Delegation & Prioritization

1. Delegation & Prioritization Crystal Brewer, Sonya Jones, and Jennifer Preuss

2. Prioritization and Delegation Decision making skills in difficult situations become second nature to RN’s. However, when we begin in our roles as RN we will need guidelines and information in order to make the necessary decisions that will insure the patients safety and care needs are met. Prioritization and Delegation are two areas that the RN must become familiar with and competent in practicing.

3. Prioritization Prioritization involves deciding which needs or problems require immediate action and which ones can be delayed until a later time because they are not urgent. RN Considerations: • Is it life threatening? Or the potential to be life threatening? • Is it essential to patient or staff safety? • Is it essential to the patients’ plan of care?

4. Prioritization When prioritizing patient care: • Always consider ABC’s first • Then look at changes in the patients’ status EX: Abnormal labs, change in LOC, and pain • Long term health issues EX: Education & coping • Maslow's hierarchy of needs can be used by the RN as a guideline

5. 2014 National Patient Safety Goals As of January 1, 2014 The Joint commission has listed Improvement of staff communication and use alarms safely as some of the goals to obtain. • NPSG.02.03.01- Improve staff communication Get important test results to the right staff member on time. • NPSG.06.01.01- Use alarms safely Make improvements to ensure that alarms on medical equipment are heard and responded to on time Working in a team and providing adequate delegation will ensure these goals will be met

6. Delegation • According to ANA, delegation is the transfer of patient personal care duties to an UAP. The legal responsibility of the patients care and outcomes remains with the RN. • The question is how do we safely delegate?

7. The Five Rights of Delegation The national Council of State Boards of Nursing in the US identified five rights of delegation: • Right circumstance • Right task • Right person • Right direction and communication • Right supervision Each Right is a key to successful safe patient care

8. Delegated Care According to the ANA, tasks that can be delegated are: • Vital signs • Turning and positioning • Bathing • Ambulating • Calculating I/O • Specimen collection • Blood glucose testing • Obtaining an EKG • Documentation of Non assessment care

9. Do not Delegate • Assessments • Medication Administration • Assessment Documentation • Patient Teaching • Collaboration with the MD • Dressing changes These interventions require the RN only

10. Impeding Factors to Successful Delegation EBP research shows the following to impede successful delegation: • Age • Work Ethic • Role Conflict • Personality • Management

11. Team work • The ANA stresses the importance of using the five rights to achieve successful outcomes for the patients. • Shift reporting with the members on the team will cultivate a trusting relationship. EBP of shift reports between the RN and UAP has led to decreased time delays of pertinent information.

12. Communication is key When delegating to team members use: • Clear • Concise • Correct • Complete Communication to provide optimal patient care

13. Outcomes of Inadequate Delegation Missed delegated care includes: • Turning and Positioning Q2H • Ambulation • Personal care • Blood glucose monitoring And it leads to less then optimal patient outcomes and can become costly

14. Outcomes of Inadequate Delegation The center for Medicare & Medicaid Services, as of 2009, will no longer reimburse hospitals for less than optimal patient outcomes that occurred during hospitalization Preventable outcomes that can occur due to inadequate delegation are: CAUTI Stage III & IV pressure ulcers Manifestations of poor glycemic control DVT/ Pulmonary embolisms Falls

15. Quiz Time You are a nurse on a Med/Surgical floor. You have been assigned 6 patients. Which of the following tasks can you delegate to the UAP? Select all that apply • Hand the patient their medication • Teach the patient about why their BP is high • Provide a bed bath • Obtain a stool sample • Document their assessment

16. Quiz Time Which of the following is the most clear, concise, complete, and correct communication? • Please go ambulate the new patient • I want you to feed the patient in room 8B now • I will need you to go obtain VS at 0800 on the patient in room 8B. As soon as you have them I will need you to report them to me. • So and so down the hall to the left needs you for something

17. Quiz Time As a new RN on the telemetry floor at ACH you have just received report from the previous shift nurse on your 4 patients. Which of the following patients should be your FIRST PRIORITY? • 80 year old male with CKD whose U/O was 200cc on 11-7 shift • 26 year old female with CAP with respirations 24, labored, LS bilateral wheezy and SPO2 92% RA • 45 year old male with bronchitis C/O chest pain when taking deep breath • 90 year old female with arthritis has pain level 10/10 with ambulation

18. Anthony, M., Vidal, K., (May 31, 2010) "Mindful Communication: A Novel Approach to • Improving Delegation and Increasing Patient Safety" OJIN: The Online Journal of • Issues in Nursing Vol. 15, No. 2, Manuscript 2. • Lacharity, L.A., Kumagai, C.K., & Bartz, B. (2006). Prioritization, delegation, • assignment: Practical exercises for medical surgical nursing. St Louis, MO: • Mosby Elsevier • The Joint Commission.(n.d.). National Patient Safety Goals. Retrieved January 27, • 2014, From http://www.jointcommission.org/standards • Potter, P., Deshields, T., & Kuhrik, M. (2010). Delegation practices between registered • nurses and nursing assistive personnel. Journal of Nursing Management, 18(2), • 157-165.