Are the nurses in your intensive care unit so perverted? How should critically ill patients be handed over?

Dingxiangyuan saw a post @癙正:

The process of handover required for shift handover, from top to bottom:

1: Sterilization of ventilator Water for injection (whether there is a high-risk label attached, whether the date is written correctly, whether there is a warning sign)

2: Patients with enteral nutrition (whether the nutritional solution is double-signed, whether there are any omissions in the writing format, whether there are any Paste the pipeline identification, and whether the pasting position is correct)

3: Gastric tube (whether the label contains the insertion depth date, signature, and whether there is transparent tape on the outside)

4.CVC ( The labeling requirements are the same as above, and the gauze-free patch should be replaced twice a week)

5: Artery (if there are any air bubbles in the sensor, remove them)

6: Urinary catheter ( The labeling requirements are the same as above, and must be fixed with a secondary fixation patch)

7: Skin (from top to bottom, if there is induration, it is an adverse event, and if there is a little pressure redness, a pressure ulcer should be reported)

8: Even if the nursing records are electronic and the medical orders can be seen on the computer, all the medical orders in your class must be transferred to paper medical orders.

9: Whether the various infusion pump pipeline labels are affixed, whether they have expired, and whether they are written in a standardized manner.

10: Various labels have been altered or confused and must be modified.

Anything that is inconsistent with the above will be included in the quality of care, and the quality of care is linked to performance. Everyone has the right to take note of the quality of care given to others.

This kind of succession is really tiring. After a hard day’s work, the next shift is spent finding faults.

I feel that this kind of handover sounds reasonable, but it is very abnormal and tiring to do. The key is mostly minutiae and of little use. At the same time, remembering the quality of other people's care is very emotionally damaging, and the relationship between colleagues in the department is not harmonious.

Is this the case for ICU shift handover in your hospital? Is this necessary for shift handover?

Case analysis:

In clinical practice, due to the different criticality of patients admitted to various departments, the degree of trouble when nurses hand over is also different.

For those departments that have never admitted critically ill patients on weekdays, it is much easier for nurses to hand over. They always come to the department near the time when the shift is handed over, and sometimes focus on checking on a few special patients that occasionally appear. On days when there are no surgeries or special patients, they don’t even need to check. They just simply go around the ward and check the patients. Once the patient knows where the ward is, everything will be fine. In such departments, the happiness index of nurses working is often higher than that in other departments. The stress they endure physically and mentally is much lighter than that of nurses who work long-term in intensive care units.

The nurses in the intensive care unit have been facing critical or even dying patients for a long time. It requires nurses to have a high sense of responsibility, a sense of responsibility for life, and never relax at all times. Be vigilant and devote all your life's learning to protecting an already vulnerable life. Because, at this time, every small negligence of the nurse may cause irreparable losses to the patient, even costing his life.

Therefore, the nurses in the intensive care unit need to understand everything about the patient when handing over the shift, so that they can be well aware of it in the next work, and will not be overwhelmed by the previous work. One group of nurses had already gone home from work, and they even discovered problems they didn't understand until they went to bed. Then they continued to struggle with whether to call or not to ask questions, which affected their work progress and mood, and even had a negative impact on patients and the doctor. It can cause unnecessary misunderstandings and troubles in relationships.

So, how should nurses in the intensive care unit conduct shift handovers so that they are not as cumbersome and emotionally damaging as the post mentioned, and at the same time ensure the quality of the handovers?

One: Handover in advance and give enough time for handover.

The nurse handover system clearly stipulates that each shift must be handed over on time, and the successor must arrive at the department 15 minutes in advance to hand over patients, nursing records, medical order execution, and items (emergency vehicles, narcotic drugs, etc.). Observation and care of the patient's condition and condition should be clearly communicated.

Obviously, according to the specific situation of the intensive care unit and the content that needs to be handed over, it is not enough for the nurse to arrive at the department 15 minutes in advance.

Take our neurosurgery general ward as an example. The nurses are a little nervous when they come to the department half an hour in advance for each handover.

