Something that is essential in your development as an efficient and safe care provider is appropriate time management. Below are some sticky situations and the safest and most efficient way to address them.
Q: You’re assessing your new admission. She’s crying in pain. Her blood pressure is 162/38. She needs an IV. There are pended and held orders in her electronic chart and her only pain med is 2 mg IV morphine. There’s a phone call for you from pharmacy about your other patient. All of your coworkers are busy. GO!
A: While you’re in the room, release your pended and held orders. Tell her you’ll BRB. Answer your pharmacy phone call in the nurse’s station and while you’re on the phone with them, say something like.. “So, my new admit, Mrs. Smith, just had a bunch of med orders come through. She’s crying in pain. Can you verify her morphine for me ASAP so I can give it right away? Thanks, you’re the awesomest pharmacist I know!” Grab stuff to start her IV. Grab your morphine. Start the IV. While you’re starting the IV, distract her by asking some of your admission questions. Give the morphine. Enter the answers to your admission questions. Recheck her blood pressure. It’s now 132/48 because her pain is now a 2/10 instead of an 8/10. WOO HOO!
Q: Your patient is scheduled for a pacemaker placement in 2 hours. You have to infuse 2 more units of FFP (they’ve already received 2 units) and recheck an INR before surgery. They are now requiring 5L NC and their O2 sat is 87-89%. You were awesome and have already assessed them and know their lungs are wet and they were clear 3 hours ago. Your other patient has to pee. A doctor is rounding on another one of your patients and has questions for you. Other than freak out, what do you do?
A: Grab a non-rebreather, crank the O2 up to 15L and put that on them. Page respiratory. Page the doctor. Go back and recheck his sats (now 92% and breathing easier). While you’re waiting for them to call you back, quickly talk to the rounding doctor. When the doctor calls you back, let them know what’s up and “suggest” some lasix now and between your next dose of FFP. Touch base with your respiratory therapist. While grabbing your lasix, delegate the peeing patient to your CNA. Give the lasix. While you’re looking for/filling out your next blood product request form, talk to the family member on the phone. Send for your next unit of FFP. Infuse it slower and chart what just happened in the room.
Q: Your fresh post-op patient just rolled on the floor. Your CNA took their pressure and came to tell you that it’s 72/40, he’s really sleepy, and super pale. Your other patient is eating their dinner and needs 19 units of insulin. Another one of your patients is in the bathroom and just hit the call bell. Your charge nurse just told you that you’re getting another patient. GO!
A: Ask the CNA that took the pressure to go get the other one out of the bathroom. On the way to the room, ask your nurse that’s charting to give the insulin. Go assess your patient. Take a manual blood pressure. Trendelenberg him. Check his estimated blood loss from surgery and his hemoglobin. (It dropped from 10.4 preoperatively to 6.9 and his EBL was only 150 ml). STAT page the doctor. While you’re waiting for the response, tell your charge nurse what’s going on and ask if someone else can take this admit and you get the next one. Recheck a blood pressure, reassess, and get ready to send him back to the OR!
Disclaimer – please make sure you ALWAYS follow your hospital’s policies and procedures. That will always supersede anything you read on this blog.