Faxed Report

Sleepyeyes · Nov 27, 2002

Our unit sec gets the name, dr, and dx. We give the room #; then report is faxed with the usual arrival time of the pt about 0-15 minutes. They have to give the unit sec the chart from ER and while we assess and do the database in the pt's room, the unit sec puts in the orders.

It works out ok. The ER and EMT reports are also on the chart, so we can see what meds were given, what labs were done, etc.

PS I think as soon's someone's DC'd, housekeeping has a certain amount of time to get the room ready for someone else, so it's very very rare that a room is "not ready."

ERNurse752, RN · Nov 29, 2002

We fax reports...

The pt gets admitted, so the doc faxes a sheet with pt's demographics, adm dx, adm md to Admissions...they send us a note on the computer that they received the fax, and whenever we get a room # they send that to it as well...

Then we fax our report to the floor, and they have 15 minutes to be ready to receive the pt. We've had to start calling the floor to confirm after we fax report though, b/c we had problems with the floor not being ready or saying they never received the fax.

We don't use a faxed report for ICU pts, still call report on those.

Works better than before when we'd call the floor and have to wait a long time for the nurse to make it to the phone, or have to wait for them to call us back.

Not sure how well the floors like it, although they can always call us and request that we wait to bring someone up if they're busy.

Gizmed · Nov 29, 2002

We request the bed once the MD decides on admission, report is called once the bed/room is"clean". Though it can be a challenge giving report to the floors sometimes, the real problem seems to be those in "bed control" (whoever and where ever that is..) who can't seem to ever find a clean bed until right before shift change (Hmmmmm...) which puts the floor in a bad position to take the report/pt.... We've involved the House Spvr now when these mysterious stalls present themselves and it has helped to solve most of this problem on both ends. We are about as well staffed as everyone else (NOT!) so we can understand both sides of the dilemma. If we ever find out "WHO" bed control is...they may not fare as well.

ernurse728, LPN · Nov 30, 2002

We use the faxed report system in our hospital. The way that it works is that after you have a bed assignment and admission orders you fax up to the appropriate unit...after that the nurse receiving the pt has 15mins to read over the fax. We then call upstairs to make sure there are no questions. Unfortunately we still have a terrible time getting people usptairs. The nurse usually has 90 unrelevant questions...and another 50 that are clealry filled out on the fax report... then there is usually an issue that the bed is not clean. Other common problems..."we didn't get the fax"..."that nurse is at dinner and nobody is covering for her", " I just got a new patient" That is usually when I have to bust out in my " do you have any idea how many times I have turned this team over in the past 2 hrs....not to mention the fact that my new pt is sitting outside of the room on a stretcher waiting for you to accept this Pt." There is the rare time though that the nurse receives the fax and actually calls you and says ..I don't have any questions go ahead and send them up. Sorry I have a lot of bitterness regarding the issue of getting patients up to the floor.

fab4fan · Nov 30, 2002

We have to call report, and let me tell you, sometimes there is more dodging that goes on than there was during the VietNam draft.

I am more than willing to help out the floors and hold a pt if the floor is getting slammed, but if we are up to our ears, then I expect the same. We all know that as ED nurses, we don't have the luxury of declining a pt, or making a medic crew wait until we are ready for the pt...ready or not, here's the pt.

This is probably an issue that will continue forever, but I really do get tired of the ED being considered the answer to eveyone else's staffing woes. Esp w/ ICU admits, because then they expect that we do the tons of paperwork involved in an ICU admit...yes, it gives me an appreciation for their job, but things get crazy for us, too.

Guess I'm a little bitter, because yesterday we had 2 ICU holds purely because ICU was short a nurse...two may not sound like a lot, but we're a small ED, with limited staff, so it is a lot for us.

caroladybelle, BSN, RN · Dec 1, 2002

Sorry guys but I am one of those on the receiving end........

The floor has no secretary or tech. The nurses are on the floor. Just who do you think sits around for faxes or phone calls. If we pick up the phone, chances are we just barely made it to the desk, haven't seen the fax, and may not even know that we are getting a patient because the other nurse (12 bed unit) is running her butt off.

As for "irrelevant" questions, well, sorry, but I would really love to speak to the nurse that actually took care of the pt, occasionally and knows something about the pt. I have had nurses that have read of a list of perfectly benign labs & vitals, but neglect to mention the WBC's of

And I personally just love it when the patient came to the ER at 1900 hrs, MD saw pt and wrote orders at 2300 hrs for admit, last test done at 0100 and no one calls for a bed until 0600. Pt gets to floor at 0630 w/a port that is bleeding out and PT is covered w/urine and feces. There are same two floor nurses, receiving, admitting, trying to stop bleeding,clean up pt, give report, get AM blood sugars, orders for pain med, round with MDs. When of them tries to find out why port is bleeding profusely by calling (not mentioned in "faxed" report - I suppose that it was not "relevant" enough), no one is able to tell them, because shift has changed and the ER nurse that had the pt went home (by 0715). MUST BE NICE!!!!!!!

Needless to say faxed report does not fly with some of us.

Please guys, try to remember that there are other people busy in the hospital. Just as we floor nurses don't always know what goes on at your end.....you also don't know what is going on at ours.

Peace be with you, brothers and sisters.

ernurse728, LPN · Dec 1, 2002

I am sorry that where you may work Carollady that you do not have secretary's. As for the facility where I work the floors do have secretary's, sometimes more than one. They are there to answer the phone and give the appropriate nurse the fax when it comes across. So in my opinion that is not an excuse where I work.

