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!

[tirramisue]

mark-

I used to write everything down, and then never look at the paper again for the rest of the shift. I finally realized I was doing it because everyone else did, and because whomever was giving me report expected me too. Got to the point where I had a piece of paper with two words on it and I would just throw it out. So I stopped, now I just listen. It's kinda funny, most of my coworkers know my habbits, but I still get the occasional "Don't you wanna go get some paper?" I don't need it, I find that writing everything down actually makes me miss parts of report. The other one I like is when whomever is giving me report says "You aren't writing anything down, are you even listening to me?" Well how far back do you want me to go cause I can quote you verbatim from the beginning-and I have done it.

For the people who do need a brain-find what works best for you and keep it consistent. I used to color code mine, red for the most important things (meds, IVs, DNR status, etc). Leave space to jot notes for when you give report. A lot of it depends on the facility and how their kardexes are-computerized ones can be really great, print them out, highlight the important stuff and usually have room for notes. Keep the info in the same place all the time-waste of time to have to sort thru your notes to figure out where you wrote the labs today.

[purplemania, BSN, RN]

I used the brain format while a staff nurse and again as a clinical instructor (to keep up with all the students and their patients). Very simple: I created a grid with hours across the top and room numbers along the left side. Then in the boxes of the grid I put notes or symbols representing scheduled treatments/meds (rx=med; dsg= change dressing; etc) As the shift progressed I jotted MD in the appropriate time slot for when the MD was on the floor or was called. I used the Kardex to report off on diet, diagnosis, and other impt stuff. But the grid was helpful for me to plan my shift and jog my memory when I finally sat down to document.

[Indy, LPN, LVN]

I tried a lot of different types of "brain" during school. My favorite before my practicum was a standard composition book, because paper doesn't fall out of it - I made a folder like thing in the back with some tape for the papers that needed to go in there.

But that was before practicum, and before I was allowed to keep the MAR of my patient in my possession all day. Now I have two brains. One is the 1/2 inch (or is it 1 inch? dunno) binder that has a folder pocket, where I stick my MAR's and charting pages for each patient. That binder goes with me to patient's rooms when I give meds, so I can sign off on what I gave, and it is kinda nice to have a flat tray-like thing to hold syringes, little cups and such.

The other brain is a 5x7 index card. When I get to a 5 patient load, I may have to switch to a piece of paper so that it will hold 5 patients' info. I fold it in half then draw a line on both sides of the card where the fold is. That's 4 patients. Room # and last name at top and highlight it. The only thing I do with that brain is write down, with times, what is going on with the patient at that time. Leave room? draw a line under that time slot.

Example would be: (not looking at all like my card but example of what I would write)

at top of card, under room no. I would put any labs that I got results on before starting care: K=3.9, CK/Trop neg. x3, etc.

0710: T96.8 P76 BP 110/60 R18 Lungs-bilat basal crackles -then abbreviate something about any abnormal assessment findings to remind me. I always write about the lungs tho, 'cause I can't remember from one person to the next what I heard.

0910: 2/3 of breakfast. bath.

1115: more VS. C/O headache, 5/10, gave (insert drug here)

1145: pain @ 2/10

...You get the idea. Short n sweet, with a "light acuity" patient it might not even take the whole 1/2 of a side of a card to write all their stuff down. That's so I have VS and reminders on me when I chart graphics, and so between morning meds and baths, when I do try to do some charting, it's easier to remember who had what going on. I like the index card better currently because I can feel it in my pocket and am less likely to lose it. I would prefer a small notebook but they seem to make 'em either way too fat, or 1/4 inch bigger than I want, or way too small.

Oh yeah! The brain can also be a regular hand-drying napkin from next to the sink, with a LOT of serial bp's and HR's on it and pain stuff, if a pt. complains of chest pain. Suddenly the card? what card? big ole napkin that I have to sit down with later and translate.

-Indy

[dinkymouse]

After being out of nursing for 11 years it is great to hear some of these ideas. I have started out getting my "brain" together. One thing I have to do is put it on a clipboard that I carry with me. I am one of those people who lose things alot! As a charge nurse I have Hot Charts that have to be charted on each shift. They range from UTI's, behavior, foleys, falls etc. I made out a form and a code for each chart, pts name, room number, reason for, what I need to do, vitals, edema, o2 sat. It has helped me cuz other wise I have to look for the red dotted charts and if I am in someone's room who is an hc I can get what I need. The pager number is a good idea. OUr facility doesn't have a master list of residents and their room numbers and I keep thinking I am going to find the time to make one. It is hard to remember who's where with all our residents. I am going to do the diabetic cheat sheet. I know some of them but otherwise I have to go through everyone's mars to find out.

