Silliman University College of Nursing
NCM 71
SURGERY ROTATION
Team Assignment Sheet
Team Leader: Lucañas, Princess Angel
Medication Nurse: Gonzaga, Zanthea Dianne
Bedside Nurses: Gia G. dela Torre
Patient’s Name: Gajano, Gregorio Bubotan Age: 49 years old Sex: M Room & Bed: 231-E
Diagnosis: Acute Complicated Suppurative Appendicitis
Chief Complaint: RLQ Pain
Procedure: Appendectomy Diet: Diet as Tolerated
Date and Time of Admission: October 1, 2022, 1:50 PM
Physician: Ray Enrique B. Rosario, MD
Time Bedside Nurse’s Responsibilities Medication Nurse’s Responsibilities Team Leader’s Responsibilities
6-7 - Join the Nursing Rounds with CI and the rest of - Check the Physician’s Orders for any new or - Conduct Pre- Conference with the CI and
the team discontinued/ shifted meds. the rest of the team
- Check physician’s order for any updates through - Prepare for the endorsement of the outgoing - Ensure that the kardexes, pharmacards,
the patient’s chart nurse team assignment sheets and proc sheets
- Monitor IVF and compute amount to be infused in are submitted to the clinical instructor.
entire shift (note endorsed amount also) - Remind the members of the team of their
- Prepare for the endorsement of the outgoing tasks to be accomplished for the day
nurse - Check doctor’s orders for new orders/meds,
meds taken in previous shift or meds that
are discontinued or shifted
- Ensure all the members of the team are
present and prepared for the endorsement
of the outgoing nurse
- Inform t h e CI if there are new orders from
the physician
7-7:30 - Listen for the endorsement of the outgoing nurse - Listen for the nurse endorsement - Participate in the nurse endorsement
- Take note of the significant information being - Note medications given in t h e previous - Monitor the Bedside Nurse from time to time
shift, and due meds to check if the responsibilities had been
endorsed
- Compare proc sheet to the charge nurse’s done.
- Note the IV left, diet and IV lines that the patient have proc sheet - Check for new Doctor ‘s orders and
medication that will be taken within our shift
- Remind medication nurse for meds that are
to be administered at 8 am, and to prepare
for the drug conference
7:30-8 - Drug conference on Piperacillin + - Conduct the drug conference while with CI
Tazobactam Na (Rabactam) 4.5g IV infusion - Accompany Medication nurse in preparing
for 30mins q8h, 8am with team leader and CI
- Prepare Piperacillin + Tazobactam Na the meds
(Rabactam) - Ensure that the med nurse did the 3 checks
- Do the 3 checks of medication administration of medication administration during the
preparation of the meds
8-8:30 - Routine Bedside care (V/S and MIO) - Administer t h e Piperacillin + Tazobactam Na - Accompany med nurse when administering
meds
- Coordinate V/S to the charge nurse and (Rabactam)
- Counter check MAR form and sign.
medication nurse - Chart administered medications in MAR form.
- Let the Clinical Instructor and Team - Monitor with the Bedside Nurse if routine
- Chart V/S and MIO bedside care had been done.
Leader countersign administered meds
- Check the IV lines and regulate if needed - Monitor for any adverse rxn to the - Check for new Doctor ‘s orders and
medication 15 min after admin. medication taken within our shift.
- Inform the CI for possible bed bath
8:30-9 - Prepare for possible bed bath - Accompany bedside nurse whenperforming
- Perform deep breathing exercises and ROM Bed bath and also in performing deep breathing
exercises
exercises
- Turn and Position px PRN
9-9:30 - Monitor the IV and regulate if there are alterations - Drug conference on METRONIDAZOLE - Check for new Doctor ‘s orders and
in the flow rate (Altozol) 500mg IV infusion for 30min q6h with medication taken within our shift.
- Perform bed bath team leader and CI - Conduct the drug conference with CI
- Prepare METRONIDAZOLE (Altozol) 500mg present
- Do the 3 checks of medication administration
- Monitor with the Bedside Nurse if
the responsibilities had been done.
10-10:30 - Monitor IV - Administer METRONIDAZOLE (Altozol) 500mg - Check for new Doctor ‘s orders and
- SNACK IV infusion for 30 mins
medication taken within our shift.
- Monitor IV infusion until consumed
- Chart administered medications in MAR form. - Remind CI that there will be a drug to
- Let the Clinical Instructor and Team administered at 10
Leader countersign administered meds
- Accompany the med nurse in administering the
- Monitor for any adverse rxn to the medication
15 min after admin. meds.
10:30-11 - Turn and position px PRN
SNACK SNACK
- Physical Assessment (Abdomen, Cardio and
Respiratory)
11-11:30 - Lunch - Drug conference on METOCLOPRAMIDE - Conduct a drug conference with CI present
(Metvex) 10mg IVTT (Intravenous Therapy) - Check for new Doctor ‘s orders and
q8h x 9 doses with team leader and CI medication taken within our shift.
