*Original Post Released on 9/25/2020
As a new grad nurse in the Intensive Care Unit (ICU), hearing your charge nurse tell you there’s an admission coming your way can be nerve wracking! In this article, I’m going to share with you some of the tips I use when getting an admission to make it as smooth of a transition, both for myself and the patient. Keep in mind, though, that the ICU is a critical environment and anything can change in a moment. For example, a patient can require a medical response team on the floor and be transferred to the ICU in a matter of minutes, so there is not always extra time to take these preparatory measures. Either way, arming yourself with knowledge of how to prepare and what to have for an admission can take some of the added stress off your shoulders. Let’s get started!
First, whenever possible, determine the reason for your patient’s admission because this can alter how you’ll prepare the room AND which healthcare professionals (HCPs) you’ll get involved during/after the admission. Let’s shed some light on a couple of scenarios you may encounter in this setting… For example, the patient with a gastrointestinal bleed will likely require additional suction set ups as well as potentially blood tubing (be sure to check their hematocrit and hemoglobin if able and have these labs ready when calling/talking to the provider). An additional example could be the ventilated patient. A ventilated patient or one who was recently intubated will require ventilator setup and assistance from the respiratory therapist for transfer to your unit. You’ll want to make sure RT is aware of the pending transfer and when it is to occur so they can be present.
Next, gather your supplies to be able to set up your room. Yes, I say this is the next step, because if you have time, you can print off the patient’s labels/armband and flow sheets later. If its an emergent admission, your charge should step up or ask for assistance in getting these printed for you while you set up the room. To help you with this step, I’ll share with you the typical items I gather to set up my ICU room (without any regard to a particular admitting diagnosis).
For your patient, you’ll need a yellow gown and socks, appropriately sized BP cuff, pulse oximeter*, electrodes*, and bracelets (ID, fall risk, allergy). For the room’s supplies, you’ll want to grab a suction canister*, a Yaunker, a stack of medicine cups, IV tubing labels/dated sticker, a sequential compression device (SCD) machine and stockings, handful of alcohol swabs, urinal/top hat, thermometer, a “christmas tree” or “nipple” for the oxygen port, and an IV pole with at least 2 pumps.
For all your IV needs, be sure to grab primary and secondary tubing sets*, swab caps*, extension tubing for IV catheters*, and multiple flushes. For lab purposes, have a MRSA swab (used to detect MRSA presence in the nares) ready along with a biohazard bag and one of your patient’s labels. Some other considerations may be extra suction canisters for bleeds or ventilated patients, oral care kit (in general but ESPECIALLY for ventilated patients), and NGT/OGT supplies if this line is in place. NGT/OGT essential supplies include: piston syringe, stopcock, bridle (NGT), pill crusher, etc.
Make sure to time, date, and initial items that should be routinely changed out within the patient’s room. These items include, but are not limited to, NGT/OGT supplies, suction canisters, urinals/top hats, bedpans, feeding tubing, IV tubing, etc. Marking these items with the date/time and your initials proves that you’re doing your part to prevent infection and encourages the accountability of your colleagues as well.
Now that you’ve got all your supplies, let’s set that room up for the admission process! If you have an awesome team like I do, your colleagues will likely get your patient transferred and stabilized while you get report. If this is the case, you’ll want to have everything on hand for the team so the admission can be completed swiftly and as smoothly as possible. (Side note: In light of that last sentence, ALWAYS be sure to ask if the patient has any life sustaining drips running. If so, make sure you have them expedited from pharmacy and on hand at the time of transfer so you have reduced risk for a code situation.) Okay, now let’s really get into the room’s setup.
Grab all the typical items included in the patient’s bed or on the patient themselves (Ex: leads, cords, gown, socks, yaunker, BP cuff, pulse ox, SCD machine, etc.). Once they’re placed on the bed, position the bed in the appropriate position for zeroing (according to the bed/manufacturer’s instructions) and zero. Doing this prior to the patient’s arrival helps give you the most accurate weight which is crucial for weight-based dosing of critical care medications. On my countertop, I place the patient’s armband/bracelets, the thermometer, labels for their IVs, and the MRSA swab with biohazard bag and label.
Make sure all your devices are plugged into protected outlets (ours are colored red) to ensure continued power even in an outage. Once your IV pole and pumps are plugged in, position them next to the monitor for ease in titrating those critical care medications based on the patient’s hemodynamic values. This also reserves the space on the other side of your bed (often next to the door) for the ventilator, if your patient requires one. Make sure to lower all the side rails on the patient’s bed prior to their arrival to aid in their transfer from the stretcher to the ICU bed.
Next to my IV pole, I use the patient’s bedside table initially to set everything on after the bed has been weighed. I lay it all out in an organized and consistent manner to make it as easy as possible for my colleagues to assist me. Of course, never forget to thank your coworkers for their willingness to help and efforts afterwards. I am a firm believer that collaboration among healthcare professions and teamwork among colleagues enhances both the patient’s experience and their outcome. The ending outcome may vary (death, returning home, rehab, etc.), however each and every staff member that interacts with the patient has an opportunity to make their experience less traumatic and more respectful. I’ve had patients who were expected to pass away and did so more comfortably and surrounded by a loving environment simply because of the staff members’ actions.
We have the ability to set a precedent for their admission experience with our very first interactions with the patient. If we are organized, methodical, and prepared, this transition is smooth for both staff and the patient/their family. With practice and preparation, you can develop a routine for the admission process that works for you within your facility.I truly hope this article helped arm you with information to help you better prepare for your first (or next) admission. Hopefully my words also helped shine a different light on the process so you can gain some insight into other reasons behind the importance of being organized, thorough, and prepared for your clients’ admissions. Happy admitting!