Things to Remember

When the team rounds in the morning, a plan for each patient is discussed and formulated. The plan should be implemented as early as possible. Many of the medication changes that are made need to be made early so that drug levels are not affected, or plans for biopsies, etc are not affected. If you are busy with other patient work and are unable to institute the plan early, please call the nurse coordinator who will be happy to assist you as much as possible. The nurse coordinators are excellent resources and are quite accomplished. It is very important to make the floor nurses aware of the plan for the day. We try to make sure that the floor nurses are available for rounds; however, sometimes they cannot make it because of patient duties. Please make a point of finding the floor nurse responsible for the patient and let them know the plan for the patient. This becomes particularly important when dealing with medication changes.

• Review all medications, especially antibiotics and analgesics, every day, and discontinue or taper those that are no longer needed.
• Try to put orders in during rounds so that they can be implemented early.
• Minimize blood draws and try to group them together. These patients have timed blood draws around their immunosuppressants so try to draw all labs at that time. Sometimes this is impossible and you should explain this to parents if it cannot be done this way.
• Discuss the plan with the parents ONLY if it is clear to you. Avoid expressing personal opinions. These parents are usually very anxious and can get very confused and angry if they hear different plans.
• Every effort should be made to avoid parental confusion or dissatisfaction. Most of these patients have lived with life threatening disease for an extended time. Their parents are often stressed to the breaking point. If you feel that a parent is getting upset and the situation is likely to get out of hand, DO NOT try to defuse the situation yourself - consider this an emergency to be dealt with by the nurse coordinator or the attending.