Nurses need to check the tube and skin conditions of each comatose patient. They need to measure the vital signs and pupil size of patients with ECG monitoring. They need to know something about the fluids the patient is infusing. They need to check whether the indwelling needle or deep vein catheter has any external components. Seep, wait. No matter how quick the nurse is, no matter how hard she picks up the key points, there is still so much content that needs to be handed over that you have to check and master.

This is the case for handovers in ordinary wards, let alone the intensive care unit where all critically ill patients are.

Therefore, when intensive care unit nurses take over, they should try to leave themselves enough time to hand over according to their own personality characteristics and the specific conditions of recent department patients. Only in this way can the handover content be completed within a limited time and colleagues can get off work on time. Only in this way can you not miss the parts that need to be handed over due to the rush of time during the handover process, which will cause trouble for your subsequent work.

2: Focus on key patients and key content must be handed over clearly.

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

Special critically ill patients, as mentioned in the post, must have clear handovers from head to toe. Especially if a patient has multiple pipes at the same time, the nurse should straighten and clarify the labels of each pipe when both parties are present, so as to avoid confusion between them, causing illusions in observation and errors in operation. , causing irreparable losses to patients.

As for the extra workload that is dispensable, it can be brushed off during the handover and ignored.

Nurses must not take chances and turn a blind eye to some areas that must be handed over because they find it troublesome or want to save trouble.

Three: Understand each other and don’t find fault with each other.

As the saying goes: Feng shui takes turns. Today you picked up a lot of problems that were not faults when you took over someone else's shift. When it is someone else's turn to take over your shift one day, they may also remember your original pickiness, which prevented you from getting off work on time in the face of all kinds of problems.

In order to reduce the number of shift handovers, most intensive care units implement a twelve-hour shift work system. Being in a tense working state for twelve consecutive hours, the body and mind have already reached the limit that a person can bear. In this working mode, nurses must understand each other and take over some details that are not principled. Nurses must know how to be tolerant.

No one is perfect. Everyone has their own strengths and weaknesses in character. Just like some nurses, although they do not pay attention to details and do not look perfect, they are quite diligent in their work. Also willing to help others. Some nurses seem to be well organized, and every job they do seems to be perfect, but in their eyes they only have themselves, and sometimes they want help from others in their own duties.

Therefore, we must learn to see the advantages in others instead of dwelling on their shortcomings.

Four: If you encounter any problem, explain it to your face and do not report behind your back.

A harmonious colleague relationship is conducive to the development of nursing work and is also conducive to the nurse's mood when working.

Therefore, nurses should pay attention to maintaining the relationship between each other in their daily work. For some problems that occur occasionally and are not corrected despite repeated admonishment, they should make it clear in person when handing over the shift, and even give a warning to avoid similar problems. The error appears in the same place next time.

In this way, for those colleagues who can understand clearly, not only will they not resent your ruthless guidance, but they will even be grateful for your reminder. After all, what we are facing is life, human life is at stake, and there is no room for any falsehood. Your guidance is the stumbling block that prevents him from making deeper mistakes, and he will understand your good intentions.

However, if you find a mistake and don’t say it to your face, you will be fine with everything, and then go to the boss to report it in the blink of an eye, you will hurt each other’s feelings and even make the other party feel resentful, which is not good for the future. The smooth progress of nursing work.

Five: Cooperate with each other and live in peace.

Nursing work is a continuous process. 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 every system, leaders must take into account the mutual collaboration between nurses, peaceful coexistence, promote unity among nurses, and let everyone work together as a rope, ** We work together toward a common goal for the development of the department and for the collective honor.

Mutual supervision like the one mentioned in the post, where each other has the right to record other people’s nursing quality defects and link them to performance, is obviously not conducive to the unity of nurses, and may even make each other feel dissatisfied. Resentment arises, which greatly reduces the effectiveness of the continuity of nursing work.

Notes on handovers in general wards:

1. Carry out handovers in strict accordance with the handover system.

2. Comatose patients should focus on communicating their skin condition to prevent the occurrence of pressure ulcers.

3. If you find that the patient is not in the ward, ask for the reason to prevent accidents.

4. There must be a spirit of cooperation and a sense of collective honor. When encountering problems, both parties should communicate in a timely manner. Do not ignore the matter and allow mistakes to continue.

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

6. If you find a problem that is difficult to define, it is best to ask a third person to be a witness.