Mags4711

I try to dissuade them from even popping when reintubating (if it is a semi-controlled situation). The trays slide out and spin, so the lower half of the baby can remain in the warm environment. I even do tub baths in pink basins with the tops down (even on intubated babies). I admit, I may be a bit of a freak about certain things. (Hey, the first step is owning up to it, right? :-) )

Whoatemyburger: You work in a NICU where there's *high* turnover?? I don't think I've ever heard of such a place.

There is data that speaks to the possibility of it taking hours for the box and baby temps to stabilize after having the "top popped." I only open if ABSOLUTELY necessary. And it usually isn't.

Yes, there is literature that speaks to the benefits of gravity bolus feeds versus pump feeds. I'll dig through my stuff when I get a moment and post some links. My hospital used to use syringe pumps and we'd start feeding over an hours, then decrease to 45 mins, then 30 mins, etc. Now unless your baby is a surgical kiddo or has to be continuous for some reason (rare), or has demonstrated severe reflux that is made better by putting the feed on a pump, the baby is gravity fed. We tape up the syringes less than 10cc, for larger than that we use the soft arm posey velcro restraints and hang them from the IV pole arm on the Omnibed (using oral extension tubing).

Depending on the availability, often after 1-2 years you can get a day/night rotation. Our unit only rotates folks 1-3 nights/4 week schedule. But for straight days? 12's will take 26+years. Straight 8's on days? 28+ years.

Hello everyone! My institution (teritiary care, Level IIIc NICU) is moving to scanning for med administration soon. I have been charged with the task of polling other NICU's to find out how you all "really" do it. I know ideally you are to affix a barcoded ID band directly on the patient and scan that. However, we all also know that reaching scanner wands into incubators isn't the easiest thing to do, we also know the itty bitty ones generally don't have ID bands placed on their bodies, etc. Additionally you don't want to unwrap a sleeping infant to get to their ID band on their ankle. So what do you all *really* do? Do you actually scan the ID band that is on the baby's body? If so, where do you place the band? Do you always place it on the wrist? Do you have an extra ID that you affix to the end of the bed that you scan? Do you have a certain type of ID band that may have more of a "luggage tag" appearance that you make sure is hanging out of the blanket when you wrap the infant? Do you place your ID bands on the connector for the Pulse Ox or ECG leads? Do you print out some scannable sheet and tape it to the front of the bed and scan that? Thank you VERY much for your responses!

Same here, every baby that enters our unit gets swabbed on admission, every Monday (unless positive, then they are no longer screened), and on transfer or discharge.

We have been using CHG wipes on our neonates for a little over a year. We only decolonize if they turn positive, though (CHG wipe baths for seven days, and Bactroban Nasal Ointment 2% to nares and umbilicus for five days). Thanks for the well wishes! I have looked through lots of forums, and rifled through just about everything I can here on allnurses, but most everything you read is not neonatal specific. I was hoping to capture exactly the kind of wonderful info given by yourself and others in this forum that is geared towards our population.

Hello fellow NICU folk! I am working on MRSA best practices and am trying to get a sense (beyond what the "Consensus Statement of the Chicago-Area Neonatal MRSA Working Group" says) of what *your* NICU's are doing re: MRSA practices. Could you please answer the following questions? 1. Do you routinely screen for MRSA? If so, who and when/how often? (for example, we screen ALL on admission, then once a week thereafter unless positive) 2. If someone is positive, do they get retested? Can they come off precautions? 3. Do you Universally Decolonize ALL patients (MRSA+ or not) with CHG bath? 4. Do you cohort nursing or patients or both (i.e. one nurse has only MRSA patients, or do they care for a MRSA+ and non-MRSA patient; do the MRSA+ patients get moved together?)? If only one patient on the unit is positive, is that patient made a 1:1? 5. How is your unit configured? (Single Patient Rooms, wards, etc.) 6. How do you handle visitors? Do they (parents included) have to gown and glove? What about multiples? Kangarooing? Hello ID folk! I am working on MRSA best practices for our neonatal ICU and am trying to get a sense of what your institutions in general are doing re: MRSA practices. Could you please answer the following questions? 1. Do you routinely screen for MRSA? If so, who and when/how often? (for example, we screen ALL on admission, then once a week thereafter unless positive) 2. If someone is positive, do they get retested? Can they come off precautions? 3. Do you Universally Decolonize ALL patients (MRSA+ or not) with CHG bath? 4. Do you cohort nursing or patients or both (i.e. one nurse has only MRSA patients, or do they care for a MRSA+ and non-MRSA patient; do the MRSA+ patients get moved together?)? If only one patient on the unit is positive, is that patient made a 1:1? 5. How do you handle visitors? Do they have to gown and glove? Thank you all in advance!