- Prepare METOCLOPRAMIDE (Metvex) 10mg - Ensure that the med nurse did the 3
- Do the 3 checks of medication administration checks of medication administration
- Remind the CI that there will be a
medication to be administered at 12
12-12:30 - Routine Bedside care (V/S and MIO) - Administer METOCLOPRAMIDE (Metvex) - Check for new Doctor ‘s orders and
- Chart V/S and MIO 10mg IVTT (Intravenous Therapy) q8h x 9 medication taken within our shift.
- Check IV lines doses
- Check if V/S and MIO is plotted in the chart
- Start calculating the MIO - Observe for any signs of rxns of the drug
- Accompany med nurse in administering the
- Chart administered medications in MAR form.
- Let the Clinical Instructor and Team medication
Leader countersign administered meds. - Inform the bedside nurse to start the FDAR
charting
12:30- - LUNCH - LUNCH - Check for new Doctor ‘s orders and
13:00 medication taken within our shift.
13-13:30 - Do FDAR charting and give to the Clinical - Drug Conference on TRAMADOL - Check for new Doctor ‘s orders and
Instructor for checking +Dexketoprofen (Skudexa) 75mg/ 25mg ½ tab medication taken within our shift.
PO q8h with the team leader and CI - Conduct a drug conference with the CI
- Prepare TRAMADOL +Dexketoprofen present
(Skudexa) 75mg/ 25mg - Ensure that the med nurse did the 3
- Do the 3 checks of medication administration checks of medication administration
- Remind the CI regarding the drug to be
administered at 2 pm
14-14:30 - Administer TRAMADOL +Dexketoprofen - Check for new Doctor ‘s orders and
(Skudexa) 75mg/ 25mg ½ tab PO q8h medication taken within our shift
- Monitor for any signs of rxn of the med - Accompany the med nurse in the
administered
administration of the med.
- Chart administered medications in MAR form.
- Let the Clinical Instructor and Team Leader
countersign administered meds.
14:30-15 - Turn and position px PRN - Final checking of medications with team leader - Accompany bedside nurse in checking
- Prepare charting and CI (DO NOT THROW boxes/ampule/vial of amount left in IV bag
administered meds) - Help the nurse calculate the intake and
- Ask CI to check draft nurse’s notes - Final checking of adverse rxns or side output
- Wait for CI’s approval effects of meds - Countersign bedside nurse’s charting
- Final calculation on the amount infusedduring the - Final checking if all medications - Lead in final checking with CI of
shift, and amount left. administered were charted in MAR. administered medications by medication
- Perform final charting on the chart nurse
- Have team leader and CI countersign - Final checking if all tasks are completed,
charting and if the care plan was
fully accomplished.
15 - Endorse shift to charge nurse and incoming - Listen to endorsement of the bedsidenurse - Listen to endorsement of the bedside
nurse. to the charge nurse nurse to the charge nurse
Silliman University College of Nursing
NCM 71
SURGERY ROTATION
Team Assignment Sheet
Team Leader: Lucañas, Princess Angel
Medication Nurse: Gonzaga, Zanthea Dianne
Bedside Nurse: Kollman, Ronald Christian
Patient’s Name: Lagutap, Luke Zayden Age: 2 years old Sex: M Room & Bed: 275
Diagnosis: Inguinal Hernia, Bilateral; Uncircumcised penis Diet: General Liquids
Procedure: Herniotomy-bilateral w/ circumcision under GA
Chief Complaint: Inguinal mass, Left
Date and time of admission: September 30,2022; 11:44 AM
Physician: Ray Enrique B. Rosario, MD
Time Bedside Nurse’s Responsibilities Medication Nurse’s Responsibilities Team Leader’s Responsibilities
6-7am - Join Nursing Rounds with CI and the rest - Check the patient’s chart for new or - Conduct Pre Conference with the CI and
of the team discontinued meds. Especially check the rest of the team
- Check updates in the physician’s order Physician’s Orders. - Ensure that all paper requirements are
through the patient’s chart - Prepare IVTT medication as needed. submitted on time
- Monitor IVF and compute amount to be - Prepare for the endorsement of the outgoing - Remind members of the team of their tasks to
infused in entire shift (note endorsed nurse be accomplished for the day and what is
amount also) expected from them
- Prepare for the endorsement of the - Discuss the needs of the px for the day
outgoing nurse - Check doctor’s orders for new orders/medsand
meds taken in previous shift
- Prepare for the endorsement of the
outgoing nurse
- If there are new orders, inform the CI
7-7:30 - Participate in the nurse endorsement - Participate in nurse endorsement - Listen for the nurse’s endorsement
- Note for the IV left and the kind of IV - Note medications administered during the - Monitor with the Bedside Nurse i f t h e
solution administered. previous shift, and due meds responsibilities had been done.
- Monitor IVF (hourly volume and flow rate) - Check for new Doctor‘s orders and
and check if it is in line with your medication taken within our shift.
calculations - Remind medication nurse for meds to be
- Reposition px prn administered at 8m , and to prepare
- Take note of things done in previous shift for the drug sconference
7:30- 8:00 - Drug conference on Paracetamol (Naprex) - Conduct the drug conference with the clinical
150mg with team leader and CI present instructor present
- Prepare Paracetamol (Naprex) 150mg slow - Ensure that the med nurse did the 3 checks of
ivtt x 6 Doses medication administration during the preparation
of the med.
