Abandonment???

meownsmile, BSN, RN · May 10, 2007

If you are a JCAHO hospital you will be abandoning this type of report within the next year im sure. We just changed all our reporting to verbal face to face with walking rounds to introduce and answer any other questions that might come up.

We work a mix of 12 hour shifts for some and have a couple left still working the 8 hour day shift. We all have to rearrange our assignments at 1500 and then again at 1900 dependant on patient load. PIA for sure, but verbal report makes it a lot easier and less likely for what you described to happen. Good luck and dont feel bad. I dont necissarily agree it was your fault either.

ginger58, ASN, RN · May 10, 2007

In California abandonment as defined by the BON as accepting a patient and then leaving them. You never accepted the patient.

EarthChild1130 · May 10, 2007

I would find some written policy and procedure on it and compare what that says to what is being practiced. Whether or not you choose to make an incident report is up to you, but if a patient is harmed because of this unit's practice, your license will be on the line along with the nurse who left at 1500. Best of luck to you!

SassyRedhead · May 10, 2007

re: jhaco on hand off communication:

http://www.jointcommission.org/nr/rdonlyres/a6839682-0a43-4053-86fb-923257674f09/0/07_npsg_faqs_2.pdf

[2e] what is a “hand-off” communication?

the phrase “hand-off communication” refers to a real-time process of passing patient/client/resident-specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient/client/resident's care. the information is usually about the patient’s current condition, ongoing treatment, recent changes in condition, and possible changes or complications to watch out for. examples include nursing change-of-shift report; physician sign-out to a covering physician; anesthesia provider or circulating nurse report to the pacu staff; ed staff communication with staff at a receiving facility when a patient is transferred. [2/06]

[2e] our nursing staff prefers to audiotape the change-of-shift report. is this acceptable?

it is not our intent to prohibit the use of taped reports. however, this method will not be acceptable unless it includes an opportunity to ask clarifying questions and to receive answers in a time frame that is consistent with having complete and accurate information available to the patient’s caregivers when they are providing the care. a process that relies on the option to call a nurse from the previous shift at home if there are questions about the taped report will not meet this requirement due to the understandable reluctance to do this as routinely as the question would be asked if the nurse were available face-to-face. [2/06]

[new—2e] is hand-off communication required when a patient moves from an inpatient unit to radiology or other diagnostic testing unit?

yes. the information communicated may be limited to what is relevant to the procedure, but it is a “hand-off” and should follow a standardized procedure. at the very least, this will ensure that staff in the testing area know that the patient is there and it will provide an opportunity to properly identify the patient and the test to be done. [new, 1/07]

rags · May 10, 2007

re: jhaco on hand off communication:
http://www.jointcommission.org/nr/rdonlyres/a6839682-0a43-4053-86fb-923257674f09/0/07_npsg_faqs_2.pdf
[2e] our nursing staff prefers to audiotape the change-of-shift report. is this acceptable?
it is not our intent to prohibit the use of taped reports. however, this method will not be acceptable unless it includes an opportunity to ask clarifying questions and to receive answers in a time frame that is consistent with having complete and accurate information available to the patient's caregivers when they are providing the care. a process that relies on the option to call a nurse from the previous shift at home if there are questions about the taped report will not meet this requirement due to the understandable reluctance to do this as routinely as the question would be asked if the nurse were available face-to-face. [2/06]

from what it says here about jhaco's point of view your facility is in violation. i would make out that incident report and/or speak personally to someone who cares what jhaco has to say. after all it is not about the facility or the nurse. it is about the pt and their care and safety. as that patients nurse it is your responsibility to ensure they receive proper care and to be their advocate if need be. by taking the stand that you will just remember to check the board because "that's they way they do it here" is not being responsible for your pt's care.

that's the way i see it. take it for what it's worth to you. :innerconf

no matter what it is not an easy or comfortable situation for you. i'm sorry for that.

rags

JenNJFLCA · May 10, 2007

This sounds like my floor! We give face-to-face reports, but sometimes I finish getting report and I suddenly come to find they have switched my patients or added another one. I put my foot down and they don't do this to me anymore without telling me first. It's irritating to get report (which can be lengthy depending on the pt and RN) and then come to find out you're not really getting those pts. It's also irritating at 0730 when I've already started my routine and I find out I have another pt. As a nurse you need to be flexible and roll with the punches, but common courtesy also needs to utilized. I can't believe that no one on your floor tells anyone that they're picking up another pt! That is abandonment to me. Think of how you would feel if that was you or your loved one?? Sounds like a lawsuit waiting to happen.

allnurses Guide · May 10, 2007

This doesn't make any sense. And it is dangerous.

I'd definitely make an incident report. These are not meant to be punitive but to find the things that don't work well and fix them.

steph

karenna · May 10, 2007

Same old, same old. Want a better life? Get out of the hospital.

Jo Dirt · May 10, 2007

There are a lot of micsonceptions about what constitutes patient abandonment. This nurse did not abandon the patient. It was a mistake, though a sloppy and potentially dangerous one. It also doesn't seem like it was necessarily anyone's fault.

