Mark Klimek Study Guide 26: Prioritization, Delegation, and Staff Management

4 things that answers to prioritization questions will always include

1. Age.

2. Gender.

3. Diagnosis.

4. Modifying phrase.

Age and gender are irrelevant to prioritization. Modifying phrase is the most important.

4 rules of prioritization

1. Acute is a higher priority than chronic.

2. Fresh post op (12 hrs) is a higher priority than medical or other surgical.

3. Unstable is higher priority than stable.

4. The more vital the organ, the higher the priority. Only use as a tiebreaker. This refers to the organ of the modifying phrase, not the diagnosis.

What to look for in an answer that makes a patient stable:

Stable, chronic illness, post op greater than 12 hrs, local or regional anesthesia, lab abnormalities of an a or b level, ready for discharge, admitted more than 24 hrs ago, unchanged assessments, experiencing the typical expected signs and symptoms of the disease with which they were diagnosed

What to look for in an answer that makes a patient unstable:

Unstable, acute, post op less than 12 hrs, general anesthesia in the 1st 12 hrs, lab abnormalities of a c or d level, not ready for discharge, newly admitted, newly diagnosed, admitted less than 24hrs ago, changing assessments, experiencing unexpected signs and symptoms.

4 things that always make a pt unstable whether it is expected or not

Hemorrhage, high fever (over 39), hypoglycemia, pulselessness or breathlessness.

Order of organ vitality

1. Brain.

2. Lung.

3. Heart.

4. Liver.

5. Kidneys.

6. Pancreas.

Which pt is the highest priority:

a) A 16 year old female with meningococcal meningitis who had a temp of 103.8 since admission 3 days ago.

b) A 67 year old male with IBS who spiked a temp of 100.3 this afternoon.

B.

Age and gender do not matter. Diagnosis - meningococcal meningitis is acute, high priority. IBS is low priority because it is acute. Modifying phrase is most important - changing temp makes them the highest priority. Look for typical, expected symptoms for stability.

Count out high and low priorities.

Stable or unstable - Angina pectoris?

Stable because angina is chronic.

Stable or unstable - Angina pectoris with crushing substernal chest pain?

Stable. Chronic and expected symptom.

Stable or unstable - Ang term-5ina pectoris not relieved with nitroglycerin?

Unstable. Angina unrelieved with rest & nitro is MI, acute condition.

What can not be delegated to an LPN?

Starting an IV, hanging or mixing IV meds, pushing IV meds, administer blood, work with central lines, plan care, perform or develop teaching, take care of unstable patients, do the first of anything, admission assessment, discharge, transfer, or the first assessment after a change.

What can not be delegate to an HCA (aid)?

Charting about the pt, meds (except topical, OTC barrier creams), assessments, treatments (except enemas).

What can you delegate to an aid?

ADLs, mobilization, hygiene.

What should you not delegate to family?

Safety responsibilities.

What 4 answers often appear when answering questions about inappropriate staff behaviour?

Tell supervisor, confront them and take over immediately, talk to them about it at a later date, ignore it.

Which answer is never correct with questions about inappropriate staff behaviour?

Ignore it.

What should you ask yourself when answering a question about staff behaviour?

If it is illegal, dangerous, or inappropriate.

What should you do if staff behaviour is illegal?

Tell the supervisor.

What should you do if staff behaviour is dangerous?

Intervene - confront immediately and take over.

What should you do if staff behaviour is illegal and dangerous?

Intervene first and then tell the supervisor.

What should you do if staff behaviour is inappropriate, but not illegal or dangerous?

Talk to them about it at a convenient time.