We are all private rooms (Level IIIc) and visitors are allowed at all times. We have now also moved to bedside report (standing in the patient room, parents and visitors present!) to allow parents to feel more a part of the process, and to force double checking of pumps/drips. Our legal eagles also call it "incidental disclosures."

I would say about 40% of our staff are friends are with current patients, probably close to 60% are friends with previous patients and families. I do have a problem with it. I won't do it. I have four former patient families that are friends with me on FB, we didn't become "friends" until 1-4 years later. This is out of about 550 friends. I have denied many friend requests as well. I do not baby-sit, I have gone to one birthday party. Work is work, personal life should be personal life. Many of my co-workers will babysit or go to birthday parties, it makes me very uncomfortable. Also, we have a couple of RN's who take pics of babies and text them to the parents or text moms about how the baby is doing that day. Again, makes me VERY uncomfortable. Lines are blurred and crossed and then what happens if the unthinkable (death) takes place with that child? I **NEVER** give a family my personal contact information. One mom was texting one "primary" nurse and complaining about another, then after discharge she was texting questions to the nurses. Not good. My mother was a nurse and she taught me that there are distinct lines and boundaries and life is so much simpler when those are not crossed. She was right.

If you've ever had an art stick, you'd understand why I am about to say what I'm going to say. I HATE THEM!!!!! Lots of our RN's will do them to get "larger" samples of blood (and not even try a venous). It makes me nutty! To me an arterial poke is a last resort, or it sure as snot should be. The pain is *incredible* and yes, you run the risk of losing that artery. I also only occasionally see anyone doing the Allen's test. Which should be an absolute MUST. Sure, I understand that sometimes, you simply have to get an arterial sample. But I do think they are performed too often.

I work across the state from you, Kalamazoo, and we have open visitation 24/7. We have been that way for at least six years and I still dislike it. Only the parents are allowed to stay in the rooms for the half hour at shift change, though. But anyone can be at the bedside during rounds, which IMHO is *ridiculous*! We have 9 to 13 babies in each room and "try" to give report away from the bedside, but...it is *very* limited space. When I contacted our HIPPA attorneys about this, I was told it's considered "incidental disclosure" which is covered. I disagree, it is not "incidental." we could ask them to step out and voila! It's not an issue. But we do this "Patient and Family Centered care" stuff and it's parents first, parents first, parents first. I mention the rounds thing because there are occasions when a family member or grandparent may be visiting and hear something or a plan for the baby before mom and dad do. I personally think only parents should be allowed at the bedside during rounds as well. Later this year we'll be in a new facility and all the rooms will be private, so the HIPPA thing won't be a huge issue. But then they'll be able to room in 24/7...

We send cards after death, six months, and then at a year out. We order our cards (and a nice natural paper box) from Memories Unlimited, Inc http://www.memoriesunlimited.com/ Our transporters take the baby down in a basinette to the morgue.

My hospital just paid for us to take the NICU review course that Dr. Verklan gives. It was quite thorough and good. Seriously, vent changes??? That's not even in my scope of practice! How can they ask what vent changes should be made?

THANK YOU to all who have replied. Keep them coming, folks! Anyone use iPhones?

Hello fellow NICU folks. We are building a new hospital and our NICU is going from 9 to 12 bed rooms to all single care rooms. Needless to say it's quite an adjustment for most of us. I've been charged with the task of coming up with a list of must-haves for our new communication devices. We currently use old Spectralink phones (very old). Vocera *badges* are 97% not an option, but the phones haven't been ruled out. Other units are currently trialing Cisco 7825 phones. What do you feel you need to do your job safely? Do you need your device to be able to be completely hands free? For those who use Vocera badges, how often do you leave them in hands-free mode? Does anyone use smart-phones? Do you use phones for more than just phone calls? (Such as to get labs from, receive pages, text other staff or MD/NNP, to page MD/NNP?) Do different level care providers carry different devices (Techs may carry pager, MD/NNP carries smart phone, Charge RN carries smart phone, RN staff carries regular phone)? How does alarm escalation work for you (who gets next alarm, do you even have it enabled)? Are your vent and pump alarms tied to your phone? Anything I may have missed? Thank you all!!!

Many, many, many of my co-workers do it. Quite a few go to birthday parties and exchange cards and go to lunch together, too. I do not. I feel like I'm putting them out of the nest and sending them off to fly, once they've been discharged, it's time for them to establish a life without me in it. I appreciate when they send Christmas cards to the unit and include updates and pictures. We have a reunion every summer and all graduates get invited back, so there are opportunities.

