When is a patient your patient?

[shannonFNP]

I'm curious on how you all feel about it, especially if there are some legal nurse consultants in the mix. When is a patient actually your responsibility? The other day, one of our nurses was on her lunch break when a patient was put into her room from triage. The patient was coded within a few minutes. She arrived, just hearing of her new patient, and was responsible for doing the code sheet (just about finished with the code by then, regained pulse, etc) and for doing the initial assessments on the patient. What if this had happened and no one knew the patient was coding? Sometimes our tech's don't put patients on the monitor. Who is responsible? Or even taking the code out of the situation, many times a patient will be placed in a room and the nurse isn't made aware either because someone forgot to tell them or the nurse was busy in another room and never got the message. Even if you put "initial contact," what is the legality of this situation?

[MassED, BSN, RN]

Well, I do work ED and this scares me!

where I worked previously, they did AWAY with triaging of patients and just sent a person back to your room, where you then triaged them - no VS, no story, NOTHING. Talk about scary!! Try having FOUR new patients then not having any clue about what acuity they might be.... truly insane.

[Anna Flaxis, BSN, RN]

where I worked previously, they did AWAY with triaging of patients and just sent a person back to your room, where you then triaged them - no VS, no story, NOTHING. Talk about scary!! Try having FOUR new patients then not having any clue about what acuity they might be.... truly insane.

We've been struggling to implement a rapid triage system like this, where the patients are brought directly back and triaged in the room. It works great when we have rooms and staff, but when we're full and/or understaffed, not so great.

Have you ever noticed too, that how things go depends a lot on who is in charge? We can be getting our butts kicked and yet nothing falls apart, we're only on the verge of chaos, when one CN is running things, or things just go to hell and you walk away glad nobody died on your watch, when the other CN is running things.

[KayRN910]

We've been struggling to implement a rapid triage system like this, where the patients are brought directly back and triaged in the room. It works great when we have rooms and staff, but when we're full and/or understaffed, not so great.

Have you ever noticed too, that how things go depends a lot on who is in charge? We can be getting our butts kicked and yet nothing falls apart, we're only on the verge of chaos, when one CN is running things, or things just go to hell and you walk away glad nobody died on your watch, when the other CN is running things.

We have implemented this system for the last year or so and actually works pretty well, unless the doc gets in there at the same time you do to triage (they push our docs on their patient greet times, so they are on your heels most of the time). We still have a single triage nurse till 11 or 12, then a 2nd triage added. Sometimes it's okay, sometimes you need more help, but I agree with the charge statement... days with a good charge go sooo much better with that rapid triage system.

[vanburbian]

where I worked previously, they did AWAY with triaging of patients and just sent a person back to your room, where you then triaged them - no VS, no story, NOTHING. Talk about scary!! Try having FOUR new patients then not having any clue about what acuity they might be.... truly insane.

This is how it is where I work, and I HATE it. I do the triage on approximately 80% of all my patients. So, at times, I am triaging 4 new pt.'s within 20 minutes, trying to start lines and get labs, hook up to monitor, and get the EKG, as well as chart, and ask all the stinking triage questions, the risk assessments, the allergies, meds, immunization, screen for nutritional, suicidal, abuse, and MDRO's.

We don't have techs either.

If that's how we're gonna do "triage", then I'd rather have the nurse in back and just have the reg/admitting people bring patients back.

[edrnbailey]

In most situations, it is 'your' patient only after you have received report. If you are not on the floor when the patient arrives, then the patient is the responsibility of the nurse who received report while you are away.

If someone is transporting a patient to an open bed in the ER then that person bears responsibility until the report or handoff is done.

How can a patient be placed in a bed without someone to receive them??? Poor planning, bad policy.

This works well in most areas of nursing.... EXCEPT the ED and other transient care areas. There is little report to be received on a new patient. If they present via the front door the "report" is simply the triage. In many ED's the triage nurse does not move the patient from the triage area to a patient room a tech or CNA does this and assists the patient in donning a gown and places them on the appropriate monitoring equipment. If the primary nurse is available he/she will assist or complete this and perform initial assessment then. BUT, and it is a big but, the primary nurse is in another patient's room then he/she is not aware or able to assess the patient until they are available. That nurse is still responsible for the patient in question. There is an assumption of care in a timely matter. If the patient is critical/emergent and is brought to room by the triage nurse then someone should assume care on arrival to room. Often times report is as follows..... "Mr. A is 59 yo with chest pain radiating to left arm. started 1 hour ago while raking leaves. he has a cardiac history of HTN and MI x2 with stents and CABG. EKG ordered on on the way to room." That's it.. you go from there. A truly emergent or potential code is not fully triaged before being placed in a room. That is completed once the patient is in the room so that treatment is not delayed, so there is no report. The charge nurse who is monitoring the flow of 2-20 nurses cannot in reality notify each nurse of every patient placed in every room. Each nurse is responsible for managing his/her room assignments and the flow of patients in those rooms.

