Report without Orders? - page 3

by missbutton

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Is anyone else expected to routinely take report and accept a pt from the ER with out seeing the admitting orders? I just transferred from med surg to the icu; and I'm now forced to routinely take report on pts without the ER... Read More


  1. 0
    Quote from nerdtonurse?
    With us -- nightshift, anyway...

    1) we get the heads up that we may be getting one -- we let the ER know know many beds, how many nurses we have. That gives the charge time to decide if we need to find another nurse to come in if we're already running at 3 each

    2) We "stalk" the patient in the computer -- look at their vitals, labs, what they say they came in with "abd pain" for example, vs. what the labs/radiology says -- elevated ETOH, or elevated liver enzymes, positive troponins, etc. Helps us determine if they need the most experienced person on the shift, and that one of their patients needs to go to someone else being called in, or if they're run of the mill and any of us can take it.

    3) ER calls and formally requests the bed, via the house supervisor (she's like the air traffic controller for the hospital -- "gallbladder-niner, you're clear to approach on ICU room 3")

    4) we prep the room -- are they going to need a vent? dialysis? every IV pump in the place? If they're likely to code, we'd rather put them in the larger rooms so the code team doesn't kill each other, so we might call back and say put them in room A instead of room B

    5) we get report from the nurse. I hit the high points -- cardiac, resp, gu, gi, iv, drips, any psych issues, basically is this person likely to try to kill us or is the family nuts? Most of the time, we're told "call doctor X when they get to the room" -- the ICU intensivist comes over, looks them over, and then does any stat consults, writes a bunch of labs and orders.

    6) We get the patient, and sometimes find that everything we thought ... was wrong. Usually as we're running from the room screaming for security....*grin*

    Ah, yes- the computer stalking
    At a hospital I worked at, we had a frequent flier who would call EMS if she didn't take a dump for more than 2 days (no MOM, no magic bullet first, no Fleets- call the Marines, and get out the Dyson vacu-colon).... She'd demand that the ER sink an NG (who in their right mind asks for a 16 FR hose down their throat?....well, that explains a lot about this one). If the sup called and said an admission was coming, the collective charge nurses on any potential floor (OB was L U C K Y ) was online in a heartbeat looking to see if this one's name was in the ER....then we'd call the sup and ask who had her last, and actually get into battles to avoid her - LOL. Once she was admitted, she'd complain about the brand of orange juice we had , and hang on to that stupid NG like it was an Oscar- she worked hard for it, or something...

    We all wanted to get her a lifetime supply of prunes and AllBran, and have a phone tree to call her to remind her to drink enough and go for a walk every day... anything to keep her HOME !!
  2. 0
    Quote from xtxrn
    Ah, yes- the computer stalking
    At a hospital I worked at, we had a frequent flier who would call EMS if she didn't take a dump for more than 2 days (no MOM, no magic bullet first, no Fleets- call the Marines, and get out the Dyson vacu-colon)....
    LOL @ vacu-colon! And we've got some frequent fliers who'd line up for one! I swear, if I had a dollar for every time I said, "Ma'am, do you usually get up at 3 am and give yourself a soap suds enema? Then why do you want one now, since you just pooped 3 hours ago..."

    We need to find whoever's telling these folks they need to go to the bathroom every 6 hours and smack'm with a 2x4....
  3. 1
    Quote from nerdtonurse?
    LOL @ vacu-colon! And we've got some frequent fliers who'd line up for one! I swear, if I had a dollar for every time I said, "Ma'am, do you usually get up at 3 am and give yourself a soap suds enema? Then why do you want one now, since you just pooped 3 hours ago..."

    We need to find whoever's telling these folks they need to go to the bathroom every 6 hours and smack'm with a 2x4....

    The Cult of Supreme Colon Consciousness
    - have to be at least 70 y/o to be a card carrying member !!
    diva rn likes this.
  4. 0
    Quote from missbutton
    Is anyone else expected to routinely take report and accept a pt from the ER with out seeing the admitting orders?

    I just transferred from med surg to the icu; and I'm now forced to routinely take report on pts without the ER sending me the order. The med surg floor that I came from insisted that the orders be faxed before report was given and maintaining that prevented a lot of problems from ever reaching the floor or the pt. It seems kind of dangerous to me, but I was wondering what you guys think.

    Thanks
    In my experience, no pt. can be sent to the ICU without the basic bridging orders being WRITTEN: airway, cardiac and prn pressor orders, and an Intensivist handoff, PERIOD. Otherwise, it's a dump pt., and they can stay in ER all night for all I care.
  5. 0
    I once had a pt that was sent up with a HR of 20 (junctional on the monitor, confirmed on 12 lead), rectal temp of 96.5, spO2 of 85% on 4 liters. White as a sheet. This was before we had emergency response team in place at my place of work. The MD asked what was the BP...I said I could palpate a radial pulse, and slight femoral, but couldn't get a BP. He told me to try manual. I told him how the heck do you hear korotkoff sounds if the pulse is 19-21???
    Then we had to hold the pt on my floor till a bed in the ICU was ready. I had no orders on this pt when she was sent up. I had no report given.
  6. 0
    Quote from elthia
    I once had a pt that was sent up with a HR of 20 (junctional on the monitor, confirmed on 12 lead), rectal temp of 96.5, spO2 of 85% on 4 liters. White as a sheet. This was before we had emergency response team in place at my place of work. The MD asked what was the BP...I said I could palpate a radial pulse, and slight femoral, but couldn't get a BP. He told me to try manual. I told him how the heck do you hear korotkoff sounds if the pulse is 19-21???
    Then we had to hold the pt on my floor till a bed in the ICU was ready. I had no orders on this pt when she was sent up. I had no report given.
    Totally inexcusable.
  7. 0
    Crazy thing was, the pt was a&ox4...and she didn't WANT to go to the ICU, and refused to use the bedpan...she wanted to WALK to the bathroom. I kinda liked her.
  8. 0
    Quote from elthia
    Crazy thing was, the pt was a&ox4...and she didn't WANT to go to the ICU, and refused to use the bedpan...she wanted to WALK to the bathroom. I kinda liked her.
    As inexcusable as no report is, at least the patient wasn't a nightmare
  9. 0
    Thanks for sharing... I now feel very spoiled by my little hospital.


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