Tell me about your "brain" or "cheat sheet"

[nurse_wannabe]

In the book "Training Wheels for Nurses," the author mentions "brains" or "cheat sheets" of experienced nurses. When I was in school, I always wondered how nurses managed to organize their shift and remember who got what meds or treatments when. Now I know: they use their "brain!" For anyone who doesn't know what I mean by "brain," it is the way nurses record and organize information about what they need to do, when they need to do it, and what they have already done, in a way that works best for them.

According to the book, the key to a successful "brain" is to have a set format that remains the same every day.

So, to help all of us new grads out with our first nursing job, please tell us all about the format of your personal and unique "brain." Do you organize it by patient, room #, hours of the day, doctor, or task? Is it on paper or computer? PDA? Folder or clipboard? Database? Index cards? Something even more creative?

Since the type of "brain" you will use probably depends on the field of health care you are in, it might also help if you state that in your posting (if it's not too personal.)

Thanks so much!

[Thunderwolf, MSN, RN]

My little brain usually consists of steps to certain procedures/protocols, certain medication reminders, and telephone numbers that I need during the course of my shift.

[markjrn]

Well nowadays, my brain only has one patient on it so it is very different from the past. But in the past, I developed my own brain - very generic with open "blocks" for rooms/patients on one side, and a "graph" of hours on the other side. I would take the hours matrix and write in all of my scheduled meds, labs, tx, etc. On the pt side I would go by room number, and write in any info I thought was pertinent during report. At the bottom of the hours side, I would write down any prn's given, etc, that I wanted to point out during report.

I used that for years on med/surg, tele, stepdown, etc. It worked well and actually many nurses photocopied it. I could never be bothered with the pre-printed brains that have special places for IV, O2, etc, becuase I was always too busy trying to figure out the right place to write everything. Empty space made every place the right place! :chuckle

Yes, brains are very important. :) It kills me when I'm giving report to someone and they don't write anything down, or even have a pen and paper. :stone

[pink2blue1]

Well believe it or not, as a CNA I use a "Brain" too. All of the CNA's do, well most of us anyways. Mine is a Notebook that I can keep all of my pateints kardex's in and then I clip my activity sheet on the outside. On the sheet I include the patient, room and bed, dx, Dr., Diet, wether they have a foley or not. or an NG tube. I record vitals, I&O and when they get their bath, linen change and oral care. It helps me stay very organized throughout the day. Even though I am not passing meds and stuff yet (I just started my nursing program) this helps me keep on top of everything. As CNA's in our hospital we have 10 patients each. After lunch we chart on the computer about if they have had their baths, linens and stuff and also what % of their meal they ate and the diet. Having my Brain really helps keep me organized. I think everyone should have one! ;-)

Shannon

[markjrn]

pink2blue1 said:

Well believe it or not, as a CNA I use a "Brain" too.

I totally believe it, of course! I have seen many CNA's take report better than nurses. You've got responsibilities too!

[SarasotaRN2b]

What a great idea for a topic! I hope more responses come in. Once I finish my first semester of nursing school, I plan on applying for a PCA position where I am now working as a unit secretary. Then of course, hopefully get my med-surg training as well.

Again, great idea!

[leepgirl]

As I new grad in the NICU I developed by own "brain" It is half sheet size and has fill in areas for the most common items such as "feedings:____________via_____ ____ml's q ______hrs" I included the most common items found such as lines with areas to note there size and where they are secured "UVC:___fr @___cm@______" then I can just fill in these areas during report. I then made a table for the 12 hours I am there were I could list meds and tasks for each hour. In additon I have an area to make notes as well as a designated place to note anything I'd like to pass on in report "Mom visited want Doc to call" etc. I took me about 1 hour to make but has saved me an innumbearble number of hours with my organization. In NICU we usually have no more than three patients so I'll have one sheet for each. And thats my brain!

[allele, LPN]

I use a blank sheet of paper folded into four blocks. One block per patient. Every block is set up the same way every day. I put down the patient name, room number, age and MD(s) in the top left corner, below that I put their surgery with date, or any other reason for admission, and below that the allergies and then their full past medical hx. Then the rest of the block is to write down report from the previous shift and I use a corner for IV fluids or drips, epidurals or TF. I put my VS and assessments right on the flow sheet from the start and both my "brain" and my already organized head to toe assessment flowsheet go with me when I tape report! One thing I have to suggest, once you find your "niche", don't try to change to a better "brain" layout!! I tried switching to graft paper once and once I switched to index cards, all it did was confuse me. I thought they'd be more organized because I saw other people use them and THEY looked so organized!! And they were, but their methods weren't for me. Our CNA's use "brains" too, some are preprinted by the unit, other CNA's make their own. It's always a good idea!! :)

[joyflnoyz, LPN]

I work a combination rehab/medicare some LTC thrown in. Our patients don't change much day to day I take a blank sheet of paper, and make headers

ie. ACCUCHECKS NEBS SAO2 Treatments Foleys Incisions ABT PRNS injections Times under the headings, then pts name

example:

ACCUCHECKS

1700 Jones ____

s/s____units Reg

2100 Smith____

s/s ____humalog

27 units lantus

NEBS

1700 Tulip ALB/ATRV

Sunflower ALB/ATRV/Mucomyst

I can just fill in my results and whatever sliding scale they get if any.

As I go through the treatment book, I can update. I'll make 4 copies of my "master sheet" for the week, and mark any changes(say, lantus was decreased from 27u to 20u QHS)

I make 1 line through things that are done, but so I can still read it. I give report from my brain

There is also room to write notes..like family requests/complaints, behavior changes if I've changed out a foley..things to jog my memory

That's why it's my BRAIN

[DusktilDawn]

I designed my own "brain" which I use at work. It contains relevant data about my patients, times for VS & Chemsticks & labs, drsgs/drsgs changes, times for meds, tests & consults done or to be done, allergies, special orders (ie: NPO, CBR, etc), IV sites & fluids including TPN, and a blank section to include important details from the previous shift (ie: pt had BM, foley to removed, N&V, etc), pager number to contact resident on call. There is enough room on my sheet for info on 8 patients, although I usually have 6. I usually have to slightly change my assignment 4 hours into shift, usually add a patient, sometimes give up a patient. I've had co-workers make positive comments on it, they are more than welcome to copy it if they wish. I've updated this "brain" about 4 times since I started it, and I will probably continue to fine tune it. I also leave time reminder "tags" out for certain tasks for my self and then remove them when they are completed.

I find because I write down info, I tend to remember it better, so I don't constantly need to refer to my "brain".

Excellent topic for a thread Nurse Wannabe!!!

[chachh, BSN, RN]

I am a new grad, but used a brain before as a cna. It depends on what works for you. My new thing that I do that I really like though is that when I take report I write down everything in black, then throughout the day I write down all the new stuff that happens (lab results, orders received, etc) in red. That way when I give report I know what the new info is that happened during my shift (especially helpful if the same staff is coming back the next day).

[Catys_With_Me]

Thanks everyone. I'm a nursing student and during my first year I made myself a brain as well. It was a little crude and underwent several changes as I started to figure out what was working and what wasn't and it always seemed like I never had enough room. Some of the suggestions here have been really helpful as I'm trying to design something better for clinicals this coming year. This site is such a great resource!