The day/night coverage system allows for shorter clinical periods for the residents. The key to continuity of care becomes the hand-off – THIS IS CRITICAL THAT IT BE DONE CORRECTLY. If this system is to work effectively, the handoff needs to be completed in a way that allows a seamless transition of care. Please take the time needed to perform an effective handoff.The handoff should be performed at the patient’s bedside with both the daytime and nighttime resident present. In addition to discussing clinical course and situational awareness, you should discuss any nursing concerns brought up during your shift. It is NOT appropriate to perform sign-out in a computer room or away from the bedside. This handoff is the key time for housestaff coming on to gather as much information as possible on events and plans that were made during the previous shift. It is useful to take a computer with you to review notes/labs/patient data. Often many questions can either arise or be solved by physically assessing and examining the patients, as well as for discussions with nursing staff and to review the glass doors for updates.
ChIMP (Checklist for Intensive care Morning Pre-rounds) This checklist is used overnight to organize the clinical responsibilities PRIOR to AM rounds.
- Review overnight events
- Review pre-ops for next day
- NPO status
- Dextrose source if patient received Lantus and is NPO
- Anti-coagulation status
- Review labs
- Electrolyte repletion
- Review CXR’s
- Emergent procedures
- Restraint orders
- Fill out orders for patients that require restraints for next day and
time orders for 0700
- Review SBT’s (spontaneous breathing trials)
- Extubate as indicated after discussion with fellow/attending
- PICC line consults