SJWH-NICU Staff Relief Process

 

• Staff meal breaks will be coordinated by Team Lead of respective neighborhood, to assure maximum patient coverage
  
• Wireless Cisco phones will be handed off to support staff member for restroom and meal breaks
  
• During meal breaks, "support staff" member to modify their patients' B850 monitors to receive their fellow TM's patient alarms by selecting Data & Pages, then Other Patients, then selecting the patients they are covering, select "Auto View Always", and select "Receive Alarms"
  
• Upon fellow TM's return, wireless Cisco phone is returned, and B850 monitors are modified to disable remote alarm viewing

SJWH-NICU Shift Start and Shift End Processes

 

Shift Start

0645/1845: Report to 3^rd floor Staff Lounge for huddle

• Clock-in at Unit Time Clock
  
• Staff lockers available for secured storage
  
• Huddle information relayed
  
• Neighborhood designation received
  

Report to Neighborhood assigned and view NICU Assignment Sheet

Obtain Cisco phone and Sonitor Locator badge per Assignment Sheet (may not be from "off-going" nurse)

Obtain report on each assigned pt. following Kardex "Patient Hand-Off"

Perform Chart Check

Update dry-erase board in each assigned room, greet visitors if present

Proceed with assignment

 

Shift End

Relay any supply needs to PST to assure work carts, giraffe drawers, and milk refrigerators are stocked for on-coming shift

Complete all charting, outstanding tasks, and outstanding orders

If visitors are present, assure their needs are met prior to shift report

Transfer devices to assigned TMs

Complete report following Kardex "Patient Hand-Off"

Perform Chart Check

Return to 3^rd floor Staff Lounge for belongings and Time Clock

 

 

 

 

SJWH-NICU Transfer Process

• Patients from 2^nd floor will be transferred to 3^rd floor when Level 2 criteria is met, and staffing and vacancy allows
  
• Patients from 3^rd floor will be transferred to 2^nd floor when Level 3 criteria is imminent or met (must be transferred before HFV is initiated)
  
• If possible, schedule transfers to occur prior to shift change, to allow following shift staffing to accommodate census change
  
• Transfer Team will consist of Bedside RN and PST (Resource RN and Delivery RN to assist if able)
  
• If pt. is receiving oxygen therapy, RT will join transfer team
  
• Giraffe shuttle will be utilized for pt. transfers (if giraffe due to be changed within 4 days, transfer pt to clean Giraffe from receiving floor at this time)
  
• Bedside RN to obtain patient's medications from Pyxis bin and place in giraffe drawer for transfer
  
• Bedside RN to obtain patient's chart and room folder contents for transfer
  
• PST to obtain HM and/or formula from existing refrigerator and place in giraffe drawer for transfer
  
• Bedside RN to disassociate transferring pt. from existing monitor in I-View
  
• Transferring floor's HUC to transfer pt.in Cerner (automatically "dirtying" room in Teletracker)
  
• RN to discharge pt. from B850 monitor and remove PDM and install in Transport Pro monitor
  
• Transfer PDM from Transport Pro monitor to "discharged" monitor
  
• Transfer Team transports pt. via southernmost elevators to receiving floor
  
• Once in vacant room, install patient's PDM into receiving monitor, and place "receiving" monitor's PDM in Transport Pro
  
• Transfer team to admit pt. into monitor via Admit/Discharge menu on B850
  
• Transferring Bedside RN to give report to Receiving RN following Kardex "Patient Hand-Off"
  
• Receiving RN to associate pt. with "receiving" monitor in I-View
  
• Receiving floor's CN to update device assignments in West-Call and Emergin
  
• 2^nd floor CN to update NICU Patient Tracking log
  
• Transferring PST to update Visitation Tracking Log on both floors
  
• Housekeeping will clean vacated room
  
• PST will clean equipment in vacated room
  

Patients to remain on 2^nd floor

All CPAP, SIMV, HFOV, HFJV

RDS/TTN

PPHN/Hydrops

Perinatal depression / Resuscitation @ delivery

CHD

Surgical diagnoses

Non-viable live births (X beds)

Congenital birth defects

R/O Seizures

UAC/UVC/Peripheral arterial lines

Vasoactive/Sedation drips

Chest tubes

Exchange transfusions

Suspected NEC or pneumatosis

External ventricular drains

 

 

 

 

 

 

 

 

 

 

 

 

 

Patients eligible for transfer after transitioning

R/O Sepsis

Less than 2 Kg

NAS

Hypoglycemia

Temp Instability

Hyperbilirubinemia

Poor PO feeders

 

 

 

SJWH-NICU Admission Process

• LDR/OR calls NICU 2^nd floor CN (#827141) when NICU team needed
  
• CN notifies delivery team:
  
  • Sends message to delivery team (Del. RN & Resource RT) via nurse call system (enter room # and brief description if known, and not previously relayed)
    
  • Calls on-call Neo/NNP
    
  • Sends "Delivery Team down" message to Resource RN
    
• CN accesses OBTV to expedite admission
  
• DT notifies CN of respiratory support, etc. to have at bedside (confirming admission)
  
• CN notifies PST for support
  
• HUC initiates admission of patient into Cerner, generates MR#
  
• PST obtains "admission-ready" chart, containing patient labels if available
  
• PST to facilitate entrance of team into unit and follows team for support
  
• DT enters unit via southernmost entrance (neighborhood "2 Purple")
  
• HUC enters pt information into census log and master record
  
• CN generates "wee id", obtains posey, verifies pt bands and assures "Newborn Identification" sheet is completed
  
• Neo/NNP completes orders and communicates to Resource RN, Delivery RN, and/or Charge RN, which faxes completed orders to HUC (stamp "Faxed" and document date, time, & initials)
  
• HUC enters orders once fax received
  
• PST prints facesheet and barcode labels from neighborhood, if not printed before arrival of DT
  
• PST prepares PKU slip and adds pt to PKU tracking list
  
• Resource RN, Delivery RN, and Charge RN (and Bedside RN, if available) execute admission assessment, orders, and charting
  
• Del. RN orders cord blood work-up and sends to blood bank
  
• PST cleans and prepares transporter/giraffe shuttle for next use, returns to station (TBD)
  
• CN adds pt to NICU pt tracking list

B850 Monitors

For those of you who have had monitor training, what do you think should be our practice regarding bed-to-bed viewing?  There is an option to only have the alarms breakthrough, therefore only when the other patients alarm, the monitor of the room that you are in will split-screen with a view of the alarming patient's display and corresponding alarms.  We need to determine what is best practice for our new unit.  Until further notice, only bradys will be coming to our Cisco phones.  Therefore, we would see if one of our babies are desatting, when we are not at our desks in view of all the monitors.