H6000 Hospitalist Tip Sheet

• Daily multidisciplinary rounds at 1030 AM in south east conference room
• It is expected you touch base daily with bedside RN for each patient

• These patients are often unable to communicate, have d/c barriers, and more issues with behaviors, moving, eating etc that will be best highlighted for you by RN!

• Floor initiatives

• Control number of shifts that sitters are needed, neuro patients use sitters at higher rate than other floors

• Please consider 1:1 sitters as a nursing intervention; do NOT order on Kardex unless you discuss with RN and have a specific reason you want to make it clear that the sitter should not be discontinued until YOU discontinue the order
• If you write “1:1 sitter” in your note, please specify if you mean “PRN per nursing” or “wean as able” or “do not wean until instructed by physician”
• If you want to discontinue sitter to facilitate discharge, please make this discussion with RN as they may still have sitter due to behaviors that are not yet managed

• Falls

• Neuro patients are very high risk, when admitting please consider specifically telling patient that even though they may not feel like it, they are a fall risk, discuss calling RN for bathroom or any ambulation
• Make sure call light and phone and tray table are where the patient needs them

• Early discharges

• Goal is to discharge 3 patients before noon, please be open and helpful to these discussions identifying patients for the next day

• Floor specific issues

• Stroke and ICH

• Order sets

• You MUST use the designated order sets for all stroke and ICH admissions, the hospital is tracked on this metric and you will get feedback if you miss this
• A TTE should not be ordered on all stroke patients, this should be a discussion with neurologist

• RN swallow screen limitations

• If patient has certain stroke features like slurred speech or facial droop, they will automatically fail the bedside swallow test
• Patient may have been given diet in ED but fail floor swallow test due to this criteria
• If you want patient to have a diet anyway, you need to place an order saying that patient is OK for diet despite failing RN swallow screen

• Restraints

• Vail beds are being used more, need to be reordered daily same as limb restraints

• Holds

• No such thing as PRN hold ie “If patient tries to leave, please hold”

• Security will NOT touch the patient if there is no hold in place; if patient trying to leave, there often isn’t time to page provider and get hold

• If patient voluntary currently but high risk of leaving, provider should discuss A) patient capability of leaving and B) risk to patient if they elope

• If high enough risk/concern, consider placing hold even if patient is voluntary

• Delirium

• Please consider making PRNs available for delirium at night if you know this has been or will be an issue
• Consider scheduling melatonin instead of PRN