Are you ICU and nurses so abnormal? How should critically ill patients be handed over?

Lilac Garden saw a post by @ Zheng Sheng:

Handover process, from top to bottom:

1: Sterile water for ventilator injection (whether high-risk signs are attached, whether the date is written correctly, whether warning signs are hung)

2. Enteral nutrition patients (whether the nutrient solution is double-signed, whether the writing format is omitted, whether the pipeline label is attached, and whether the paste position is correct).

3. Stomach tube (whether the date of insertion depth is written on the label, whether it is signed, and whether it is coated with transparent glue).

4.CVC (the marking requirements are the same as above, and no gauze piece is applied twice a week).

5: Arteries (even if there is a little bubble in the sensor, you have to get it out).

6. Catheter (the identification requirements are the same as above, and it must be fixed with secondary fixing paste)

7. Skin (from top to bottom, induration is an adverse event, and a little redness will report pressure sores)

8. Even if the nursing records are all electronic, you can see the doctor's orders on the computer, and all the doctor's orders in your class should be copied to the paper doctor's orders.

9. Whether the pipeline labels of various infusion pumps are properly affixed, whether they are out of date, and whether the writing is standardized.

10: All kinds of labels must be modified if they are altered or confused.

All the above inconsistencies should be included in the quality of nursing and linked to performance. Everyone has the right to remember the quality of care of others.

This succession is really tiring. After a hard day, everyone is finding fault.

I feel that this handover sounds reasonable, but it is very abnormal and tiring to do, and most of the emphasis is on details, which is of little use. At the same time, remember that the quality of care of others is also very hurtful, and the relationship between colleagues in the department is not harmonious.

Is the ICU shift in your hospital like this? Is this necessary?

Case study:

Clinically, due to the different severity of patients treated in different departments, the trouble degree of nurse handover is also different.

For those departments that have never treated critically ill patients on weekdays, it is much easier for nurses to hand over. They always come to the department near the shift, and sometimes they focus on a few special patients who are available occasionally. On days when there are no operations or special patients, they don't even have to see them. They simply walk around the ward and know what the patients in the ward are, and everything will be fine. In such departments, nurses' job happiness index is often higher than other departments. Their mental and physical stress is a little lighter than that of nurses who have worked in intensive care unit for a long time.

Nurses in the intensive care unit, for a long time, are faced with critically ill or even dying patients. They need nurses to have a high sense of responsibility, a sense of reverence for life, always be vigilant and devote their life-long study to protect their already fragile lives. Because, at this time, every little negligence of nurses may cause irreparable losses to patients and even pay the price of life.

Therefore, nurses in intensive care unit need to know everything about the patient during the shift change, so that they can know fairly well in the next work, so as not to find their unclear problems after the last nurse comes home from work or even goes to bed, and then continue to struggle whether to call or not to ask questions, which will affect their work progress and mood, even have a negative impact on patients and bring unnecessary misunderstanding and trouble to the doctor-patient relationship.

Then, how can nurses in the intensive care unit change shifts so as not to hurt feelings as complicated as the post said, and ensure the quality of handover?

One: hand over in advance, giving enough time for hand over.

It is clearly stipulated in the nurse handover system that each shift must be handed over on time, and the successor should arrive at the department 15 minutes in advance to hand over patients, nursing records, doctor's advice and articles (ambulances, narcotic drugs, etc.). ). The patient's condition and the observation and nursing of the condition should be handed over clearly.

Obviously, according to the specific situation of the intensive care unit and the contents that need to be handed over, it is far from enough for nurses to arrive at the department 15 minutes in advance.

Take our neurosurgery ward as an example. Nurses are a little nervous when they arrive at the department half an hour early for each handover. Nurses need to check the pipeline and skin condition of each comatose patient, measure the patient's vital signs and pupil size by ECG monitoring, understand the patient's infusion situation, and check whether there is extravasation of indwelling needle or deep vein catheter. No matter how fast the nurse moves, she can't help but have so many things to hand in for you to check and master.