On a completely different note the OP's nurse was on lunch break. This means another nurse assumes care of the patients in those rooms for that time. There should be a report on the patients in progress at that time. As a rule of thumb always document when report is given and who it is given to on each patient. Even when it is just for a 30minute lunch break. The receiving nurse is the nurse responsible for the patient in question and is responsible for completing the paperwork including code sheet and initial assessment.

[marlboroking]

Where I work we have about 53 beds and it's busy most of the time. Our triage has only two rooms. There are no cardiac monitors, suction, scopes, beds, etc.. Just a dynamap, chair, weight scale, etc. We only have one nurse and two techs. Our department has recently instructed the charge nurses to assign a lobby nurse, but most of the time there is no lobby nurse. When there is a lobby nurse, they are usually called by the charge nurse to do other things (lunch relief, take up patients, etc.).

I can understand a nurses frustration when they receive a new patient from triage and they haven't caught up with their other patients. But keep in mind that the triage nurse must accept all patients coming in regardless. There is no refusing a patient out there. And it's difficult when you have 20 patients in the lobby and 15 lining up to check in.

As a triage nurse, I make it a point to put the least critical patients in the lobby if there are no rooms available. And I will hold rooms open in anticipation for critical patients coming in (something our department despises with flailing arms. They want all rooms filled at all times and no one in the lobby. ha ha.). I make sure that all protocols are done when time allows and when we have techs available. I try my best to make it as easy as possible for the receiving nurses.

Where I work, nurses are assigned to rooms. I don't think a nurse should refuse a patient that is placed into their room because they didn't receive report or because they are unable to take care of the patient. If they are unable to take care of the patient, then they should have called the charge nurse for help and/or asked for the help of their peers around them. And at the least, the should have called the triage nurse to let them know what's going so that they can alert the charge nurse and/or nursing supervisor as well. You can't expect me to keep a patient that's been stabbed in the chest out in the triage area just because you aren't caught up. I can't treat them out in triage. If there's a room open, I am sending them to that room. If you can't take care of them you should have called me so I could alert the charge nurse and you should ask for the help of your peers and alert the charge nurse as well.

[VICEDRN, BSN, RN]

My first job...you received a report, even if it was just a call if the patient was critical or potentially critical. My present job? You hear nothing even if the patient is crumping and everyone knows. Nothing like walking in on an obvious stroke that was bedded in your room for well over a half hour and you didn't know.

I personally think its appropriate to give report on a patient that comes to your room, even if its two or three sentences, "hey, dude in there looked septic. had his labs drawn in triage, tech is putting him on the monitor./possible stroke in your new room./chest pain looks like ACS for real/EKG paged." something. it doesnt have to be big and long.

as for the issue at hand, i would have charted nothing as it is, as mentioned, false documentation. you weren't there, you can't chart it.

[brainkandy87]

In the ER I work in, each nurse has four assigned rooms and there's usually 1-2 float nurses (20 bed ER). If anyone comes in with CP, they are taken straight back without being triaged like everyone else would be and whatever nurses/techs are available meet the triage nurse in the room. If the assigned nurse is in a room with a procedure or something, they just come catch up. Usually the charge nurse will chart on what's been done up to that point. If someone comes in with something other than CP but just look like they are on their way down, we'll run the same type of procedure and take them straight back.

We've yet to have a situation where a non-urgent pt crashes while waiting to be seen by their primary nurse (fingers crossed). Our wait time is usually only a few minutes, but of course, that few minutes is critical if they crash.

[BLONDIE1630]

Unfortuntately this is a situation I face all too often. We do not have a "triage" nurse - we are each responsible for doing the triage on our own patients. There are times the tech will put the patient in the room, not get vitals or place them on the monitor - because they are told to get the patients from the waiting room first (and they do not always remember to go back and get the vitals). I have a real issue with one tech (who is a paramedic outside of our facility) that will bring me a "chest pain", do the EKG but not put the patient on the monitor...GRRR.. Our administration tells us that if a patient codes in the waiting room it is all of our licenses on the line so we must bring all patients back no matter how full we are and utilize hall spaces, disaster strechers, wheelchairs, etc. this makes me flamin mad!!! HOW CAN WE GIVE QUALITY NURSING CARE IN THOSE SITUATIONS?!?!

[Altra, BSN, RN]

Our administration tells us that if a patient codes in the waiting room it is all of our licenses on the line so we must bring all patients back no matter how full we are and utilize hall spaces, disaster strechers, wheelchairs, etc. this

If you think about this threat logically, you'll know it is nothing more than a scare tactic. I'm sorry that your management feels the need to tell tall tales in order to implement an immediate bedding initiative.