mpccrn

Looking for how different units handle patient's home meds. We are horrible at returning them upon discharge. Currently, we put them in a bag with the patient's name on and put them on the countertop in a locked med room. I find them there long after the name on the bag even rings a bell and I'm looking for a better practice. Any ideas?

sign me up!

I haven't had lunch in 35 years....rarely get paid for it. It comes down to staffing by numbers. You can't leave 1 nurse in an ICU and when they staff only 2...oh well, you loose. Administration won't understand why we won't leave because that would be admitting that staffing by accuity makes more sense than staffing by patient numbers, but hospital's are a business now and patients are our customers. Boy was that a mistake. Morally staff does not leave because we truely care about the safety of our patients, more so, than our own sanity. We are currently making an all our effort to try and take lunches, some days it works, some days it doesn't.....again, it's what going on in the unit that is the determining factor. Just having 1 more set of hands would make all the difference but that does not make economical sense to the accountants running the place. Maybe they need to become patients and see how it would be to suddenly not have a nurse for 30 minutes....maybe then......

ICU ratio's at my hospital are anything that is required.....1:2, 1:3, 1:4

Perhaps if nurses didn't have to use our vacation time when we get sick, we'd stay home and prevent passing on illness to our patients!

How does everyone feel about the latest trends in hospital administration's demands that all nurses must receive the influenza vaccine or wear a mask the entire time they are on duty....including eating lunch!

oral gastric tubes decrease the changes of sinus infections. By bypassing the nose you deminish the risk.

online ACLS is just fun! It's like a video game. It'll let you do anything you want.....even give epi during VT haha. I wouldn't go back to the regular course!

our ratio for Cardiac SDU is 5:1, working hard to cut it to 4:1. Is 5:1 do-able? sometimes, does it suck? Always. There is something about that 5th patient that just puts the assignment over the edge

1.) Does your intensive care unit have a specific guideline or protocol regarding enteral nutritional therapy in critically ill mechanically ventilated adults? a. Yes and it is clear, concise, and easy to understand b. Yes, but I don't quite understand it c. No d. Not sure 2.) In your practice, do you routinely insert a nasal or oral gastric tube in the critically ill mechanically ventilated patient? a. Always nasal b. Always oral gastric c. Whichever is easier d. The purpose of the tube drives my decision (for the purposes of draining or feeding) e. Other_________________________________________ 3.) In your facility, for the purpose of temporary enteral nutritional therapy, what type of feeding tube is most often initiated? a. Salem Sump (gastric) b. Other Gastric______________________________________ c. Post pyloric (Nasojejunal : NJ tube) d. Not sure e. Other_feeds are usually started with the already placed NGT. If there is a prolonged intubation, a dubhoff or fredric-miller tube is placed. 4.) After enteral nutritional therapy has been ordered, what assessment criteria drives your decision that the critically ill mechanically ventilated patient is ready for enteral nutritional therapy to be initiated? a) Bowel sounds auscultated in all four quadrants b) Lack of abdominal distention c) Patient has been intubated for more than 72 hours d) The therapy has been ordered so there is no other criteria necessary e) Other_________________________________________ 5.) What rate do you currently initiate your enteral nutritional therapy in the critically ill mechanically ventilated patient? a. 10 milliliters an hour and advance to goal as tolerated b. 20 milliliters an hour and advance to goal as tolerated c. Bolus feedings d. I start my feedings at the goal rate e. Other (please describe)___________________________ 6.) What monitoring criteria do you employ when caring for a patient receiving enteral nutrition therapy? a. Gastric residual volumes b. Promotility agents c. Patient positioning d. All of the above e. Other HOB is always elevated 30 degrees at least. If the patient has to be placed flat for whatever reason, the feeds are stopped and restarted once the HOB is elevated again. 7.) What assessment criterion currently drives your decision that the patient will tolerate an increased rate of enteral nutrition therapy a. Bowel sounds auscultated in all four quadrants b. Lack of nausea and or vomiting c. Lack of diarrhea d. Gastric residual volumes e. Other______________________________ 8.) After initiation of enteral nutritional therapy, how often do you assess gastric residual volumes? a. Every hour if residuals remain high b. Every four hours c. Every eight hours d. Once a shift e. Other_____________________________________ 9.) What amount of gastric residual volumes would you consider acceptable to advance your feeding rate? a. There should be no gastric residual volume b. 10% of amount of feeding instilled c. 20% of amount of feeding instilled d. I do not use gastric residual volumes as an assessment criteria to determine patient tolerance to enteral nutritional therapy e. Other_Less than 150cc ___________________________________________ 10.) When assessing gastric residual volumes, what amount would you consider "High volumes" which would cause you to "hold" the patient's feedings. a. Greater than 50% of the amount of feeding instilled b. Greater than 250 cc in a four hour period regardless of the rate c. Greater than 500 cc in a four hour period regardless of the rate d. Greater than 100 cc in an hour regardless of the rate e. Other __150cc_in 4 hours, protocol calls to stop the feeds for 1 hour and then restart feeds, check residual in an hour, if it is still high, contact the physician. 11.) When assessing gastric residual volumes, how much do you consider an acceptable amount to return to the patient? a. I discard all gastric contents b. I return all gastric contents c. I return only 250 cc of gastric contents d. I return only 500 cc of gastric contents e. If the residual is 60cc or less, I return it to the patient, if over, I discard it all. 12.) How often do you flush your feeding tubes? a. 60 cc every 2 hours b. 60 cc every 4 hours c. 60 cc every 6 hours d. After administering medications e. Other__100cc q 4 hours if their NA levels are ok. Please feel free to add additional comments:

We do sedation vacations on every patient. It not only gives us time to evaluate the neuro statis of the patient, their readiness for extibation but also allows a better idea of how much sedation is actually needed for the patient. Too sleepy is not always good, comfortable is better. We do VS and a Ramsey scale every 15 minutes during the trial. Hope this helps.

