In the past when receiving patients from the ER, they printed a report to the floor and then called to give a verbal report. Now the process has changed to improve pt flow. Now, the report is printed to the floor, the ER nurse calls the floor nurse to answer any questions. If the floor nurse happens to be busy taking care of one of her other patients and can't answer the call right away, the patient is sent to the floor, accompanied by a tech. Now don't flame me here, I am NOT in ANY way putting down ER nurses... I just feel like it's not safe to send a patient up to the floor without a real report... If the nurse has not received report, they have not really technically accepted the patient assignment, right? How can we safely accept a patient we know nothing about? How do we know a patient is safe to be on our floor if we don't kow anything about them. We can't stand by the printer waiting for a report to print when we have 4 or 5 other patients.
We have recently had several problems with this process, receiving patients with BP of 60/30 (report sheet said 110/70), sats of 78 (99 by report), laying in soiled sheets (continent per report sheet), barely breathing, markedly abnormal labs (also not on report sheet and never addressed), important consults not called (cardio for CP, neuro for CVA), STAT orders not initiated... Almost every day this week we have received a patient from ER and had to call the doctor or call a rapid response right away and send then to the unit. Which takes sometimes an hour or more away from our other patients... then the room gets cleaned and the process starts all over. I don't want to start anything here, I just feel like a verbal report SHOULD happen, even if just a brief reveiw of systems/abnormal labs with oppurtunity to ask questions...
What is the ER handoff process at your facility like? Does it work? And how is the relationship between the ER and the floors?
I have also been on both sides of this issue. I spent 3 years in ICU, 8 yrs on Cardiac floor, the last 3 years in ER. Let me start by saying I'm not going to criticize either group of nurses here. I honestly believe that most ER nurses have no idea what goes on on the floor and most floor nurses have no idea what goes on in the ER.
When I first transfered to a cardiac telemetry floor it drove me crazy to find that yes my pts are on telemetry, but you could only see it at the nurses desk and you only got a rhythm strip and a heart rate, no BP, no SPO2, nothing else and your pt may be 10 doors away from the nurses desk! I quickly learned that I wasn't receiving pts that were that critical.
On the tele floor if a pt began having chest pain, we got placed them on O2, got an EKG, gave and asa and three nitro and called the doc. Was I capable of starting a nitro gtt,..sure,.but I had sometimes 8 or 9 other pts to care for and couldn't possibly monitor a pt on a nitro gtt! My floor had way different protocols than ICU,..and for good reason.
When I moved to ER it was a whole new ball game. I suddenly had almost no limits on meds I had on hand and was allowed to give,..and I had a doc right there to order what was needed. I never got report on pts,.they just show up! It was a very different atmosphere to work in.
I was recently placed on a committee to address hand off issues with the floor. We were having many of the same concerns you mentioned in your OP. We now call report, then call as we are leaving the ER. We must wait at bedside for the RN to come into the room and wait for the first set of VS. We take a print out of the pts ER chart and record time we arrived at the room, time accepting RN arrived, and the VS. The floor keeps a copy and we keep a copy. Honestly this makes me feel like a 3rd grader,..but it has stopped a lot of the "she didn't tell me that in report" complaints.
I get so very frustrated when I hear my co workers make statements like "the nurse on 3 west is refusing this pt,.she says he isn't appropriate for her floor,..isn't she a real nurse? We took care of him for the last three hours now it's her turn. Doesn't she realize we are crazy busy down here!" Well,..yes but don't you realize that Nitro gtts aren't allowed on her floor,..or that GI bleed with a BP of 90/60 will probably go south on her and she doesn't have the time or the staff to get VS Q 15 min to even notice when it happens! Then of course, when it does happen the pt will be transfered to a unit bed, and turn over of beds on the floor is way more time consuming and complicated than moving from ER to the floor!
I am often ashamed of the behavior of my co workers both in ER and through out the hospital for making the assumption that someone is trying to get out of work, or that somehow they are the only nurse in the hospital that is running their butt off! Get over yourselves folks. We have rules and protocols for a reason, to give the pt the best care we can.
I'll step off my soap box.
Last edit by BrnEyedGirl on Oct 2, '10