And for the record I do not feel that abnormal lab values are "irrelevant". On our fax reports, which are very in depth by the way, there are several spaces for all abnormal lab results, xrays etc. They also include dx for admission, pmh, allergies, current vs, heart rhythm, lung sounds, skin assessment, diet, IV, IVF, whether they are receiving oxygen and by what means, abd assessment, diet, and a place for what meds they have received.

And yes I do get irritated by having to answer these questions that are already clearly written on our fax report. It is a waste of time. And another thing Carol, I have been a floor nurse before, I know what it is like up there. But have you ever worked in the ER? Do you know what it is like to have a drug seeking pt laying on the call bell for his Dilaudid every 45secs, 2 pt's on vents with multiple drips, and get a brand new pt that is having chest pain and needs a line/labs/Ekg, an assessment done and documented and needs nitro but you have to be careful because his BP is hanging around 100 systolic. And you better hop that this pt is not having an MI and needs to be ready for the cath lab in 30mins. In those kind of situations no I do not feel sorry for the floor and I do not want to hear that the nurse is at lunch or that you just got a new pt, or your shift ends in 20mins. That is Bull-S%&t. I am sick and tired of the Er getting dumped on. We get blamed for everything and written up left and right. Do I ever right the floors up...NO...because I don't have time!

fab4fan · Dec 1, 2002

I don't mind calling report, but what does get me is when I bring a pt up to the floor and get no help transferring the pt from the gurney into the bed.

It's one thing if everyone is running around like crazy, but often there are one or two people at the desk, talking. They watch me wheel the pt past the desk to the room. Half the time the room is not set up (and I give the floor an extra 15-20min after I call report before I get there...so it's not like no one knows ahead of time).

So then I get the room set up, then I have to walk around and find someone willing to help transfer the pt.

And I would never send a pt upstairs covered in feces, or bleeding out from a port.

As for why the pt gets delayed coming upstairs? Well, after I called report there was a chest pain walk-in, then an amb. crew that arrived unnanounced ("We didn't have time to call report."). One of my other pts. had things that were ordered stat while I was on the phone calling report on someone else...and so it goes. Believe me, most ER nurses want to get the pt out of the ED as soon as there's a bed...we don't want to hang on to people.

I also worked "the floor" and know how frustrating it is. I think our ED is pretty accomodating...we also respond to multiple requests from the floors to come start difficult IV's, which helps

them out (personally, I think that nurses should learn to do the more difficult sticks instead of falling back on the ED...improving one's IV skills just makes sense, although I know sometimes there just isn't time to sit and work with an IV on a busy floor. It just gets to be a habit...anyway, I digress.).

We need to work together, that's for sure.

ernurse728, LPN · Dec 1, 2002

I totally agree Fab...that was a point that I was going to make in my earlier post. Not getting any help when we take the patients upstairs is a chronic problem. In our case we only have to take up the patients that need to be on a heart monitor. We have a transport team that assists us with patients admitted to general/medical floor. But everyone dreads taking up the patients admitted to a telemetry floor. There is never a monitor there to hook up the patient to. (we use tele-packs that fit in there pockets). There is almost never an oxygen flow meter to hook them up to, and forget about an IV pump! The same thing happens everytime. We walk by the desk, drop off the chart, ask the secretary to let the nurse or PCT know that the patient has arrived. Then we get to the room and wait a minute...I start getting the patient ready for transfer, ring the call bell in the room, still nobody comes to help. Again, I can understand it if they are busy. But I am sick and tired of being ignored when I get up there. They don't realize that I have my own team of patients back downstairs waiting for me, and probably a new patient in the room that I just emptied that needs to be worked up. And as far as my patients go, they are in perfect condition when they arrive to the floor. There labs have all been done, even the ones that aren't stat, meds have been given, and if it is in between meals I make sure that I make them a tray. And they certainly are always clean, foley bags emptied, and not bleeding from any orefice if it can bel helped!

caroladybelle, BSN, RN · Dec 1, 2002

Ernurse728,

Yes, I have worked the ER, I have dealt with drug seekers and quite frankly have dealt with cardiac drips on the floor, starting them and titrating them. Some oncologists refuse to put induction chemo pts on in the unit unless they must !!!!!!! be vented (due to the high infection rate in ICUs). Which means that we have Bipap. If they can be extubated, we can get pericardial windows and s/p esophagastrectomies. And quite frankly, the only time in my 12 hour shift that I generally get to leave the floor is to give chemo or ganglicyclovir in the ICU (they don't give chemo or access ports), to give methatrexate/access ports in postpartum or the ER (because they don't give chemo or access ports- especially after the bleed). And I have yet to call ER to do an IV start-they are usually the ones calling us for a start. It has yet to matter to anyone whether the nurse is at lunch or not-the patient comes to the floor anyway- at my facility. I am sorry if that is the case where you work, it is not the case where I am at.

And ,yes those charming "one size fits all "forms do have spaces to put abnormal labs. But it seems that the individuals that fill them out, never would write them down. Invariable one would care for the pt, someone else calls for orders, the tech got the vitals, and the ER MD spoke to the pt/family about code status and other matters. Half the time, we never got a faxed report that matched the pt. Please accept that what is important to the ER, with what is going on at that time in the ER, is not necessarily what is important to the floor for continuity of care.

And yes, we do have pts w/sudden onset CP - that need stat EKG's, blood labs, CXR. And we get told that the nurse has to transport the pt to xray, and we have to call all the stats/put the orders in the computer/take care of the pt somehow someway. So frequently the floor gets dumped on (no sec/tech) also.

So, we all get dumped on , not just the ER.

PS. I am not Carol - I am Caroline/or Carolina, thank you. Peace be with you my brothers and sisters.

caroladybelle, BSN, RN · Dec 1, 2002

PS. I haven't had time to write up problem sheets either.......not that it would do a bit of good where I work.......the suits would just stick them in the old circular file.