Pediatricjo

You need to be an anesthetist. You talk very little to the patient or family & then they are unconscious. Most I know also don't talk to the staff a lot. Stay out of surgery or ICU. The patient may be unconscious but you have to talk to the rest of us. Maybe phone triage? Personally there are days I just hate the phone. And when I have had one trial after another with persons who seemingly left their brain or common sense elsewhere I hate people. Get the marshmallow shooter.

We were having this discussion this morning about how to co-sign in the EMR/BCMA for medications such as IV pain medications, IV heparin, insulin, TPN, chemo & so forth. Our current record only allows us to type in who we verified the medication with. We found we can scan their badge & have it entered into the EMR, which brings up a potential security issue. I would like to know how others record verification or co-sign nurse with their medications.

I ask "are you having any pain?" or "what is your pain level?" I also encourage the alternative measures such as repositioning, warm pack, cold pack, ambulation, etc. Remember though, a patient's pain is their perception, not yours.

Aspiration Pneumoniae could develop in 24hrs. Whether it was due to the water/meds or the feeding would require sputum samples & possibly a bronche. Continue to follow aspiration prevention standards & it should be ok. Especially with only bolus items, not continual feedings.

Our policy states "All patients will have a complete assesment done at the beginning of every shift; the nurse will document any changes from the baseline assessment (admission). Assessment of body systems that have not changed will not need to be documemnted as unchanged." Our pediatric policy is not as clear. We have EMR so it is easy enough to click a box for normals. I was just wondering what standards for Pedi assessment were elsewhere.

The question has come on our unit what is proper: a documented full assessment or an assessment charted by exception. Currently we document a full assessment every shift. One of our nurses floated to another adult unit and they are charting their assessment by exception, except the initial assessment.

Just an update. The committee met again and the proposer was there to explain that it does not have to be each abnormal lab value. One could click the item to say they notified the physician of abnormal lab or x-ray & what was done. There is a space to type which values or results you notified them of but it is not mandatory. Hopefully the policy will reflect this also. Thank you so much for your feedback.

We have some "special" patients over the age of 18 that the pediatricians have aged out for us. There is a Pediatrician shortage in our town & they need the space in their practice. However, we have found that adult units do not always recognize the differences in developmentally delayed adults & adults with special needs & the rest of their adult population. They miss subtle changes. On the other hand, we get adult post-ops or medicals. We opt for the GYN post-surgicals.

ChristineN, I never thought of that. I just took it for granted. We leave ours indefinitely for the above stated reasons. When we did Outpatient Infusion therapy on our Pedi unit we didn't have infected PICC lines or Central Lines or Ports. 6 years of Pedi nurses doing this. The infections & such came from adult inpatient units. We did have an issue with PICC lines clotting frequently though. Our research basis for the policy was INS & so on.

We have a critical value note for those items. In this we either notify the doctor & what was done or we didn't & why we didn't. It's all electronic charting so it's point-&-click. THis is new. THis is contained within the body of the nurse's note & at the moment would require the nurse to printout each lab for that draw/time, enter the abnormal (out-of-range) values (no matter what or how many) & then note if we called the doctor & what was done or we didn't call the doctor & why not. We have the potential to autofeed the lab (i.e. cbc) into the note because they do with the doctor's progress notes. One would have to scroll through the entire note to see if we did anything else but oh well. I do like ClassicDames suggestion from their facility & will bring this up tomorrow. It seems like a lot less typing. Not to mention less chance of being found in violation of a policy. Thank you all so much for your advice. I will post what gets decided & why.

Does any other facility require you to enter non-critical values into the nurse's note? We have now placed a section in the nurse's note for entering abnormal lab values, did you call the doctor & what resulted, why you didn't call the doctor. There is possibly a new policy coming that would require us to enter each lab value. At this time there is no definition of if it is each & every lab value or a particular out of range but not critical value. We have a place to enter critical lab values & what we did about it.

You can use the same things. Post an idea pad on the wall to let them write ideas. Still look at what they seem to have trouble with or what the doctor's say. When approaching summer or winter have inservice for the upcoming disease of the season.