The handover of general wards is still the case, not to mention the intensive care unit of critically ill patients.

Therefore, nurses in ICU should leave enough handover time according to their own personality characteristics and the specific situation of patients in recent departments. Only in this way can we complete the handover in a limited time and let our colleagues get off work on time. Only in this way, I won't miss the place that needs to be handed over because of the rush of time, which will bring trouble to the next work.

Two: handover of key patients, and the key contents must be clearly handed over.

During the handover, both nurses should focus on key patients.

Particularly critical patients, as the post said, must be handed over from head to toe. In particular, if a patient has multiple pipes at the same time, the nurse should straighten out and clarify the identification of each pipe in the presence of both parties, so as to avoid confusion with each other, resulting in the illusion of observation and operational mistakes, which will cause irreparable losses to the patient.

For those unnecessary extra workload, the handover can be ignored.

Nurses should remember that in some places that must be handed over, don't take chances because it's too much trouble or to save trouble, and let yourself turn a blind eye.

Three: understand each other, don't pick bones in eggs.

As the saying goes: the wind and water turn. In other people's class today, I picked a lot of faults that are not faults. When it's someone else's turn to give you a class, you may think of your original mistakes, so that you can't get off work on time in the face of all kinds of mistakes.

In order to reduce the number of shifts in ICU, 12-hour shift system is mostly implemented. Being in a state of intense work for twelve hours in a row, my body and mind have already reached the limit that a person can bear. In this working mode, nurses should understand each other, and the nurses who take over should know how to tolerate some unprincipled details.

No one is perfect, everyone has his own advantages and disadvantages. Just like some nurses, although they don't pay attention to details and don't look so perfect, they are hardworking and willing to help others. Moreover, some nurses seem to be in perfect order, and every job he does looks perfect, but he only has himself in his eyes, and sometimes his work is complaining and asking for help from others.

Therefore, we should learn to look at the advantages of others instead of clinging to their shortcomings.

Four: when you encounter problems, make it clear to your face, and don't report behind your back.

Harmonious colleague relationship is beneficial to the development of nursing work and nurses' working mood.

Therefore, nurses should pay attention to maintaining the feelings between them in their daily work. For some accidental problems that are not hopeless, it is necessary to make it clear in person during the shift change, or even give a warning to avoid similar mistakes in the same place next time.

In this way, for those colleagues who can carry it clearly, they will not only hate your ruthless advice, but even appreciate your reminder. After all, what we are facing is life, a matter of life, and there is no room for falsehood. Your advice is a stumbling block to prevent him from making deeper mistakes, and he will understand your kindness.

However, if you find a mistake and don't say it in person, everything will be fine with a pleasant face, and then report it to the leader in the blink of an eye, which will hurt the feelings of the other party and even make the other party feel disgusted, which is not conducive to the smooth progress of nursing work in the future.

Five: Cooperate with each other and live in peace.

Nursing work is a continuous process, and each shift needs and has the responsibility to check the work of the previous shift. Only in this way can the overall quality of nursing work be guaranteed.

Therefore, when formulating various systems, leaders should take into account the mutual cooperation between nurses, promote the unity among nurses, and let everyone twist into a rope. * * * For the development of departments, for the honor of the collective, we should work towards a goal of * * *.

As the post said, it is obviously not conducive to the unity of nurses, and even makes them resentful, which greatly reduces the effectiveness of continuous nursing work.

Matters needing attention in general ward handover:

1. Handover shall be carried out in strict accordance with the handover system.

2. Coma patients should focus on skin conditions to prevent pressure ulcers.

3. If the patient is not in the ward, ask the reason to prevent accidents.

4. Have the spirit of cooperation and a sense of collective honor. When encountering problems, both parties should communicate in time and not let their mistakes continue.

5. It is best for the handover person to accompany the successor into the ward for face-to-face handover to prevent omission.

6. If you find a problem that is difficult to define, you'd better ask a third person to be a witness.