What are your must-do's?

[missdeevah]

what are some things at work, that you always make sure that you do, and never go through a short cut? whether it's a routine order of perfoming a task, checking the rights 3 times before a med pass, checking the charts at a certain time and in a certain order, or a method that you use to ensure that you don't forget to give a medication or check a lab result at a certain time?

[Do-over, ASN, RN]

I fold a blank piece of paper into quarters - each quarter gets a patient's sticker and next to that I list all the times meds are due, and the times of any timed lab draws. Then, as I go, I can take notes on each patient in his or her section, write labs etc and then use it for giving report.

If I get more than 4 patients, I use the back. My nights are much better when it stays at four!

[queenjulie, RN]

I must have my brain!!! It's a sheet that list all my meds an times to give along with swan numbers, iv med gtts.

I can understand listing what time you need to pass meds, but do you really list every single med? Doesn't that take forever? I frequently have patients with twenty or thirty meds, and if I had six patients, I can't imagine hanging out at the beginning of the shift, writing out eighty or ninety med names.

[pixie99]

When I hang a piggy back antibiotic, I stand and stare at it long enough to count 1-2-3 drips in the drip chamber. Always. this is after I got chewed out about leaving a piggyback clamped. The three drips is about the only OCD thing I do at work.

[StrwbryblndRN]

My must do's for my night shift:

1)We have computers in the rooms and I save time by charting as I go. Except assessments.

2)I check charts right after rounds. Most do this later in am but I have found missed orders that could have been resolved earlier.

3)I inform my pt's of everything I will be doing in order to maintain their rights. I have found many nurses not good at this. It also helps if you advice a pt you will be waking them up @ 0400 for a scheduled abx.

Many things are a must otherwise just to be safe. Like med administration, fall precautions etc.

[LouisVRN, RN]

1) During rounds ensure that bed alarms are on and beds are plugged in, pain is controlled, and IV is not about to go off.

2) During report i draw empty boxes next to things that I need to be sure to do so I don't forget anything and also make sure I get a complete and accurate report, anything that the offgoing nurse can't answer for me, I put a box next to so I can look it up/ask the patient before I have to give report.

3) Review all orders for the day for all my patients before I do anything.

4) Never ignore a patient that says they "don't feel right"/"chest pain" or chalk it up to the easiest solution

5) Write all the times I administer pain medications down, so I can reassess and chart appropriately

6) As charge, never leave before I have checked in with everyone to see if I can do anything before them. Nothing more annoying as a staff RN as being the last one there with a long list of things left to do and no one asked to help before they left.

7) Don't get lazy about filling out incident reports, its the only way theres a chance of somethings being changed.

[tokmom, BSN, RN]

I agree with most of what you wrote but the bolded might be against infection control.

What? You don't agree with everything?

Actually for those on Iso. I made copies of their mar for the big med times. So if they had meds due TID, I would make three copies. We only have 3-4 pts max, so it's not like I had reams of paper to deal with. After I was done with the MAR, I would shred it into a million pieces, and throw it away.

[catlvr]

Call me silly, but I check feeding tubes for placement *every* time I access the tube. I know some nurses who are comfortable checking it once a shift, and some who don't ever check for placement. I guess that I'm fussy about all tubes - IV lines, catheters, drains...they get checked every time I walk by the room (I work in a nursing home with 24 pts - half short term rehab and half long term care).

[cogath]

3 med checks and running protocols

also reconcile IV's and check tubing/site

[Do-over, ASN, RN]

Call me silly, but I check feeding tubes for placement *every* time I access the tube.

Hey silly! I do the same, and check residual.

[NurseKatie08, MSN]

I'm pretty obsessive about the three checks/safety with med administration

On the side of keeping organized, I'm a fanatic about having my med cart organized/stocked just so. Have to have cups, med cups, straws, spoons, alcohol wipes, syringes etc all stocked up before my shift starts. Also keep my stock meds & presciption meds organized in a certain way. I hate when there are multiple cards of the same med open--drives me nuts!

[missdeevah, NP]

i read through all the responses, and was reminded about a thing or two that i need to be more vigilant about. loved the responses. i always:

-round on patients right after report, and check o2 sats at the same time

-check my charts for orders. at this time, i also quickly glance through the h&p. it's always interesting the things you learn. on a side note, i cannot stand it when nurses admit patients and do not list a single thing under the patient's medical history-as a way to quicken the admission. i mean...i would really love to know that my patient has chf etc.

-note down any pending labs and tests and times that i need to check or order them

-find out who my diabetics are and make lines at the bottom of my kardex to later fill in with their blood glucose values.

-during my first rounds, always check and note down if any iv meds are running, and at what rate, then later compare to mar when checking charts.

-note down the bp and hr next to bp meds

-i only note down meds that are to be given outside of regular scheduled med pass times.

-always right down what orders a doc gives me, and then read them back, even if the doc acts like he/she is in a rush and ready to get off the phone.

-always flush saline locks during my first med pass and ensure that they are working. i work on a telemetry floor and there's no telling when you will need that iv in a rush.

-ensure that bed alarms that need to be on are on.

-give report to techs when they come in at 11pm. just a quick heads up...room 401 is npo from midnight, 402 is q6 blood sugars, 403 is on a bed alarm, 404 needs a urine sample...etc

-jot down on the back of my kardex what time i give prn meds and later chart on them, or do it immediately if possible.

-inform my pt's if they are to be npo and why

-if i'm done and someone else is struggling, i will offer my help. however, there are some nurses that will never accept help of any kind from anyone. i think this is plain silly, but that's just my opinion

[Yiggs]

I am very anal about checking blood pressure and pulse before I give cardiac meds. I also read the pill wrapper and review the MAR several times before I hand the pills to the patient. Check if the pt. is "breathing right" before the off going nurse leaves (lol).