ER to MS transfers

[Allmy?]

Hello,

I am looking for some research material for a topic. I'm currently writing a paper for a BSN class (if you have any material please attach to your response)on ED and MS transfers and was hoping to hear some personal accounts on this topic.

I am currently a nurse on a MS floor that is having some problems with ED admissions being transferred to our floor without having doctors orders being done. (e.g. One patient had an order for an NG tube placement while in the ED, 2.5 hours later when he came up to our floor the NG tube still was not placed and the MS nurse had to fill out an SSA (safety alert) on delay in care.) I have lots more examples but this was the most recent. I realize being an ER nurse is a very intense job, but MS floors can sometimes be just as busy.

[psu_213, BSN, RN]

(e.g. One patient had an order for an NG tube placement while in the ED, 2.5 hours later when he came up to our floor the NG tube still was not placed

Out of curiosity, was the order written by the ED provider or by the inpatient attending (or consult). If it was written by the ED provider it should have been done, no doubt it should have been done before the pt came up. If it was written by someone on the inpatient team then there is a bit more of a discussion to be had.

[JKL33]

It's important to know whether the NG tube was an ED order from 2 hours back, or an inpatient order that wasn't addressed in the ED.

If it was an ED-originated order that never got done, you will handle that by following your facility's policies. Most times this is not a realistic "safety" issue although I realize it has been hyped as such. Anyway, follow your policies. Write it up if you must, etc.

If it was an inpatient order and there was a 2-hr delay in the patient reaching the inpatient bed, your place has bigger problems.

The ED exits to screen patients for emergency, initiate urgent treatment/stabilize the patient, determine their disposition, and move patients out of the department.

To be honest with you, an ED patient with an NG order and a pending admission who is not actively vomiting (or in some other way in urgent need of an NG) - is by far not the priority in any ED in this country. I do understand that it's hard to understand it in those terms, and it is unfortunate. But it is nevertheless true.

[Emergent, RN]

The latest research indicates that, for SBO, NG tubes should ONLY be used for active vomiting. The evidence supports avoiding, if possible.

Routine nasogastric decompression in small bowel obstruction: is it really necessary? - PubMed - NCBI

[Triddin]

Stat medications, blood products or interventions not done which would keep the patient from actively crashing/ preserve life/ affect patient safetywould cause me to fill out a safety event. For the ng, I wouldn't fill one out after 2 hours. 2 days, ya then probably.

I also would not do one about an ng not being inserted unless the patient was an ileus actively vomiting (which refers back to my first point). The goal of ER is to stabilize patients, then send them to the ward.

[marienm, RN, CCRN]

An alternative view of the problem your facility is having could be that the ED doc should only order stat tx (EKG, boluses, cultures before antibiotics, intubation, pain control, and imaging...just enough to determine whether the patient needs to be admitted or not).

I work in a teaching hospital so I know I have the advantage of having a lot of doctors around, but I'd really prefer that the primary team takes over writing all the orders beyond the stat triage stuff. Even then, we still get goofy orders- a confused encephalopathic patient with cirrhosis (ie: possible varicies) recently had an order for an NGT that the ED didn't place. We asked the MD if the patient *needed* to have it and the MD said, "oh, it's just so we can give the lactulose. You can skip it if the patient can swallow." We skipped it!