have been in nursing the easier it is to read people and situations and the more comfortable I find starting some small talk. I am still not completely comforatable 100 percent of the time, but it is easier to transition into the role of therapeutic communicator.

My advice-go to Microsoft Office Online, they have a great nursing resume template that will spark the ideas you need to create a great resume.

I am afraid that may be the case, but I would like to prevent anything bad from happening.

Hello all, I am hoping this forum can help me do some fast and convincing talking to my CEO. Here goes, up until about 6 months ago we had 2 fulltime monitor techs that watched the monitor for 16 hours a day and assisted with unit secretary work. This left night shift as the only shift without a designated monitor watcher. Six months ago we had layoffs and cut many positions...including Monitor Techs and CNAs. I am concerned about the safety issues with not having someone designated to watch the monitor. Perhaps if we still had CNAs it wouldn't be quite as bad, but without CNAs my Charge Nurse is going to have to leave the desk to help the 2 LPNs working on the floor. (It would help to insert I work at a 25 bed critical access hospital and our census ranges from 8-15.) My CEO thinks the nurses need to watch the monitor and in theory this can happen, but out in the real world there are always patient needs that can't be anticipated and the nurse is forced to weigh the patient safety of leaving the monitor versus going to the patient. We made the transition to a fulltime Monitor tech several years ago based on a state inspectors ruling that we fell below the standard of care. My CEO takes this ruling as an interpretation and wants to see in writing where it says there must be a designated person to watch the monitors. I know all the arguements, but I am having a hard time finding it in writing that a designated person to watch the monitor is the standard of care. I have found several articles and position statements that recommend this practice, but I haven't found something that I think could clinch the arguement. How are these things handled at your hospital? Do you know of any articles, position statements, etc. that support a designated monitor watcher? Any help is appreciated.