I don't think it will hurt your attempts at returning. Life needs change our ability to devote ourselves to the job, any good manager will recognize that. Try to go back when you can devote the time off shift to make yourself the kind of nurse invaluable to your patients. Express that in the interview: your regret at having to leave before, your reasons you had to leave and how your place in life changed so that success is within your reach. A good manager will give you points for being honest to yourself and doing what was best for your patients

yep, 20 minutes minimum, then groin and circ checks q15 min x4, q 30min x4, q1hr x4 then q4hrs

I currently work in a rural community hospital where I rotate between ICU and stepdown. Our ratio is 5:1. Most days it's a nightmare....there is something about that 5th patient that makes the goal of the day to stay just one step before impending disaster. We are currently working really hard now to get that ratio decreased to 4:1......and it looks like we'll win! Can't wait!

It's been a few years, but yes when I worked shock-trauma, we use to prone people as a last ditch effort to try and oxygenate them. There are always risk when proning a patient, risk of dislodging tubes of any variety including the ETT. I found it did work on increasing O2 levels but can't really say it did much for the big picture. As mentioned, it was always a last ditch effort when all else failed. Having said that, it only takes one patient saved to make it worthwhile.

I don't mind students that shadow me but I do expect interest, enthusiasm and some decent questions.

Let's face it, no one will beat us up better than ourselves when we make a mistake. A mistake is something we all strive NOT to ever do.....but it happens sometimes. Fessing up is the best action you can take after making a mistake. It gains you the respect of your boss and fellow staffmembers and you'll sleep better at night (or day). Attempting to cover up a mistake can only lead to more bad things. As you gain experience, you'll better judge the ramifications of the mistake you made. Hang in there.

I belong to AACN, a critical care nurse organization. You pay the membership fee and that's it. Memberships can be 1 year, 2, or 3. The membership allows me to access up to date information, gives me free CEU's, and fulfills a requirement for clinical ladder.

set the pump at a rate of 200, thus the 100ml bag will infuse in 30 min.

I had a hospice aide sister of a patient once think she should dictate her brothers care in the ICU. She made soooo much trouble for me, reporting me to everyone and anyone that had to listen to her. Finally the nursing supervisor put an end to it by talking to the patient himself asking him if he was satisfied with the care I was giving him and if he had any concerns about his care. Thank god he was still oriented at that point! He asked if his sister was causing trouble again and when it was confirmed, he asked that she not be allowed in anymore. I was grateful to them both. While it was not difficult to justify my every action to superiors as I comply with standards of care, it would have been difficult trying to prove I did not 'threaten' my patient verbally as she accused me of, had the patient not been able to deny it.

Welcome to ICU nursing! Yes, early in the flu season we had 2 staff people that got sick before a patient was diagnosed (they didn't yet get the flu shot). Actually we're seeing more influenza in patients that did have the flu shot this year than any other year.....guess they didn't pick well when compiling this years shot combination. It happens.

I'm currently doing a QI project involving interruptions while pouring medication. I am gathering data for a 2 month period, tracking medication errors and will implement a 'no interuption zone'. While nurses are pouring meds, they will not be interrupted for anything or by anyone (short of a life threatening emergency) and see if the errors decrease. It's part of the 'just culture' trend. Staff members are excited by it as they can be easily interrupted by phone calls, doc questions, chit-chat, family members, etc 20 times or more during one pour. Another study we did recently was about OR patients being admitted post of to ICU with their name bands and T&C bands cut off them and taped to the chart. While we understand why it is important sometimes to remove the bands, it was unacceptable to not replace them. Another study we did was a smoking cessation education study. Were smokers given material they could use to quit before discharge? Was it documented. Same thing with CHF teaching. We did a study to reduce ER to ICU admit times. We documented the time we were called for the bed, the time the bed was given, who in ICU would be taking report, when they called for it, who they got report from, the time of report and finally the arrival time of the patient to ICU. It was amazing how the time was cut down once there were names of people who could be held responsible for unnecessary delays. Missed meds from pharmacy....funny while they knew they were being looked at, there were less and less meds missed but now that the study is over, the missed meds are back.

That's exactly right. Our hospital policy states that only 10cc srynges can be used on PICC and Midlines. Anything smaller will generate too much PSI and can result in catheter rupture

It all comes down to how bad you want it. Your experience could be invaluable as there are pre and post partum moms that require ICU nursing. Go for it! My current ICU manager was first an ICU nurse, then worked OB for years and she's the best manager I ever had.

In a single word......everything!