High Yield Tips for a Super Smooth Month

The attendings, fellows, fellow residents, PAs/ARNPs, and nurses all have particular expectations of you. Understanding these expectations is the key to a smooth, easy month.  Better to know these things before the rotation starts.

Signout etiquette — Be on time; be efficient and to the point.

  1. During signout you don’t have to give each patient’s backstory every day. Just what the plan is, changes made during the day, what the night/day team needs to follow up on.  (New patients should be succinctly presented)
  2. Pay attention during rounds. If you are on-call for your team, write down notes on the plan on each patient so you can present it at signout later. “It wasn’t my patient” shouldn’t be said during signout. Every patient on your team is your patient.
  3. 10 mins prior to signout, stop what you’re doing and print the list and go to the room. DO NOT BE LATE FOR SIGNOUT.
  4. Again: DO NOT BE LATE FOR SIGNOUT.
  5. Be efficient during signout. No long pauses, no looking stuff up on the computer.
  6. Do not answer the phone while giving or receiving signout. Make someone else in the room answer the phone and take a message.

Pre-rounding:

In the morning, talk to the night nurses before they start signing out to the oncoming nurse (around 645am). Do not interrupt their signout. (This is a sure way to make nurses mad at you).

Don’t ask the nurses things that you can easily find in the computer (like the patient’s urine output) or ask them to tell you the patient’s drips (when you’re standing right in front of the pumps). This will make them even more angry than interrupting their signout.

Do ask them to help you read the pumps if you don’t know how yet.  Do ask them if anything interesting happened overnight, and if there are any particular orders they need from us before rounds.

Rounding:

  1. During rounds, enter orders for each other.
  2. If you are presenting:  you should not be entering orders.
  3. If you are not presenting:  you should be paying attention and entering orders.

Maintaining your patient’s orders list:

Take responsibility for the orders entered on your patients and for cleaning them up each day. Unused and superfluous orders and PRNs should be discontinued.

This includes:

  • drips that are no longer needed (No longer on levophed? Hooray! Delete it!)
  • all “insta-glucose gels”/”d5w in NS” PRN orders (only need d50w order)
  • unused electrolyte protocols
  • PRNS that are not used, etc

Too many orders leads to people unsure of what is actually going on with patient and what they are actually using/getting. A million unused PRNs is fine for the floor but is not really appropriate for ICU patients unless they actually are using them. These are the sickest patients, and we need to know exactly what the patient is getting.

In the unit, you typically can leave after family rounds if you are not on call and your patients are tucked in. However, you are not allowed to leave before:

  1. Your patients are updated on Swift
  2. All orders are entered on your patients
  3. All orders are cleaned up on your patients
  4. Patients with transfer orders have new, updated transfer of care note each day.
  5. Any patient that was transferred out of the unit with a TRACH needs a pulmonary consult.