ICU Workflow

Hello friends!

Before I immigrated to the US, I really wanted to know the workflow to have an idea of how things are done here, so I searched my copy to share it with you. Here’s the usual workflow in the ICU:

ICU WORKFLOW

Start of Shift – Report

·       Print rhythm strip

·       Get report from the previous RN at the bedside

·       Assess skin

·       Check gtt rates and set up (wt)

o   Some gtts are weight-based (i.e., propofol); make sure that the wt in the infusion pump is correct

·       Any gtts low? Need to send an intervention?

o   The pharmacy prepares gtts, and usual gtts are in the pyxis. Some gtts, however, need to be ordered, so make sure to send a med request before you run out.

·       Check EPIC

o   Any new orders?

o   Any meds pending?

o   Double-check labs

§  Labs are usually drawn at 4 am in the morning, and electrolytes are replaced based on protocol

·       Check advance directives – HCP or DNR?

·       Make post-it note for each pt with time meds/labs are due to organize day

o   Epic has a worklist which shows your task for the whole shift and the time you need to accomplish it

0730 – 0745

§      Eyeball both patients, but see sickest pt first

§      Bring in meds and any supplies you will need

§      Complete assessment

§      Try to complete your nursing documentation as early as possible, just in case something happens

o   During Assessment in Each Room:

§  Zero A-line & CVP if applicable; check cuff pressure

§  Check all tubing dates, labeled? (Tubing expires q4 days)

§  A-line, wound, drain drsg’s – intact? Clean? Dated?

§  Check ETT and placement

§  Confirm vent settings to MDs order

§  Check critical alarms on the monitor – set alarm settings appropriately

§  Administer meds

§  Reposition pt, mouth care, suction

§  Complete flowsheet in EPIC

§  Complete whiteboard in each pts room (write your name, doctor, RT, social worker etc.)

§  Make sure each room has an oral airway, tongue blade and ambu bag

0745-0800

§       Bring in meds and supplies for the 2^nd pt

Complete full assessment on 2^nd pt

0900

·       Computer documentation

o   Nursing documentation

§  Flowsheet

§  Nursing note

o   Education

o   Care plan

1000

·       Reposition pts, mouth care, update flowsheets

·       Any new orders?

o   on the even hours – turn, reposition, patient care

1100

·       Bathe pts if applicable

·       Get pts out of bed (OOB) is applicable

·       Computer documentation

o   On the odd hours – computer documentation; make sure your flowsheets are all caught up

1200

·       Reposition pts, mouth care, update flowsheets

·       Meds, fingersticks

1400

·       Reposition pts, mouth care, update flowsheets

1600

·       Reposition pts, mouth care, update flowsheets

1700

·       Meds (you are allotted an hour before or after a medication is due to administer meds; for example, if your med is due at 1700, you may give it as early as 1600 or as late as 1800. This way, you may plan ahead of time and cluster meds.

1800

·       Reposition pts, mouth care, update flowsheets

·       Fingersticks

·       Empty all drains and record

·       Finish computer documentation

End of Shift

·       Clean pts’ room

·       Restock C locker

·       Make sure all orders are carried out and meds are given

·       Obtain any new orders if needed

·       Are all labs transcribed on the flowsheet?

·       Is the I/O flowsheet complete? Do your numbers add up?

·       Is all the computer documentation complete?

·       Make sure medicated gtts are available for the next shift; send interventions if needed (i.e. send pharmacy med request through EPIC)

·       Sign off narcotic gtts with next shift

·       Make sure plan of care and education is completed

·       TF tubing changed or in the room for the next shift?

Delight thyself also in the Lord; and he shall give thee the desires of thine heart.

-Psalms 37:4