Life in the ICUs

The ICUs at Emory Healthcare are not like your Thursday night hospital program on TV! They may be action-packed and full of variety; however, all the effort television puts toward drama, Team Emory Healthcare puts toward teamwork.
 
Recently, two of the real-life Emory Healthcare ICU stars shared what really happens on their units. 

Read Bea Noel's story, where she describes the elements of teamwork in her day!

Read Edward Norris' story, where he gives a detailed description of a day of clinical care!

Bea Noel, neuro ICU at Emory University Hospital MidtownBea

“One day, I might care for a 21-year-old patient with a fresh craniotomy,” said Bea Noel. “The next, I may be working with a 60-year-old man who had a lumbar laminectomy. The one constant from day to day is teamwork.”

Noel, a skin champion and safety representative on her unit, as well as a DAISY Award winner, gave a glimpse into a few elements of that teamwork:
 
Huddle up!: The day starts with a briefing with the nurses from the previous shift. We call this a huddle.
 
Bedside shift report: Shortly after, the outgoing nurse and I coordinate the bedside shift report. This process, one developed here at Emory Healthcare, takes place in the room in the presence of the patient and family. This way, everyone can participate and be a part of the care team.
 
Goal setting: Next, my patient, the family and I work together to set certain goals for the day. This could be anything from reducing pain level to a specific point or being out of bed for two hours.
 
Rounding: Everyone participates in rounding – physicians, nurses, nutrition team, pharmacists, patients and families. 
 
Huddle up on the way out!: At the end of the day, I huddle with the incoming nurse and say goodbye to my patients. I go home with the satisfaction that I have positively impacted the lives of my patients for that day. We often get visits from patients and their families to thank us for the care we provided, care that allows them to return to a more productive life – free from chronic back pain, free of a tumor or free from the residual neurological deficits of a hemorrhagic stroke.

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Edward Norris, surgical transplant ICU at Emory University HospitalEdward
 
Edward Norris, a skin/wound champion and member of the unit’s Quality Council, captured a day of clinical care on his unit. Check out his day below.

A.M.    

Coffee!

7:00

Bedside shift report for two patients. This includes the family, when available.

7:30

Review medications for the day. Develop plan of care and set the goals for the day.

7:45

Surgeon and residents in to see Patient 1 with GI bleeding. Discuss with MDs the blood transfusions overnight and latest hemoglobin and hematocrit levels post-transfusion. Plan for additional units of red blood cells.

7:55    

Collaborate with Respiratory Therapy on Patient 2, who is on a ventilator. Turn off sedation for “daily awakening” in preparation for spontaneous breathing trial. The goal is extubation.

8:00

Partner with another nurse to turn and clean a patient.

8:10

Conduct full assessment of both patients – the most critical first. Example procedures include a delirium screening, glucose monitoring, bedside dialysis (continuous renal replacement therapy) and pain assessment.

8:45

Start morning medication administration.

9:45

Family arrives at bedside to visit Patient 2. Update the family on the patient’s condition and extubation goal. Encourage the family to communicate with the patient, help with stimulation and breathing, and orient the patient to the events surrounding hospitalization and what’s going on back at home with loved ones.

10:00

Patient 1 patient rounds with MD, NP, residents, Pharmacy and family. Discussion about Patient 1’s condition, program and plan.

10:30

Patient 2 met all respiratory/hemodynamic parameters and is cleared for extubation. Partner with Respiratory Therapy on extubation. Educate patient on coughing and breathing exercises and actions to take to expand lungs and prevent pneumonia.

10:45

Blood ready to hang on Patient 1. Check with another nurse to ensure safety – correct patient, correct identification, blood bank number, etc. Stay with patient to monitor for reaction.

11:00

Check Patient 1 vital signs.

11:10

Patient 2 exhibits nausea. Intervene with medication and repositioning.

11:30

Report on both patients to buddy nurse, so I can break for lunch.

noon

Check with buddy nurse on any issues during break. Assess and monitor patients. Adjust insulin on Patient 2.

12:15

Medication administration. Check for interactions. Send request to blood bank for Patient 1.

12:30

Patient 2 patient rounds.

2:00

Work with Patient 1 and Patient 2 on care needed, such as dialysis attention for Patient 1 and breathing exercises for Patient 2.

3:30

Partner with technician and MD on bedside upper endoscopy procedure. Most of the non-emergent bedside procedures, like this one, occur during the afternoon. Other procedures for critical patients that can occur at any time might be intubation or line insertions.

4:30

Patient 1 abdominal wound dressing change.

5:00

Prepare Patient 2 for trip to MRI for scan of abdomen, pelvis. At this time, call the resource utilization nurse (RUN) to see if she/he is available to go with the patient to the procedure. This is a huge help to the ICU nurse, especially with MRI. (The ICU nurse must stay with the patient for the entire procedure, which can take an hour or longer.) While the RUN and patient are in MRI, the ICU nurse can care for his/her other patient, and it helps lighten the burden of other nurses having to watch/care for the other patient while ICU nurse is down in MRI.

6:00

Gear up for end of the shift. Hang IV nutrition. Make sure all drains are emptied and documented. Make sure all computer documentation is complete; medications, interventions, tasks charted appropriately.

6:30

Patient 2 returns from MRI.

7:00

Bedside shift report to nurse who took care of patient the previous night. 

Of course, this is just a high-level overview of the day! Hourly, we check in on each patient. We continually interact with the patients’ families. In addition, we also participate on code teams to respond to emergencies outside the unit. These codes can happen at any time, and we are always ready to respond!

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