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Nursing Quick Reference

NICU Code Documentation | NICU Nursing Guidelines  | Hospital Epidemiology (MRSA & VRE)
NICU Feedings | Tools to Share with Parents | NICVIEW Camera
NICU Nurse's Guide: Admit to Discharge | Primary Care Guidelines

NICU Code Documentation

NICU Nursing Guidelines 

Hospital Epidemiology (MRSA & VRE)

Employee Education

Educate yourself on commonly seen communicable diseases. Information on Vancomycin Resistant Enterococcus (VRE) and Methicillin Resistant Staphylococcus aureus (MRSA) can be found below. Why do we have to isolate patients with these organisms? Explore the links below to find out why it is important to protect both patients and employees from passing on these organisms.

Patient Education

Patients may have questions about why they need to be isolated; help patients understand what is happening through patient education. Download and/or print out information on Vancomycin Resistant Enterococcus (VRE) and Methicillin Resistant Staphylococcus aureus (MRSA) for your patients and their families.

Other Resources

Links for other websites and resources are available to answer your infection control questions.

NICU Feedings

Breastfeeding

Feeding Order Bundles

Bovine Fortification
750 grams - 1250 grams (July 2022)
1250 grams - 2500 grams (July 2022)

 

Cardiac or Surgical Infants
Cardiac-Surgical #1 (July 2022)
Cardiac-Surgical #2 (July 2022)

NICU Feeding Discharge Plans

  • NICU Discharge Plan #1 – MOM+ Enfacare: 
    • English (cal/oz): 22 |  24  |  26
    • Spanish (cal/oz): 22 | 24 | 26
  • NICU Discharge Plan #2 – MOM + Term Formula:
    • English (cal/oz): 22 |  24  | 27  | 30
    • Spanish (cal/oz): 22  | 24 | 27 | 30
  • NICU Discharge Plan #3 – MOM + AR Powder:
    • English (cal/oz): 22  | 24
    • Spanish (cal/oz): 22 | 24
  • NICU Discharge Plan #4 – Preterm:
    • English (cal/oz): 20  |  22  |  24 | 27  |  30
    • Spanish (cal/oz): 20  |  22  |  24  | 27  |  30
  • NICU Discharge Plan #5 – Term:
    • English (cal/oz): 20  |  22  |  24  | 27  |  30 
    • Spanish (cal/oz;): 20  |  22  |  24  | 27  |  30
  • NICU Discharge Plan #6 – Semi-Elemental:
  • NICU Discharge Plan #7 – Elecare (Elemental):
  • NICU Discharge Plan #8 – Neocate (Elemental):
  • NICU Discharge Plan #9 – Puramino (Elemental):
  • NICU Discharge Plan #10 – Enfaport:
    • English (cal/oz):  20  |  22  |  24  | 27 |  30
    • Spanish (cal/oz): 20 | 22 | 24 | 27 | 30 
  • NICU Discharge Plan #11 – Similac PM 60/40:

How Long Can You Leave Your Formula Hanging?