[sastein]

I started in LTC this summer and found it to be very overwhelming at first. Now, I love it and have developed my own brain sheet. I don't know how to upload a file here, but I can give a quick description. I used Microsoft Word to create it. In landscape view, the far left side has a small column for the room number. Next to that is a larger column for the Resident's Name/Diagnosis and Doc. Following that are 3 small columns that I check off as I give meds at different times (depending on which shift I'm working..afternoon shift would have 1600,1800 and 2000). Then I have a column for BG checks followed by a larger column for treatments. The last two larger columns are my To Do column and a Report column. This has really helped me to stay organized.

I usually write and highlight if a resident takes pills crushed in the Report column. I also go through the MAR and write any high alert meds in the treatment column (example: I circle a "C" if a resident is on coumadin). I really like having my treatments and my meds on the same brain sheet. This has helped me to stay organized and get things done quickly.

I hope this is helpful to anyone who is starting out in LTC. It's really great once you get used to it :)

[RNSC]

I work in NICU/Level2 nursey so I never have more than 3 patients. My card is 4x6 index that I print our from Excel.

Name:

Resp :

Nurtition:

Labs:

Meds:

The other half of the card has times. This where I mark when to give meds, tx and feedings. I write my "report" on the blank side of the card.

I hope this helps

[KungFuFtr]

I work in the ER and I have 3 PTs. If I work in Urgent care, I usually have 6. I'll fold a piece of paper and put a Pt's sticker in each grid. Mostly, I just write on my hand.

[Katie5]

tirramisue said:

mark-

I used to write everything down, and then never look at the paper again for the rest of the shift. I finally realized I was doing it because everyone else did, and because whomever was giving me report expected me too. Got to the point where I had a piece of paper with two words on it and I would just throw it out. So I stopped, now I just listen. It's kinda funny, most of my coworkers know my habbits, but I still get the occasional "Don't you wanna go get some paper?" I don't need it, I find that writing everything down actually makes me miss parts of report. The other one I like is when whomever is giving me report says "You aren't writing anything down, are you even listening to me?" Well how far back do you want me to go cause I can quote you verbatim from the beginning-and I have done it.

For the people who do need a brain-find what works best for you and keep it consistent. I used to color code mine, red for the most important things (meds, IVs, DNR status, etc). Leave space to jot notes for when you give report. A lot of it depends on the facility and how their kardexes are-computerized ones can be really great, print them out, highlight the important stuff and usually have room for notes. Keep the info in the same place all the time-waste of time to have to sort thru your notes to figure out where you wrote the labs today.

You must have a retentive memory like wow!

You do this on all your residents?

[anonymurse]

Thanks for focusing on a very important tool.

On my tele floor, we use a written report sheet that's evolved over a period of years. Pretty much everyone jots notes on it all shift from beginning to end, including continuity stuff to pass on. It paints an amazingly clear picture.

In a new LTAC, report sheets are used, but they haven't had a chance to evolve yet, and usually they're scribbled out hurriedly at end of shift. I have to dig into the charts much more to ensure things don't fall through the cracks.

[RADIATION_RN]

I am so glad to come across this post! For the last 6 years I have been working as a radiation therapy medical assistant in an outpatient clinic and just recently got a second job working PRN as a clinical assistant on a busy oncology floor. I had my first 2 orientation shifts this past weekend and I felt so scatter brained! The aides on the floor do have pre-printed "jot sheets" but I found them lacking in alot of areas. So I made some of my own and I am still having to make adjustments. I am applying to an RN program next month for a Fall 2010 admit and I wanted this hospital job to help me gain some more experience. WOW! I quickly wrote down things in the aide-aide report but I still felt so disorganized. After my shift I went home and Google'd some templates for brain sheets. I found one and made some adjustments. My next shift was so chaotic that I lost my "brain" sheet halfway through the shift! After getting home after midnight I found it.....in my back pocket. Uuughhh!! The nurses tell me I will get more organized as I get more used to the routine of the floor, but it is so different than my full-time job. When I was trying to go to sleep I kept thinking I had forgotten to do something. I am not even off orientation yet! hehe!

So as a clinical assistant, it helped me to have a column at the top listing times from 0700 - 1900 if I work 7a - 7p then a separate one for 1900 - 0700 for 7p - 7a. (I am major OCD) hehe! For the left columns, I have Patient name, room #, RN assigned to patient, age, sex, code status, diagnosis, and diet. Once I get into a routine I plan to update it to add a spot for accuchecks and other misc. info.

[silverhalide]

Does anyone have a good format cheat sheet for LTC - 20 pt's? I am experimenting, I wouldn't mind seeing other ideas. ?

[pockunit, ADN, RN]

So I have this one that I've been using, and it's working okay but I know it will change depending on what floor I'm on. Right now, though, it gives me the down & dirty that I need for basic care. If anyone likes it, feel free to use it and change it as you see fit. It takes up a full sheet of paper, which I don't like, but old eyes being what they are, well...

3pt brain.doc