Friday, July 31, 2009

What Works on the Floor, Doesn't Necessarily Work in the ER

Good idea on the floor: 4:1 nurse ratios.  It helps keep the nurses from being overworked.  Result for the ER: management wont even consider the much safer 3:1 ER ratio because "we are just following the law".

Good idea on the floor: printing rhythm strips on monitored patients.  It proves that someone is paying attention.  Result for the ER: Despite the patient's heart rhythm clearly documented on the EKG we just got and their telemetry reading being displayed 2 feet from the doctor's head, I still have to take the time to go print a rhythm strip and sign it.

Good idea on the floor: hourly rounding.  It gets the nurses up out of the piles of mandated paperwork and into the patient rooms.  Result for the ER: I have to leave my crashing patient in 5 to go fluff the pillow of the ingrown toenail pain in 6 to prove that I'm "customer service oriented"

Good idea for the floor: treatment goal posted on the whiteboard.  It gives everybody an idea of what, specifically, that patient is hoping to achieve.  Result for the ER: with patients rotating in and out every hour or two, there is no way to keep up with individual goals.  The end-product: everybody's white board says "goal: to feel better."  Yeah, that's a nice one to have up on the board at the end of a failed code.

Do you have any others?


AtYourCervix said...

I don't work the floor, I work in L&D. We don't do hourly rounding - it more like Q 15-30 minute rounding and documentation. Then again, we have stricter nurse/patient ratios.

Early labor: 2-3 patients (note, this does NOT include the fetus in the ratio - however, we are also caring for and documenting on the fetal condition, as well as maternal)

Active labor: 2 patients

Pushing/delivery/recovery: supposed to be 1 patient, but we know how that goes........

Triage/assessment: up to 4-5 patients at one time. Which really equates to 8-10 patients, including the babies. More so if we're dealing with twins.

High risk antepartum: depends on stability of the situation. Sometimes 1:1, sometimes 2-3:1.

No whiteboard with the goal listed. That's just stupid, to be honest.

mitchsmom said...

I'm also an L&D person... two of my examples that come to mind:

Good for the Med Floors: q2h I.V. assessments - we are basically 1:1 or 1:2 with our patients and are usually adjusting some kind of I.V. med q 20-30 mins... we would KNOW if our IV's were messed up... we don't need to be reminded to check them

Good for the Med Floors: Seasonal staffing rules with no vacations in Winter (Florida here!). The "Season" in L&D is around Jul-Oct... so because our hospital INSISTS on ignoring the fact that our "season" is totally opposite from the rest of the hospital, all of our staff is forced to go on vacation when we are drowning, and fully staffed when you can hear a pin drop.

A lot of your examples work the same for us, since we triage & treat most pregnant people after 20 weeks (unless they obviously have a major trauma and are about to die, they come to us)- flu, appendicitis, whatever...