A question for ER nurses

purplemania, BSN, RN · Sep 29, 2001

You get calls because (1) the person monitoring the fax is not the nurse taking care of the patient and there is not a system for getting the chart and the fax together or (2) the fax is not legible or (3) there is SO MUCH info faxed that it would take a week to read thru it and it is easier to ask the pertinent questions rather than sit down and read several pages of gobbly-gook (it is gobbly-gook if you don't know where to find it and have to look at every word on every page). Another problem I have had is that the info is not up to date on the fax. I have had patients tell me they no longer are on this medication, etc. and I have to verify.

Do your patients always go to the same ER? If so, talk to the ER Director about getting a form made up that the referring nurse can quickly fill out. Then when report is given get the ER Nurse's name and fax to that person. Talk to the hospital and find out what their needs are and see how you can work it out. Believe me, the ER nurse does not want to stop what they are doing and phone you. SO FRUSTRATING to that nurse. Been there. Done that.

Nurse Jenni · Sep 29, 2001

I'll be more specific....

These 'copies' are just that a hard copy sent with the pt. in an envelope that the nurse has to open and look at to get our phone #!

only current med sheets are sent so the ER know exactly what meds hd been admin. befor pt was transfered Our pt's have a choice of three 'local' hospitals to choose when we admit them...depends on their preference and where their primary doc has privileges.

Thank you for your input...however I feel like the 20 minutes or so wasted on copies is just that..20 minutes wasted!

OzNurse69 · Sep 29, 2001

I work in ED at present - used to be in colorectal surgery with lots of hostel/NH pts admitted for surgery - usually our problem was when we asked for a letter from the facility or Dr the response from the pt/carer is either "What letter?" or "Oh, sorry, I didn't think it was that important, so I left it on the kitchen bench". Then we have to ask the pt where they live, look up the phone no. in the phone book, and ring the staff there to find out the details we need to know

CEN35 · Sep 30, 2001

let's see..........

patient sent in for ams..............and nothing on the chart or report about their baseline ms? then when we call.........nobody seems to know?

sent in for a fall? ask.......do they walk? well im not the person who normally takes care of them. or i'm not sure? most of my call backs are, because we can't seem to ever find out where their baseline is?

then i call and get, theyr'e not mine.........hold on 5 minutes.........ok different wing.........ohhhhhhhhh her.......im just the na...............hold 5 minutes...............oh.....well i just took over care before they sent her so i dont know?

it's always something? we can never seem to find out patients baselines from nursing homes? that is a huge!!!!!!!! factor in attempting to get to the bottom of a situation

just my 2 cents

:)

Charles S. Smith, RN, MS · Sep 30, 2001

Originally posted by Nurse Jenni
I'm in long term care. When we send a pt. to the ER we make copies of their cover sheet with all pertinent personal info. contact, insurance, MD etc, their Advance Directives, any insurance cards/medicare #'s,Dx's Med sheets and treatment sheets, report is also called in by the RN. on there current condition, a transfer sheet is also sent with S&S MD ADL status Mental status before and during what ever episode there being seen for....I assume most LTC's do the same...my question is WHY DO WE STILL GET PHONE CALLS FROM THE ER OR MED/SURG FLOORS FOR ALL OF THIS INFO WE'VE ALREADY SENT? I would really appreciate any logical answer. I haven't gotten any yet!

CEN35 makes some good points. We never really know just what the baseline functioning of our LTC patients really is, when the last time they actually saw a physician, when was the last comprehensive assessment done and what were the results. Fortunately, we get frequent visitors from some LTCs and we have been able to amass the needed info over time, but for first timers, LOC and LOF(level of functioning) is really important. Your efforts however to get us the meds, living will, etc are NOT in vain. So take heart, that we do use that info.

best chas

P_RN, ADN, RN · Sep 30, 2001

Something else I might suggest. If the SECRETARY was the one who got the envelope.....NO ONE was allowed to touch any papers until the chart was assembled.

