Question

It is the beginning of the evening shift on a step-down unit. Your team for the evening includes you (the RN), another RN, one LVN, and one UAP. Here are the patients on the unit:

Room 1A: 50-year-old female with ovarian cancer. Had an argument with her husband and is asking that all visitors be restricted.

Room 1B: 88-year-old female with dehydration. Is now confused, and a urine sample is needed to rule out a urinary tract infection (UTI).

Room 2A: 44-year-old male admitted with a nonhealing abdominal wound after gastric bypass. The wound has a negative pressure wound therapy system that needs to be changed this shift.

Room 2B: 78-year-old male with bacterial endocarditis who will be returning to the nursing home to continue his IV antibiotics. Needs transfer form completed, assistance with dinner, and a bath.

Room 3A: 35-year-old male going for an IV contrast CT. Received call from radiology that transportation is on its way to pick up the patient; patient does not have any IV access.

Room 3B: 18-year-old male admitted for 23-hour observation for mild concussion after falling at an ice rink. Patient is ready for teaching prior to discharge.

Room 4A: 22-year-old female with SIADH on fluid restriction. Current fluid restriction is 200 mL for evening shift and 100 mL for night shift. Family has brought in multiple food items as well as her favorite sodas to drink.

Room 4B: 25-year-old female with PID. Needs to receive IV antibiotics, and a weight is required to prepare the proper dose.

#1. Which tasks may be delegated to the UAP? List in order of priority and provide your rationale for each room.

#2. What specific feedback does the RN need from the LVN and UAP regarding their assigned tasks?

#3. What care delivery model is described in this scenario?

#4. The UAP informs you that the patient in 1B has a fever of 102° F. After performing an assessment, you decide to call the health care provider. How would you use SBAR to communicate with the provider?

Answer 1

1.

Room	Task	Assigned to
1A	General care	LVN can be assigned with stable patients who needs only general care measures.
1B	Monitoring Collection and sending Urine specimen	RN 1- patient is confused and outcome is unpredictable and is unstable. patient requires high level of professional judgement and skills. Assessment is RN's responsibility that cannot be delegated. UAP - can collect specimens for medical tests
2A	Changing negative pressure wound therapy system	LVN. This procedure includes wound care which is LVN's responsibility.
2B	Completing transfer form Assistance with dinner and bath	RN-1. An RN must perform completion of patient care related forms UAP is trained to perform basic hygiene measures and daily needs of patient.
3A	IV cannulation	RN-2. Bed side invsaive procedures can be performed only by RN
3B	Health teaching	RN 2. A RN is responsible for conducting teaching sessions for client and family. Newly admitted un stabe patients cannot be assigned to LVN or UAP.
4A	Monitoring I/O strictly	LVN can monitor Intake and Output other than IV.
4B	IV administration of antibiotics Weight checking	RN2. RN only can administer IV medications. UAP can be assigned for weight checking as it is one of their professional responsibility and doesn't require competitive skills.

2. LVN needs to report all the gathered data to the RN. Here for 1A patient with ovarian cancer, the noted behavioral changes,for patient with NPWT, characteristic of the drainage and wound and for patient in 4A Intake and output findings needs to be reported.

UAP performs all duties under supervision of RN.

3.Team nursing care model is used in this scenario. In this model,patient care is  provided by a coordinated team of qualified nurses (RN,LPN/LVN and UAP) under guidance and supervision of a team leader who is a Registered Nurse.

4. SBAR method to communicate(Situation,Background,Assessment,Recommendation)

S:I am RN 1 on step down unit. This is about patient X in 1B .I am calling because I'm concerned that her temperature reading is high.

B:Patient X got admitted on XYZ date with dehydration.Patient is confused.a urine specimen is sent to rule out UTI.

A: The body temperature is elevated to 102⁰F, Urine sample results are yet to arrive.A tepid sponge is provided.I am not sure about her problem and I am worried.

R:I need you to come and see the patient at the earliest. And in the meantime do I need to do anything like administering an antipyretic medication?