Problems during the shift and actions taken to solve the problems.

Problem: One of my patient was for coroangiogram. Prior to endorsement to CathLab, he experienced chest pain, heaviness and tightness. After placing on high back rest, instructing to relax and to perform deep breathing exercises, and increasing oxygen supply from 1lpm to 2lpm since he has COPD, chest discomforts were relieved. I called for STAT portable cardiac monitor and oxygen tank. The BIOMED said that there are no available cardiac monitors as of that time and the next available machine would be after the patient for discharge from 6 Floor. Furthermore, the oxygen tanks available were empty or almost empty. Action: I asked the BIOMED for another source of cardiac monitor aside from them. They replied I can borrow from PACU. I redirected the line to PACU and there we have borrowed. Problem: We received the same patient mentioned above from CathLab with stable vital signs and no pain and discomfort noted. I instructed him to avoid lifting heavy objects, straining and bending his right hand to prevent bleeding. He may resume his diet as tolerated and watch out for aspiration. 30 minutes after having his lunch, he complained of difficulty of breathing and shortness of breath. Action: I increased his oxygen supply from 1 to 2lpm via nasal cannula since he has COPD high levels of oxygen will make him more difficult to breath. I placed him in high back rest. I instructed him to relax and perform deep breathing exercises. I notified the station and my preceptor and the MROD on duty attended. They elevated the situation to the CFOD and one of the consultants. Problem: I readmitted a patient for CABG. Upon taking the history and noting the home medications prescribed, he verbalized that he is still taking Aspilets 80mg twice a day per orem after meals. I remembered that the patient should not be taking any blood thinners and anticoagulants 5 days prior to the CABG procedure. Action: I relayed it to my preceptor and we elevated it to the attending physician. The attending physician rescheduled the procedure after 5 days and held blood thinners and anticoagulants as home medications. Problem: I have a post CABG patient. Every time we do our rounds, we monitor and reinforced accurate recording of intake and output. At the end of the shift, the patient had no urine output and the 8-hour fluid balance is (+) 550. We got alarmed because the patient should have urinated and he has a high risk to develop congestion and fluid retention. Action: Upon palpation, the urinary bladder is not distended. 5 minutes after, the patient urinated 200cc. According to him, he was just lazy to get out of bed to urinate. Problem: A thermoscan was missing. Action: I rechecked my bag if Ive brought it home. Good thing I always empty my pockets before leaving the unit. The charge nurse an d manager also relayed the concern to the staffs of the unit. Problem: A medication error arose from one of the bedside nurses about overdosing of nebulization.

Action: For safety and prevention, before we allow the respiratory therapist to go to the room, we double check the medication to be nebulized. Problem: Sometimes the doctor orders for an accurate intake and output monitoring at the middle of the shift. This leads to inaccuracy because prior to that order, the patient or companion may not have monitored it quantitatively. Action: Even though the patient has no order for accurate recording of intake and output, we give them a list and instructed to use the calibrated glass and asked permission to use the urinal. At the end of the shift, we endorse the intake and output quantitatively. Problem: The outgoing nurse endorsed to us that the heplock of one of our patients was patent and he even flushed and no resistance was noted. During our rounds, we observed that the dressing of the IV access is wet. After assessment, we noted that the IV access is already dislodged. Action: We relayed it to the outgoing nurse and to the MROD. Good thing the patient is for discharge and IV access removal is ordered. On the other hand, lack of assessment was noted. Problem: Breuers cart is always messy and even the Department Manager noted that. Action: The unit had a meeting last Sunday about how to improve and maintain cleanliness of the cart. They suggested labelling of the Cart and each tray as Routine Medications during the Shift, Routine Medications for the Next Shift and PRN medications. They even put a matchbox-sized whiteboard on the upper right corner of the cart and there you can label the cart as yours during the shift. I observed and maintained cleanliness and it is very effective. Problem: One of our patients requested for a wheelchair ride outside his room. The outgoing nurse attended the request since we were receiving endorsement from another bedside. He pushed the wheelchair and I remembered that patient is hooked to continuous oxygen supply. Action: After receiving the endorsement, I grabbed the portable oxygen tank and handed to the attending nurse.