I work in a 40 bed (can be up to 43) Level IIIc NICU (once called a Level IV, but now the max is Level IIIc) in a large teaching hospital. We have inborns as well as transports and our own transport team. We have four teams consisting of a resident and an intern and the occasional M4. There are a couple of float NNP's on the day shift and we have six fellows. There are usually two or three fellows on the unit in the daytime. There are a minimum of two attendings around on the day shift. At night we have either a fellow or NNP who acts as a fellow in house, along with a resident and an intern. The attending does not stay in house but is available by phone or comes in (only) if the poo-poo hits the fan. There is a "second" attending on call at night as well if the poo-poo REALLY flies. I have seen two attendings in here at night only twice. Once for triplets, once for a REALLY bad airway kid that anesthesia was trying to trach after we couldn't get him intubated at birth. (Turned out he actually had no trachea below the "cords.") Our transports are picked up by either a fellow, an RT and a NICU RN, or if the baby isn't terribly critical, a flight RN and an RT can go, and occasionally the fellow might ride along. We staff "feeder growers" at 3 per RN, rarely we might have to do 4 per RN. Our intubated but more simple kids are 2 babies per RN or the really really sick PD or cooling or maxed on every pressor kid will be 1:1. ECMO's that are fairly stable are paired. Hope that helps.

I am in a moderate sized (40 bed) Level IIIc NICU at a teaching hospital. All our rounding services expect RN input. We have had to beg, borrow, steal, plead and threaten to get them to this point. But now it's gone the other way with our neo service. If we are busy with our other patient(s), we are almost chastised for not being at the rounding baby's bedside. Surgery rounds are at 0600 with the fellow, residents, interns and PA's. In our unit only the fellow is called for anything with any of our surgery kids. Residents and interns do not make any decisions for them. The fellow on that day leads rounds and at the end after the review of systems asks for RN input. And they listen! Wow! That was the hardest group to get on board with listening to us. It took the former program chair to retire until that happened. Residents and interns are split into teams and babies are assigned to each team. Neonatology rounds are staggered based on what team was on call the night before (they get to round first) and done with the attending, fellows, NNP's, PA, resident and intern(s). The fellow leads rounds and the intern usually presents their own baby, then the attending asks questions of the intern, then the fellow and the team. They tend to be more fluid about asking for RN input during system review rather than waiting until at the end. We also recently instituted a plan of the day sheet that gets filled out (or is supposed to) daily during rounds with what that day's plan is (vent wean, feeding increases, cultures, etc.). It is also a place where we can write questions or parents can ask questions to be addressed during rounds. Hope that helps.

Us too, though the ER used to put them on all peds/neonatal cases (even though they used pumps just like the units did). When they hit the admitting unit they were promptly thrown away.

I think you will be fine. One thing I learned very early on was that trauma and burns do not discriminate... What does that mean? Well, think about who might be involved in a car accident or a house fire...could be the normal healthy 25 year old, but often is the 68 year old with an extensive medical history and/or cardiac history. I've heard of a heart transplant patient being in a trauma bed after he got biffed by a semi on his way to his first post-transplant MD appointment. I've had little old 88 year old ladies who fell down their stairs and have a ventric in and then during OR to repair their femur fracture something happened and they ended up with a new pacer...Or I had the 5 month old who fell into the hot tub and sustained 90% burns, but he also was a Down's baby with cardiac anomalies... I did Trauma/Burn/Emergency Surgery for five years in a Level I Trauma and verified burn center. I have to say I would have felt totally comfortable floating to other ICUs with a minimal, focused orientation (other than Cardio Thoracic Surgery-I'd want loads more info on IABP's, etc...). I think it's a great place to start, if you can learn under high pressure then you will be just fine.

About a year and a half ago we went to nothing below the elbows for the staff. We totally wish it included visitors! We do not allow any fleece clothing and have recently started to make nurses with longer hair pull their hair back. Mine is to my butt and I have always worn it in a bun at work. We have no policy about changing omnibed covers unless it falls on the floor or is visibly soiled. Probably should make one. All cribs, Giraffes, and Omnibeds are changed q 2 weeks.

Vanc used to be incompatible with lipids in our med books, but in the past year it has listed them as compatible. Amp can be given at a rate of 100mg per minute, so I just turn off my TPN and push it or run it on a pump at the appropriate rate and then start my TPN back up.

I work in an academic Level IIIc NICU (in case anyone is using these answers to benchmark) and we swab all admits, transfers and then weekly every Monday. We used to put all transfers into precautions on admission until negative but we don't any longer. Once positive, they stay positive until they leave. Our entire medical center is going to start swabbing all admission and transfers in a couple of months.