PICU Pre-Rounding Cheat Sheet
It may be helpful to grab some blank sheets of paper, divide into sections for each patient, & write “scratch” notes that you can use to write your actual note from, instead of constantly clicking back and forth in Cerner between your note and other sections. Whatever works best for you.
For each patient:
1- Write down the “overnight events” sign-out you got from the on-call resident.
2- Scan through the nursing progress notes to see if there were any other notable events documented.
3- Go to the progress note from the day prior and check the plan section to see what was changed during rounds, so you can confirm whether or not this actually happened as you do the rest of your pre-rounding. (When I’m in the ICU and writing daily progress notes, I bold changes to the plan each day, so that when I’m pre-rounding the next day, it’s easy for me to check what we changed the day before.)
4- Look through the PowerNotes section to see if any consultants have written new notes so you’re aware of their recommendations.
***Get ready to start the hard-core “getting numbers and data” part of pre-rounding!!!***
5- Go to the MAR summary to see:
- Were there any med changes you didn’t get sign-out on?
- Did they get any “one-time doses” of meds?
- How many doses of each PRN med did they get?
- What rate are their drips running at currently?
6- Go to I-View.
A- Start in the “Clinician Summary” section, which is what automatically opens first.
- Look at the Respiratory section to see their current respiratory support.
- Confirm this is accurate by checking in the “Vitals” tab, too! (Separate from I-view.)
B- Go to the “Pain” section, and immediately change the range to “past 24 hours,” not 12 hours.
- Write down their range of pain scores (and WAT scores, if applicable).
C- Go to the “Lines Tubes Drains” section.
- Confirm that you’re up-to-date on all the plastic stuff they have in them.
- e.g. Did their NG come out? Did they get an art line placed? A PICC?
D- Go to the “Intake and Output” section.
- Confirm that they’re getting the IV fluids you think they’re getting.
- Confirm that they’re getting the feeds/diet you think they’re getting.
- If their feed/fluid rate is going up/down, check what their most up-to-date rate is.
- COME BACK TO THIS SECTION after 7am to write down their final numbers of total ins,
total outs, UOP, stools, emesis, etc. 7am is when the nurses are supposed to complete
their final updates for the shift.
7- Go to Recent Results.
- See if they got any lab results back in the past 24 hours.
- If they got any imaging done in the past 24 hours, go to the Radiology tab and look at it.
8- Go to Microbiology.
- Make sure they didn’t have any cultures come back positive or anything like that.
9- Finally, go to Orders.
- Check the Labs section to see if there are any pending labs that were ordered but not resulted
yet, so you know to look out for them (or be able to comment “it’s still pending”.)
- Note: if a lab order says “in process,” it’s cooking in the lab. If it says “collected” or
“ordered” or anything else, it was NOT yet sent to the lab! (“Collected” doesn’t
necessarily mean collected, it just means someone printed the label.)
- You can look over your other orders if you feel like it.
10- Get your note started (if you haven’t already) and write in your overnight events, make sure your respiratory stuff, FEN stuff, and drips are up-to-date (since these are the major things that change). Remember to come back and fill in the “ins and outs” once the nurses have updated it.
11- GO SEE THE PATIENTS!
- Make sure to take your paper with you and scribble down their CURRENT respiratory support
settings, as witnessed at the bedside (NC flow, FiO2, vent settings, etc). Obviously this is the
MOST up-to-date – though it could still change before rounds so you’re never totally safe.
- Your exam will be, by necessity, fairly perfunctory. I always do heart-lungs-belly-caprefill, and
if it’s a neuro kid I add in pupils and maybe clonus or reflexes if I’m feeling ambitious.
- If it’s a respiratory kid, take note (in the MAR summary) of how recently they got albuterol.
12- If you still have time before rounds, you can put the finishing touches on your notes (including the exam you just did).
13- If you still have time after that, and you have a kid you think might go to the floor, make sure they have a hospital summary that’s decently updated.
14- If you STILL have extra time (you speed demon, you), you can start updating your sign-out, so you have less to update later in the day.
PICU FAQs
How do I transfer a kid to the floor???
1- First ask the charge nurse whether or not they have a bed.
2- Then figure out WHO you need to call to accept the patient.
- If they are a regular hospitalist patient:
- Weekdays during the day (7a-5p) – call the Hospitalist Bed Czar at 7738 (p57738)
- Nights (5p-6a) and weekends – call the PL3 at 8300 (p58300)
- Weedays from 6a-7a – what are you some kind of sadist? Wait until 7am!
- If they are a Kaiser hospitalist patient:
- Weekdays during the day, call Dave Nagle (cell: 703-328-8413)
- Nights and weekends (or if it’s not Dave for some reason), call the Kaiser paging system
at 703-359-7460 and ask to page the Kaiser Hospitalist on-call for CNMC.
- If they are a medical subspecialty patient:
- Page the on-call fellow for that specialty (see below on how to figure this out).
- If it’s neuro, you probably talked to them about it on rounds already, but just confirm.
- If they are a surgical patient:
- You probably talked to them about it on rounds – you can confirm with your fellow.
- If unclear, page the on-call fellow for that surgical service.
3- Make sure they have an up-to-date transfer summary.
- EXCEPTION: If they are going to a surgical service, they don’t need a transfer summary!
Because apparently surgeons don’t care about notes or hospital courses!
Whatever the reason, it makes your life easier!
How do I figure out who’s on call for a subspecialty?
1- Go to the Intranet and hover over the orange “Helpful Links” button on the right.
2- Select the “On-Call Schedule” and click the correct day.
3- Scroll down to find the right service (they’re alphabetical) and click the pager number of
whoever is listed as the “consult” person – or if that’s not an option, the “fellow on-call.”
NOTE: Make sure to actually look at the pager number, because sometimes the clicking
doesn’t work the first time and if you weren’t paying attention, you have to scroll all the
way down and find it again which is annoying.
4- Text-page them whatever. Start with the call-back number because sometimes pages get
garbled, but usually the first few digits go through correctly even in that case.
5- Try to call consults prior to 1pm, otherwise the service might be all whiny and not want to see
them until the next day.
How do I call outside the hospital?
- If it’s a 202 or 301 number, you can use your Ascom. Just dial 9-202-whatever (or 9-301-whatever).
- If it’s NOT a 202 or 301 number, you have to use a landline and a long-distance code.
- Dial 9-1-whole-number.
- Then it’ll go “beep-beep-beep” and you need to put in a long-distance code.
- The one I always use is 7-3-6-9-# because it’s easy to remember.