Our hope is that this Tips and Tricks Series helps you and your practice look for opportunities to not only expand your services but improve on the amazing job you are already doing for your patients!
Not all ICU's or Critical Care rooms look like this. Some have less and some have even more! Here are just a few tips that I have used through my career to navigate all of this to give the best patient care I can.
Go to the staff first. Coordinate with the nurses and other members of the care team for what treatments are being given and how you can fit in. Just because our orders say "STAT", does not mean that is the the first thing that needs to be done for the patient. If other modalities need to give immediate interventions and you are trying to jump in, the staff is less likely to help or they can interrupt your testing trying to get their treatments and interventions done. Coordination and cooperation is the key to good patient care.
Asses the room. After talking to the staff or while you are waiting to talk to staff, asses the room. Look for your best plan of action. Should you attempt behind the bed? Or measure and apply side to side? Where am I going to place my machine for the least amount of artifact?
Be prepared. Gather extra towels or pillows while you are waiting so you are prepared to shield the headbox and the wires from excessive artifact and not have to stop in the middle or ask someone else to get it for you. Make sure you have everything you need in the event of having to alter your set up due to the conditions.
Clear the room. In most cases, staff that have allowed the family in the room don't know the excessive artifact it can cause. I allow the patients' guests to stay during my application. I explain what this test does and what I am doing. I also talk to the patient no matter what level of consciousness they are. This allows the loved ones to process and ask questions. It also allows me to avoid an argument when I explain that once we start the test I will have to ask them to step out and will notify them as soon as they can come back in. Remember, this is an excruciating time for loved ones in this situation. They may be reluctant to leave and even get aggressive because of the intense emotional environment. We can ease their fears and let them know their loved on is in good hands when we explain.
Ask for help when needed! If you need the patient moved in the bed or turned, ask for help. Often times, these patients are in critical condition and may have delicate lines or medical equipment dependance. This can be tricky to navigate by yourself. Do NOT ask the family or loved ones for help. We are medical professionals and will need the assistance of other medical professionals.
Set proper expectations. Our licensure does not allow us to give results. We can set the proper expectation. "We got a good recording and the doctor will be in to discuss the results". Something to that extent. Family and loved ones will often push for more. Don't give your opinion, this can be catastrophic to the care plan and the care team when they are discussing the overall plan of care and outcomes with the family.
Clean up your mess! Nothing is worse than walking into a room after an EEG and seeing the patient, the bed and all the other equipment covered in 10 20 or nuprep. It is also very poor care to leave cleaning the patient to the staff. This is our field. We know better than anyone else how to get rid of the sticky, oily paste. Never leave your patient in that condition. This may be the last time their loved ones may see them. Take the extra time to clean all the paste off, make sure the bedding is clean ( or as clean as it was when you arrived) and all your used supplies are removed. I will go the extra step and wash and comb their hair if the situation allows for it.
There is no "easy" button for doing EEG in the critical care environment. Taking the time to coordinate with staff will make not only this EEG better, the staff will be more helpful with each test ordered in that unit. They will come to recognize your professionalism and collaboration as well as your patient care.
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