Tools to Share with Parents

NICVIEW Camera

NICU Nurse's Guide: Admit to Discharge

Primary Care Guidelines

  • RN Residents may primary after they have been employed in the NICU for 2 years. The start of the internship program is day 1 of the 2-year waiting period.
  • Experienced RNs with 2+ years of NICU experience may primary after 1 year of employment in Loma Linda’s NICU.
  • Traveler nurses may not primary.
  • A nurse can choose to primary a baby in the Tiny Baby Unit for that baby's entire NICU stay OR may choose to primary the baby only while the baby is in the Tiny Baby Unit. (ex: Baby graduates out of TBU and the primary nurse is no longer assigned as a primary)
  • The Nurse may sign herself/himself up as a primary ONLY after caring for the infant for at least one shift. Sign-up may be done after the first shift or any time prior to the next shift ➜ but only if TL1 has not made that patient assignment for that coming shift. The only time this is not required is in the case of a “previously established relationship.” (ex: Sibling of a previously primaried baby or the baby of a friend)
  • Primary nurses/babies NOT IN TBU: Primary nursing is a commitment you make until discharge. Once signed up, the nurse MAY NOT take their name off until they have spoken with the Primary Care Coordinator as well as a manager if/when necessary.
  • Incidences against the Primary Care Guidelines are placed on file. The first occurrence is a notice; the second occurrence warrants the inability to use Primary Care Nursing toward point accumulation in the advancement or maintenance of the Clinical Ladder. Further occurrences warrant manager involvement. (There are no time constraints on the second occurrence)
  • Nurses may sign up to primary only one baby at a time. The only exception is for multiples (twins/triplets) which are signed up for as a “unit.” If one of the multiples is in isolation, they are still considered part of the “unit.” (ex: You cannot sign up only for the baby in isolation or only for the baby out of isolation)
  • Primary Care Nurses CANNOT place co-workers on their primary’s list while they are not on shift. TL1 is responsible for determining appropriate patient assignments.
  • Primary Care Nurses are to collaborate with each other as well as the multidisciplinary team to form a plan of care. If unable to attend rounds/meetings, forward concerns to another nurse who will be in attendance or a physician on the infant’s team. Primaries are responsible for initiating, updating, and reviewing the progress of PARENT EDUCATION and DISCHARGE TEACHING. For long term, difficult infants, it can be helpful to place a concise plan of care in the hard chart for others to follow.
  • “Breaks” are permitted when primarying long term/difficult infants or difficult parents. Simply communicate with a Charge Nurse or TL1. A note will need to be placed in pencil on the primary sheet if the break will be longer than 1 shift. 12. Reasons to be “bumped” from your primary:
    • Isolation due date
    • TBU due date (if baby being primaried is not TBU)
    • Staffing emergencies such as skill level/acuity changes & concerns
    • Nurses staying over for a double on your primary’s list. When staying over, a nurse may not choose a list whose primary nurse will be coming to work that shift but may stay on their list if that was their list the entire previous shift.
    • Be aware of what types of infants you are able to care for. TL1 or a charge nurse may remove you from your primary if you are not able to safely care for the infant.
  • If the experience of a primaried baby is needed for an orientee, that baby’s primary nurse may choose to take the orientee for that shift rather than be “bumped.”
  • Two primaries on same list: As more babies are being primaried, it is becoming increasingly difficult to keep 2 primaried babies off the same list.
    • Babies will be moved if possible  ➜ must be at the discretion/approval of TL1
    • A primary nurse can take another list in the same room and divide the lists amongst you so each has his/her primary baby  ➜ with TL1’s knowledge & approval
    • If the above alternatives are not possible, the primary on the previous night/day will stay. (Single primary list follows original guide of 1st over 2nd… etc.)
    • If 1st primary nurse is on for one baby and the 2nd primary nurse is on for the second baby, (both nurses here are on for a first night/day shift) the 1st primary will override the 2nd Primary…etc.
    • If both are 1st primaries (or both 2nd…etc), the nurse who has been primarying his/her baby the longest will be assigned.
  • When a primaried baby is discharged home or to another unit and returns, it is a new admission. The previous primary nurses must sign up again (IF they choose as this is not expected or mandatory). The previous primary nurses may NOT sign up for this baby IF they are already signed up as a primary on another baby. Before signing up on re-admitted babies, give the previous primary nurses first option out of courtesy.
  • Primary Care information, forms, and answers to most questions can be found in the Red Resource Book outside Room 4. This binder also contains “Happiness is…” cards to post on patient beds. Please remember to use these. They act as a visual for the TL when moving babies as well as letting physicians know the baby has primary nurses.
  • DO NOT visit babies on other units. This rule has been put in place by the leadership team for the other pediatric units as well as NICU.
  • The recommendation of the Primary Care Committee is to not call in to the unit to check on a primary when not on shift. While this is not prohibited, (sharing information with anyone else IS prohibited) it is uncertain whether or not the call will disrupt patient care for your primary or other babies in the room/on the list.
  • Primary Care meetings are held on the 2nd Tuesday of odd months from 5:30-6:30pm in the conference room.

Primary Care Contacts:

Note: These guidelines can be found in the red Primary Care Resource Book by the TL desk outside of room 4. Current TBU nurses who have not yet reached the 2-year mark that currently have primary babies in TBU may continue to be a primary while the baby remains in TBU.

Meeting Notes

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