Advice to the LTC nurse...

Fngrpntsnotasin · Jun 28, 2011

Give me an example of a good report to give to an ER that i would be sending a res to. I give pertinent info along with what they can and can not do like ambulation or orientation, but what can make it go smoother or help me sound firmer? I often get chewed out after giving a telephone report because i am following our docs orders.

southernbeegirl, BSN, RN · Jun 28, 2011

What do you mean you get chewed out? by whom?

Fngrpntsnotasin · Jun 28, 2011

By the nurse taking report, i was actually told once that if it was such an emergency that i should be sending the res to the main hospital which was at least an hour away from our facility...when i asked if she was refusing to take report she said of course not and then asked to speak with the RN incharge of that resident so that they could give her report!

southernbeegirl, BSN, RN · Jun 28, 2011

This is exactly what I'm talking about. We need to improve our telephone skills with the docs and while giving report. IMO, many times an on call doc will simply tell the LTC nurse to send the patient to the ER because they don't know the patient and are not confident with the report they are getting from the LTC nurse. I have seen this happen. I have heard my nurses on the phone with a doc not giving the doc a complete picture of what is going on leaving them no choice but to cover their rear ends and say send out. I feel if we could do a better job, it would have only positive effects for us, the patient, the ER and the companies by cutting out needless transfers.

The only way to work on this is to open an honest conversation. So leave your feelings at the door of this thread please.

Think back, what could you have done or said differently to the nurse during report?

Fngrpntsnotasin · Jun 28, 2011

To be honest, I can't remember who we were sending out or why. It was years ago when I was a new nurse and my skin was much thinner :). Our Doc does like to use the "send to ER for eval and tx as indicated" route often. Now I have my info straight and know usually what say and leave out in a telephone report. I also know my residents pretty well and what their baseline is. I think my biggest flaw is being unconfident. I makes me feel like the information I give is not reliable you know?

Sparrowhawk · Jun 28, 2011

Doesn't seem to matter what we tell them..they treat us nursing home nurses like we're stupid.

mama_d, BSN, RN · Jun 28, 2011

I'm not an ED nurse but I'm gonna chime in with a request...

Please always document on the send-out sheets or paperwork when the last flu/pneumo vax was given. We floor nurses have to know for core measures, and it's easier all around if it gets done that way. Last BM and accurate mobility/neuro baseline is nice too.

Obviously that won't be able to be done in all situations, but it sure is nice when it does happen.

TinyRNgrl · Jun 28, 2011

This might be relevant or not but one night when I worked EMS we got called to a LTC for a "ill person". When we arrived the pt was sitting in a chair, chin on chest, basically occluding her own airway. First thing the nurse told me was "she is diabetic and hasn't been acting right". ME: "what was her BS". Nurse: "I didn't check it". ME: "ok. why?" Nurse: "It didn't occur to me until just now. I'm sorry, I don't normally work this shift." ME: "would it of occured to you to check this known diabetic who is diaphoretic, lethargic BS if you were working your normal shift?"

Another night. Called to another LTC facility. Arrive scene. Nurse states pt has had a fever for a couple hours. ME: "what is the temp and when was the last dose of tylenol?" Nurse: "100.3 and I didn't giver her tylenol." Orders for tylenol PRN Q4 hours as needed for pain or fever. Pt was asymptomatic, CAOx3 refused to go to hospital. Command released the pt and told the nurse to "do her job".

I am not bashing LTC nurse's. I could not do your job and I give a huge KUDOS to all LTC nurses and aides. It takes a special person to do that job. I do however, both working on the gut bucket (ambulance) and as a RN in the ED, get frustrated when incidents like the above occur all the time. But on the flip side, this happens everywhere, not just LTC. And I have known some darn good nurse's in LTC.

OK, so I might be rambling.

My advice to the OP.....when calling us in the ED for a report just give us the pertinent stuff (assuming we will have the med list and all the paperwork upon arrival of the pt). Symptoms, onset of symptoms, baseline mental status, any changes from baseline? any new medications started? any relevant medical hx? PRN medications you have given them, (PLEASE give them the tylenol if sending them in with a fever or you will get a not so happy phone call from me :)) if they are critical please tell us the code status and your assessment findings. Ask us if we have any questions or need any furthur information. But that is about all. We also get report from EMS when they arrive but it is always good to hear the nurse's report.

I am done rambling. That was just my advice.

TinyRNgrl · Jun 28, 2011

Oh......forgot this one. PLEASE when sending a pt to us with AMS that has a hx of alzheimers and or dementia, we need to know baseline for this pt and exactly what is different from baseline and if this has happened before. Duration of AMS. And esp for pt's with AMS it is important to know if they have been febrile, urine description, possible UTI? Are they being treated for a UTI? Any s/s of infection? Possible sepsis.

Ok. I am done now.

Janedough · Jun 28, 2011

Tiny EMT well said :)

CoffeeRTC, BSN, RN · Jun 28, 2011

As a LTC nurse, when I read alot of the post with anger towards the LTCs from the ER or EMS staff, I have to agree with them. I can't get over some of the stories I have heard.

As you know, the insurance companies, medicare etc are cutting back on hospital readmits and won't pay for them. Our company has instituted an big program for this. At first I was a bit inusulted that we have a book to consult with s/s and algorithism that tell us how to be nurses. (srlsy...it is very basic and includes nursing measures and what to ask the docs for when we call. It even tells us when to call the doc)

I can see how this can be very beneficial for the newer nurses or even those that don't have a clue.

We also now have a (I kid you not) 3 or 4 page transfer sheet and it really does go over everything that the ER or EMS need to know.

As a side note...getting the Flu or Pnumo info is sometimes a challenge for me when we get young or frequent short stay residents. I will now look into getting this infor more readily available (It could already be on the transfer sheet)