I got to where I had to intercept ANY papers before they reached the desk. Sometimes it felt as if the Secy. was the boss and we were her subjects.

We also had a universal transfer sheet. As far as I recall it is used in EVERY facility in the state. "Name rank and serial number"

are in the same place-always. On the "from facility line" I usually put the unit number and phone.....always thought that helped.

deespoohbear · Sep 30, 2001

I work on a general med-surg floor and help out in ER when needed. There is a transfer paper that is suppose to come with the NH patient. It always comes, but 9 times out of 10 it is not completely filled out. Like, whether the person is A&O x3, continent or not, last BM. Sometimes it doesn't even have the code status on it! That is why we call. The paperwork isn't filled out correctly. A lot of times we don't even get a phone call the resident is coming. They just show up on our door step. It is hard to determine what is normal for a patient and what is not when you don't have the first clue and there is no family present to give information. Remember, we are all in this together to help the patient. The more info we can provide to other facilities at the time of transfer will benefit the patient.

galenight, BSN, RN · Sep 30, 2001

Wow, Nurse Jenni.. it really sounds like you all have your papers in a row. I wish our local NH sent 1/2 that info. I'd be pleased to get a patient from your facility. It seems as though all the information listed is what is needed. From personal experience, I know that here sometimes report is given to the ward clerk (GRRRR!), if at all, nothing is said about current status. We usually do get med sheets but that's about it.. and sometimes nothing charted about meds for hours even though you see they were supposed to get a dose of something or other 30 min. ago. Our local NH also has called report AFTER the patient has arrived... and many times I called over steaming mad because they didn't let us know they were coming. NH is only about 1 block away.. maybe they think we can hear them talking?? So, I don't really have any advice for you.. from my perspective you are doing great... good luck

kaycee · Sep 30, 2001

Wow again Nurse Jenni.. I agree with galenight, you are the exception not the rule. We seldom get very complete info about any residents sent to our ER. We never get any info on normal mental status and as Rick said that is frequently why they are there. I would feel blessed to receive a pt from your nursing home, and I promise I wouldn't call unless it was simply to say thanks for the info:D

spudflake · Sep 30, 2001

Jenni: I can understand your frustration:( You've sent ALL the info that you think we'll need in the ER. But what we need are facts. A&O x3 maybe enough for some nurses but I've gotten that on a form when the pt. comes in with the Q sign. When did they change from walkie/talkie to Q? Dementia is a cute dx but what level??? We developed a transfer sheet for our area. Works pretty well but I have to agree with others who point out that the form IS NOT FILLED IN CORRECTLY. The nurse who decides that the pt. must go toER must also fill out the needed info. Fever - how long?, how high? what's normal for this pt? I really don't have time to fumble through unfamiliar LTC paperwork. OBRA has required LTC to chart EVERYTHING and all I want is the facts:) Besides all this mumbo jumbo Jenni, you need to realize that you are in a no win situation:o I have worked with too many ER nurses who receive pts. from LTC with the attitude that 1. LTC nurses don't know anything, 2 LTC nurses are lazy and they just want to "dump" hard to care for pts. (especially the demented) and 3. (the one I hate the most) how could those LTC nurses let this happen - especially the falls. But take heart - these are the same ER nurses that dis the transfers from rural hospitals in the same manner. I do not envy your position - that is why I am not in LTC.

debbyed · Oct 2, 2001

I wish everyone sent the info you do but it doesn't happen. Mostly what happens is what CEN35 describes.

Big thing--mental status now, baselinemental status, how long has there been a change--

When we call for further information it never ceases to amaze us that NO-ONE working knows the patient or what their base line is.

Many times additional calls are made to the LTF because the doctor has specific questions he/she needs answered that can't be found in the records sent.

P.S. Sometimes the private ambo companies loose/missplace/keep

paperwork that should go to the ER.

It's a tough situation all around and I am sorry that I don't have an answer that would make it better. :rolleyes: