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What do you think about off-the-paper shifts?
Source: Medical Pulse
Author: Lunch
This article is published by the author with the authorization of Medical Pulse, please do not reprint it without authorization.
Off-the-script shift means that without reading the medical record documents, the changes in the night shift situation of the new patients in the ward and the patients in the hospital are all memorized. What do you think about this?
1
The office before the daily morning meeting was busy, and the 5-bed patient who had diabetic ketoacidosis last night made the doctor on duty Xiao He feel tired. After rubbing his sour eyes, Xiao He opened the written handbook and looked down at the book as he was preparing to read it.
"Bring it to me and see." The director quietly took the shift book in Xiao He's hand. In fact, the director wants to test the new rotation doctor's understanding of the patients he is dealing with, so there is this one.
Xiao He was surprised for a moment, he had just arrived at this new department to rotate, he was not very familiar with the situation of the department, plus he had hardly slept last night, and suddenly his head was blank.
"Uh, last night 5 bed patients appeared DKA, blood sugar ... Blood glucose 21mmmol/L, blood gas PH7.21..." After a long pause, there was no follow-up. The director seemed to have already understood, so he asked the superior doctor to continue to add.
"5 beds, male, 39 years old, to "find blood sugar rise for more than 7 years." "The main complaint was admitted to the hospital, and the DKA symptoms were given around 22:00 last night, and the intravenous insulin infusion and rehydration were given. The inflows and outs are.... "The superior doctor roughly stated the entire treatment process.
Xiao He's face was blue and white, and his heart was really uncomfortable.
At this time, the director asked, "Is it the doctor who rotates this month?" In fact, I am only testing your bottom, and I am not intentionally embarrassed. I very much encourage everyone to do it, although it is not mandatory, but I hope that you will try to do it. It's also a test of how well you know your patients. Rescue patients are their own hands, should not be asked three questions do not know, infusion of drugs, patient in and out, vital signs are the basis to be familiar with the heart. Although I also know that your night shift is very hard, the growth process is always not easy. ”
The director shook the shift book in his hand and added: "Another point, the record of the shift book is not standardized enough, and you also need to rectify it." ”
After the adjournment of the meeting, there was a lot of discussion, and most people thought that this method was not appropriate. "Sometimes the night shift comes one after another, and when the treatment is over all night, they don't close their eyes, so where do you have the time and energy to carry things?" However, some people believe that this is not impossible, and can promote the progress of doctors through stress mechanisms.
2
Coincidentally, some time ago, there were also news reports that the nursing department let nurses leave the script to hand over the work, which caused heated discussion. Most netizens think that this will add a burden to the already heavy work tasks of medical staff, in fact, the effect of taking off the manuscript and reading the manuscript is the same, and the memory is more likely to produce confusion and omissions, and the reading of the manuscript will be more documented. There are also positive attitudes that believe that this will help the construction of the medical team.
Netizen Comments:
Netizen A: Yesterday the day shift newly admitted eleven patients, the night shift newly admitted a patient, the night treatment did not stop, the condition of the seriously ill patients changed, the medical advice of the seriously ill patients was constantly handled, the records were only after work to have time to write, not to mention the off-the-paper shift, even the shift did not have time to sort out.
Netizen B: We are off-the-script shift, too depressed, sometimes just hand over the name of the class dozens, too difficult to memorize!
Netizen C: What do you pay for the shift? Bed number, name, sex, age, diagnosis, vital signs, main complaint, time of admission, positive signs, treatment measures, changes in the condition, special treatment... These are routine operations! What else is there now? Flow adjustment results, nucleic acid results, new crown antibody results, health poverty alleviation, fall risk, pressure ulcer risk... A night shift to memorize so much content, spare me!
Netizen D: For the manager, this requirement is really not excessive, the starting point of the manager is to prove that you understand the condition of all patients, and this off-the-script morning shift is a good test, through the off-paper shift can indirectly prove that we know all the patients' condition at night. But in the actual situation, it is not like this, because people's memory is limited, if only a few patients are fine, a dozen patients, how to make each of the medical staff who have been busy all night remember?
Image source: Photo Network
In fact, everything still has to be reduced to the basics, and then think about it. The purpose of the first shift is to concisely inform all members of the department of the patient's situation in the department, such as changes in the condition, new occurrences, and the condition of new patients. On this basis, it is harmless to "innovate" anymore, because it is not detached from this core. Therefore, whether it is off-the-script or all-English handover, we should first ensure the accuracy and effectiveness of the information transmission. It is also inappropriate to give up the end of the book.
Of course, it cannot be denied that on the one hand, the off-the-script shift puts forward higher requirements for medical care, and in the long run, it also plays a positive role in improving the level of the medical team to a certain extent. There is pressure to be motivated, for example, the handling of some critical illnesses can also be picked up and remembered faster. However, nothing should be "one size fits all", good ideas are afraid of being implemented at an inopportune time, and if you disregard the actual medical work situation, with a tired brain and body after the night shift, only to be afraid that good intentions will also backfire.
The author believes that every medical care worker in the clinic is conscientious about the work, will always take good care of the patient, record the back and do not back does not affect the shift effect, in order to carry and back, consume more energy and time, it is not cost-effective. After all, the most important thing in clinical work is to cure patients.
So, what do you think of off-the-paper shifts?
Responsible editor Xiao Mai Yiyi
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