00:01
Now after lunch,
we've got a lot of things to consider.
00:04
If you take a look at this list,
we've got a discharge patient,
once one leaves, once coming in the
door, they're admitting,
you may have procedure
results returning.
00:14
You may have to re-prioritize
or change the plan of care.
00:18
Also, if your patient went to surgery
this morning, they may be coming back.
00:22
So we're about midway or in our
shift here about two o'clock.
00:25
These are some common things
we're going to have to address.
00:29
So let's take a look
at this first one.
00:31
So many times with
discharging patients,
we've got to make sure the physician
said it's okay for them to go,
we've got all that paperwork
we've got to make sure we do.
00:41
Educating the patient
is really important.
00:43
And guys,
this can take some time.
00:45
Also, you've got a document.
00:47
And if the patient's going to
another facility, for example,
we've got to usually call and
provide handoff report as well.
00:54
So all of these
points, here are things
we also have to consider in or afternoon in
regard to our organization of our shift.
01:02
Now, if someone leaves,
it's a pretty good guarantee
that you may have a new patient
coming in the door
or on your unit.
01:09
So we admit a patient we also have
these responsibilities as well,
that we've got to make sure we
organize our shift around these.
01:17
So a full initial head to
toe assessment's important.
01:20
And also the patient may have immediate
needs that have to be addressed right then.
01:25
We got to make sure
the patient's safe,
and also complete any sort of mission
pieces that needs to be done at that time.
01:32
Now next, a lot of times we're going
to get like unexpected results,
there could be some
change in orders,
we may have to let the physician
know of critical results.
01:42
So all this guys can
eat up your time.
01:44
So we may have to page for the
doctor, we've got to wait for them,
they're going to pull us from
whatever room we're working in,
we've got to communicate with
them, put in the order.
01:54
These are all time things that we
have to organize around for our day.
01:59
And lastly, in our afternoon,
anticipate some changes
in the plan of care.
02:04
So this could mean our patient
status, hopefully it gets better,
but it could decline.
02:08
We may need to provide
reassessments on our patients.
02:12
Also, a patient may need
a different level of care.
02:14
And this definitely takes a lot of
time to coordinate with the other unit.
02:18
New orders may pop up, patients
may have different tests going on.
02:23
Also, if your patient went to
a procedure or to a surgery,
when they get back,
we've got to take time,
check them in and
reassess at this point.
02:32
So guys,
we're ending our shift here,
we're getting close to the end.
02:35
And don't forget to make
sure you're documenting
and everything's up-to-date in
the patient's medical record.
02:41
So if you remember, if we can charge
at the bedside whenever possible.
02:46
Also, about this time again,
towards the end of our shift,
it's really important
to review your charting.
02:52
So I'm not saying you have to
go through every minor detail,
just make sure that everything's
up to date, that it's accurate,
because again,
this is a part of the patient's record.
03:02
Now, also, it's important,
it's easy throughout the day
that we educate our
patients all the time.
03:08
Many times we actually forget to
document this and take credit for it.
03:12
Make sure you document any education
that's provided to the patient.
03:16
Many times documenting this is
actually meeting certain standards
for that patient's
disease diagnosis.
03:23
You may also hear something
called 24-hour chart checks.
03:27
Well, it depends on the
facility and their policy.
03:30
But it typically every evening,
the charge nurse or the
nurse will double-check
to make sure appropriate
documentation is done.
03:37
And again,
make sure for the next shift,
you update the
patient's plan of care.
03:43
Okay, guys, we're about an hour
from when we get to go home.
03:47
This is actually a
really important hour.
03:49
This is the time we're going to
get ready for handoff report.
03:53
If you remember at the
start of our long shift,
we did something
called bedside report.
03:59
This is the time we need to
gather all this information
to make sure to let
the oncoming nurse know
all of the events that
happen throughout the day.
04:07
So here's a few points.
04:09
Make sure you round
on your patient.
04:11
Don't forget those four
P's and make it purposeful.
04:14
This is important here because any
additional needs the patient has,
any safety situations that we need
to address, we can do this now.
04:23
Also, here's a common example.
04:26
Many times when I'm working at
a surgical hospital and the
patient's just had a back procedure,
about this time
about 6 pm at night,
I usually give them
their pain medications
if it's allowed to
do so per the order.
04:42
Reason being is
this way the patient
doesn't have a gap of
medications of me leaving
and the new nurse coming on.
04:48
This is also a great time to address
any questions from the patient family.
04:53
And also make sure any of those
fluids running are infusions
that you check these for
volume and document that.
05:00
And again,
all this information is important
for bedside shift report
for continuation of care.