Just count it as a learning experience and an incident that won't happen again.

Antikigirl, ASN, RN · May 10, 2007

It really differs in each hospital (I did work agency for a while..talk about trying to figure out not only EVERYTHING..but who your actual pts are!). I found that being a very proactive person for finding your pts is needed! Heck..even if everything works right, and a mistake or miscommunication is done...it is your bottom on the line!

So at change of shift (I work 12's but we do have 8 hour shifts....so I can have a pt slide in unnoticed!)...I go and ask my charge daily..."do I have another?" (and check the patient census at each change just in case!).

It wasn't abondoment since you didn't know you had them...abondonment is KNOWING you have a patient and dumping them. Abondonment is leaving your responsiblity by your KNOWLEDGE....you didn't do that, and you did well for excusing yourself for the mistake that was not only yours to make!

Sounds like a revamp of patient care assignment is needed so this doesn't happen again..and if you choose such battle...I would speak to your supervisor and say "I don't want this to happen again to any pt...how can we help this?".

bigsyis · May 10, 2007

Why couldn't even the Unit Secretary page you in the room you were in to let you know that your assignment had changed, and to check w/the desk? Why couldn't the off-going nurse stick her head into whatever room you were in to let you know? Why couldn't she have written out a brief report for you and put it on your computer, or clipboard, or med cart, or leave it w/the Charge Nurse for you? And speaking of Charge Nurse (after having done that for years), just what is she in charge OF, if it isn't to know who has what pts? Whenever I had to rearrange pts for someone going off at 1500, it not only was on the assignment board, some one of the arrangements that I mentioned above were made. If the receiving nurse was tied up, I either took report for her, or had the off-going nurse write report for her, before they left.

Your scenario was really sloppy, as already mentioned, bordering on dangerous. Somebody on a dobutamine gtt needs to be having their HR and BP monitored. Who was doing that? Where was that Charge Nurse, anyway? :nono:

ProudGayRN · May 10, 2007

Howdy All,
I have a question concerning abandonment. I am a new nurse who passed boards earlier this year. At the hospital that I work for we don't give each other a verbal report, instead there is a phone system that the nurse leaves a recorded message on at the end of their shift. This is usually not a big deal for 7a - 7p and vise versa because we see each other and can ask questions if we have any. The problem is when we have 7a - 3p nurses and they leave. The remaining nurses have to take on the leaving nurses pt's. No big deal so far except, we are not always told when a nurse is leaving.
So the other day I am at the nurses station it is 1800 and the unit secretary asks me if Mr. Smith (not real name) in room 1234 can have something for pain? I replied by saying that I didn't have that pt. to which she replied, "your name is by his on the assignment board." Sure enough there it is. To make matters worse, the family member is standing next to the unit secretary while all of this is being said. I get an MAR, the pain meds and go to the pt's room. I apologize to the family and say there was a miscommunication but I am here for you yada yada yada, and assess the pt. The wife of the pt. informs me that the off going nurse told them that I would be their nurse, but that nurse NEVER mentioned that to me. To make matters worse the pt. had come up from ICU (post CABG x 5) around 1300 and was on a dobutamine drip. I was furious that I knew nothing about him. I spoke to my manager / charge about this and the response I received was "Well you need to check the assignment at 1500 to see if you are picking up any patients." Funny this was left out of the orientation I was given.
Now we don't have someone leave everyday at 1500, but I don't know who is working what schedule from day to day. Isn't it the nurses responsibility to let me know that I am picking up one or more of their pts.? As for checking the assignment board at 1500 everyday, at 1500 I may be in a pt's room giving meds, leave there to do a dressing change, then on to answer a call light and so on....... It could be 1600 or later before I am back at the nurses station.
I have spoken with my manager / charge about this and the best answer that I have received to date is "Well, I will try to let you know when you are picking one up." My co-workers just say "yeah I hate that, but that's just how it works here." I am nuts??? Is this really an acceptable attitude to have? I now just work my 3 - 12 hour shifts and pick up my over time on a different unit. I can't transfer off of the floor because I have a contract to fulfill.
When these nurses leave without saying anything does it constitute abandonment? Friday was the most recent time this happened, I had 5 pt's. Of those 5, 1 had a trach, 1 was bradying down to the low 40's and a 4.0 second pause, one was getting blood. Going to check the assignment board was not on the top of my list of priorities.
Please understand I am not upset about picking up a, we take up to 6, nor do I want to come across as complaining about the workload. If I have 5 and ICU or recovery calls report at 1800 with a transfer I know that is part of my job and get ready for the new patient and move along. It is the not knowing that gets me upset. And yes, I do keep a closer eye on the assignment board.
I have been on this floor for a few months now, half of that was w/ a preceptor, since I have been on my own I wonder how many patients I have been assigned that I never saw because I didn't know about them.
Anyways all thoughts and / or comments will be greatly appreciated.

Give me a break -- when the shift ends - its Bye bye, I for one wouldnt sit around the hospital waiting for you to come so I can spend 20 minutes of my valuable time explaining something to you that you can find out through other means - stop the crying about this, seriously.