Getting your shift off to a good start is crucial if you want to have a good day (or night). I’m a big believer in routines…and your Start-of-Shift routine (SOS) is one of the most important ones you’ll ever develop. Here’s my SOS…maybe it will help you develop your own! Here are the five things I always do right after receiving report.
1. Read the H&P
Take a look at the patient’s chart and read the H&P (History & Physical)…this is usually only a couple of pages, yet it holds a ton of useful information. Here’s where you’ll see what brought the patient in to the hospital, what the physician’s initial assessment findings were, a history of their current and other illnesses, current medications, any initial tests ordered or treatments given, and their presumptive diagnosis.
2. Check Recent Labs
The next thing you should do is give the patient’s recent labs a quick peak. Which ones you’ll be most interested in depends on the patient, but in general you’ll want to see: WBC, PLT, BUN, Cr, K, Na, Glucose, Hgb & Hct. If your patient is there for respiratory issues, you’ll want the most recent ABG; if they’re in for liver issues, you’ll want to see the AST and ALT; if they’re experiencing pancreatitis, you’ll check amylase and lipase, etc…
Note that it’s not enough to simply look at that morning’s labs. You want to see the trend…look back a few days to get a real idea of what you should be concerned about. For example, if their If their WBC is 14, you might flip out if you didn’t look at the trend and see that yesterday it was 19.5 and the day before it was 21. Though it’s still high, it’s getting better…and that is why trends are MORE important than the actual number from today’s labs.
3. Look at Meds
Take a quick look at the meds the patient is currently on, and write down your med times so you can start making a loose schedule for your day. You’ll also want to be thinking about how these meds could affect your patient…will they be nauseous, tired, etc… Look at their PRN meds to see if they have something ordered for pain or fever or nausea, if you think those things are going to come up.
4. Perform Head-to-Toe Assessment
Try to get into your patient’s room early in the shift to do a full head-to-toe assessment. When you’re juggling multiple patients, you may simply need to get a set of vital signs and do a focused assessment at the beginning of your shift. After your first med pass and when you have more time (haha), then you’ll go back in for a full head-to-toe. What’s a focused assessment, you ask? Basically you’ll want to assess the patient for whatever issue brought them to the hospital in the first place…if they had vascular surgery like our patient in this example, you’d check peripheral pulses, sensation and movement. For ALL patients, take a listen to lung sounds and give their heart a little attention, too (since you kinda need those two things to work in order to, you know, stay alive and all).
5. Make a Schedule and Set Goals with the Patient
While you’re in doing your focused or full head-to-toe assessment, you should talk to the patient about what they’d like to accomplish that day. This is also the time to share with them their goals of care from your standpoint…maybe it’s POD 2 and they need to be out of bed for all meals, or perhaps they’re getting dialysis later that day, or just really need to poop. Whatever it is, discuss it with the patient (or family, if applicable) and make sure everyone understands what the plan is.
This is also a good time to flesh out your schedule for the day. Make note of dressing changes, accu-checks, labs, meds, etc… You can use a list like I made for a patient in the ICU, or come up with your own…whatever works!
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As a student, you’ll start out taking care of a couple of patients at a time, which gives you the opportunity to really perfect your SOS routine…as you start adding on more patients, you’ll see that it’s incredibly helpful for your time management and workflow. Let me know if it helps!
Get this on audio in podcast episode 96.