This document provides information on prioritizing patient care using the ABCD system. It discusses establishing routines and reprioritizing tasks when necessary to accommodate interruptions. The ABCD system categorizes tasks into four levels: A) tasks that must be done at a certain time, B) tasks that are better done sooner than later, C) tasks that can wait, and D) non-essential tasks. The document also outlines strategies for managing stress and interruptions, including communicating with one's team and shift coordinator for help. Scenarios demonstrate applying prioritization to sample patient care situations.

1. Graduate Presentation
Michelle McKivett SDC

2. Learning Outcomes
• Be able to determine patient care planning
priorities.
• Knowledge of the ABCD system.
• Transfer knowledge from session to work
place.

3. PRIORITISING & REPRIORITISING
• Essential skill for nurses
• Strategy to accommodate and adjust to
interruptions
• Establish and maintain a routine
• Allows you to alter routine while meeting
demands of job
• Complicated tasks may need to wait until
there is more time

4. ABCD System
• A : Absolutely must be done
• Tasks that must be done at a certain time
• You will be interrupted to do a particular task if it is
not done soon
• Others need it done to do their job
• Waiting will cause a patient or his/her family distress
• A risk of hazard is present
• Most documentation and paperwork

5. ABCD System
• B: Better sooner than later
• Can wait but not too long
• Must be done today or on this shift
• Will save time and resources if done soon

6. ABCD System
•C: Can wait until later
•Things that do not have
any time frame attached
•Getting things that will be needed
later in the day
•Some paper work

7. ABCD System
• D: Do not worry about it
• These are tasks that are beneficial, but if left
undone will not affect patients or their care
• These things should get done, but no one will
be hurt if they are not

8. STRESSED OUT
• Learning to say no to requests from others if
they seem inappropriate or impossible.
• Meal breaks are essential and should always
be taken.
• At the end of each shift try not to take any
work or worries home with you.

9. TIME WASTERS
Doing too much
Perfectionism
Disorganisation: Work area, systems
Inability to say ‘NO’
Complaining

10. TIME WASTERS
• Procrastination – Can be a habit – Confront it
Ask yourself why and be honest
- Am I finding it hard to just get started?
- Am I sure I know how to do it?
- Is it my job to do it?
- Am I afraid to do it?
- Does the task seem to huge or overwhelming?
- Am I afraid of the outcome – (Fear, Success or
finishing)

11. INTERRUPTIONS
• Patient and Pain
• Doctors
• Fellow workers
• Phone Calls & relatives
• Admissions
• Manager
• Students
• Other Health Professionals

12. WHAT CAN YOUR SHIFT
COORDINATOR DO FOR YOU
• Help – need to ask
• Make calls
• Contact Drs
• Chase medication charts
• Check drugs

13. WHEN THE UNEXPECTED HAPPENS
• Don’t panic
• Talk to your team member or shift coordinator
• Assess all your workload
• Reassess patient care priorities
• Report & discuss situation with senior colleague
• Maintain a positive mental attitude
• Encourage & support colleagues
• Review situation regularly
• Review shift – put reflective practice into place - could
anything have been done differently?

14. TEAM WORK
• Teams are made up of people with
complementary skills, committed to a
common purpose and performance goals.
• Most teams can outperform individuals it is
the "people issues” that cause most of the
problems.

15. GUIDELINES TO CONSIDER WHEN
WORKING IN A TEAM
• Establish clear, achievable goals
• Set a clear plan at the beginning of the day
• Define each person’s role in the team clearly
• Insist on clear communication
• Encourage team behaviours

16. GUIDELINES TO CONSIDER WHEN
WORKING IN A TEAM
• Agree on decision-making procedures
• Increase awareness of group process
• Expect participation
• Establish ground rules
• COMMUNICATE, COMMUNICATE

17. SCENERIO 1
• You are working on a medical ward.
• You are on an early shift with 6 other nurses.
• It is 07:30. You have been allocated to care for the following patients:
Diabetic patient who has insulin before breakfast.
Anaemic patient who needs to have a blood transfusion.
A new patient who has just arrived on the ward,
A patient who is going home after treatment for a leg ulcer.
• Before you see any of your patients, another RN asks you to check a
Schedule 8 drug with her. You see the breakfast trolley arrive on the ward.
One of your patients has rung the bell.

18. SCENERIO 2
• You are working on an early shift and are looking after 4
patients. After your tea break you discover that consultants
have been in to see 2 patients and have left these
instructions:
Patient 1 may go home after you have removed her sutures,
Patient 2 (1st
day post-hernia repair) may have his IV & IDC
removed & can then get up to shower.
Patient 3 is ready to be collected from theatre,
Patient 4 rings the bell and would like assistance to shower and
have her bed made.
• Outline your plan of care.

19. SCENERIO 3
• You are working on a late shift. One of your patients
is Day 3 post laparotomy and has the following; IV
Therapy, abdominal dressing, IDC, Varivac drain. The
patient is allowed to have free fluids. His PCA has
been removed and he is having IMI Pethidine 4
hourly.
• At 13:50 the patient rings the bell and tells you that
he is in pain. Pethidine was last given at 09:30.
• Outline your plan of care.

20. COMMANDMENTS FOR REDUCING
STRESS
• Thou shalt not be perfect, nor even try to be
• Thou shalt not try to be all things to all people
• Thou shalt leave things undone that ought to be undone
• Thou shalt not spread thyself too thin
• Thou shalt learn to say ‘No’
• Thou shalt schedule time for thyself & thy supportive network
• Thou shalt be boring, untidy, inelegant & unattractive at
times
• Thou shalt not even feel guilty
• Especially, thou shalt not be thine own worst enemy, but be
thy best friend