- Remind the CI that there will be a med to be
administered at 8 AM
8-8:30 - Routine Bedside care (V/S and MIO) - Administer Paracetamol (Naprex) 150mg - Check for new Doctor ‘s orders and
- Chart V/S and MIO - Chart administered medications in MAR medication taken within our shift.
- Monitor IVF (hourly volume and flow rate)
form. - Report to the charge nurse and CI if there are
and check if it is in line with your - Let the Clinical Instructor and Team significant alterations noted in the V/S taken
calculations Leader countersign administered meds. - Check patient’s chart if the V/S has been
- Health Teaching on S/S of Infection and - Check for any adverse rxn to the plotted and charted
Wound Care medication 15 min after admin. - Remind the bedside nurse to monitor the IV
- Health teaching on how to take good care every hour
of the circumcised penis. - Accompany med nurse when administering
meds
- Counter check MAR form and sign
- Inform the CI that the med nurse will be doing a
PA
8:30-9 SNACK - Physical Assessment (Integumentary, - Accompany the med nurse during the PA
Genitourinary, Musculoskeletal)
9-9:30 - Monitor IVF (hourly volume and flow rate) - Check for new Doctor ‘s orders and
and check if it is in line with your medication taken within our shift.
calculations - Give CI heads up that bedside nurse will be
- Reposition px prn performing PA
9:30-10 - Perform Physical Assessment on - - Accompany Bedside Nurse as she does PA
chosen systems (Post. and Ant, along with CI
Chest, Cardio and Abdomen). - Accompany med nurse when preparing
meds
10-10:30 - Monitor IVF (hourly volume and flow rate) - Check for new Doctor ‘s orders and
and check if it is in line with your medication taken within our shift.
calculations - Accompany med nurse when administering
- Reposition px prn meds
- Countercheck MAR form and Sign
10:30-11 am SNACK SNACK
11-11:30 - Monitor IVF (hourly volume and flow rate) - Drug conference on Gemigliptin and - Lead drug conference while with CI
Tramadol with team leader and CI
and check if it is in line with your - Accompany Medication nurse as she is
calculations preparing the meds
- Check for new Doctor ‘s orders and
medication taken within our shift.
12-12:30 - Routine Bedside care (V/S and MIO) - - Accompany Medication nurse as she is
- Chart V/S and MIO administering medications
- Monitor IVF (hourly volume and flow rate) - . - Countercheck MAR form and Sign
and check if it is in line with your
calculations
12:30-13:00 - Lunch - Lunch - Check the patient’s chart if the V/S are plotted
and charted
-
13 - Monitor IVF (hourly volume and flow rate) - Check for new Doctor ‘s orders and medication
and check if it is in line with your taken within our shift.
calculations - Remind medication nurse for meds to be
- Reposition px prn administered at 2pm , and the drug conference
- Inform CI regarding the med to be administered
at 2pm
- Remind the bedside nurse to the begin the
FDAR
- Remind the bedside nurse to start calculating the
IV infused during the shift.
- Lunch
13:30 - Do health teaching on Range ofMotion - Drug conference on Cefuroxime Na - Lead drug conference while CI is present
for Right shoulder and arm (Profurex) 750mg/vial; 500mg IVTT q8h - Accompany Medication nurse as she is
- Do FDAR charting and give to the preparing the meds
Clinical Instructor for checking - Ensure that med nurse did the 3 checks of
medication administration
-
14 - Monitor IVF (hourly volume and flow rate) - Administer Cefuroxime Na (Profurex) - Check for new Doctor ‘s orders and
and check if it is in line with your medication taken within our shift.
calculations 750mg/vial; 500mg IVTT q8h with team leader
- Accompany the med nurse in administering the
and CI medication.
- Chart administered medications in MAR - Remind the med nurse to chart the medication
form. administered
- Let the Clinical Instructor and Team Leader
- Countercheck MAR form and Sign
countersign administered meds.
14:30-15:00 - Prepare charting - Final checking of medications with team leader - Accompany bedside nurse in checking amount
- Ask CI to check draft nurses notes and CI (DO NOT THROW boxes/ampule/vial of left in IV bag
administered meds) - Help in calculating the intake and output
- Wait for CI’s approval - Final checking of adverse rxns or sideeffects of - Countersign bedside nurse’s charting
- Monitor IVF (hourly volume and flow meds
rate) and check how much was - Lead in final checking with CI of
infused. administered medications by medication
nurse
- Reposition px prn - Final checking if all medications - Final checking if all tasks are completed, and if
administered were charted in MAR. the care plan was fully accomplished.
- Final calculation on the amount infused
during the shift, and amount left.
- Perform final charting on the chart
- Have team leader and CI countersign
charting
15 - Endorse shift to charge nurse and - Listen to endorsement of the bedside - Listen to endorsement of the bedside nurseto
incoming nurse. nurse to the charge nurse the charge nurse