Anyone fax report?

newfloridaRN · Nov 7, 2004

We fax report on all patients except ICU. Sometimes I'll have a PCU or MT patient that just needs alot of explaining, and in that case I'll call report. Most of the nurses on the floors like the faxed report and when we try to call report they utter "can't you just fax it, I'm busy!" I like the faxed report.. It's just a pain to call and say "did you get the report", I sometimes forget that step! I usually try to have my faxed report ready as soon as I'm done taking admission orders...Then when I get a bed assignment, I just fill in what has happened since then, recent vitals, etc.

Rena RN 2003, RN · Nov 7, 2004

we fax orders received for admission and all things done in the ER along with nurses notes. individual lab results etc are sent with the medical record and can be pulled up by the floor nurses. it seems to work well. the receiving floor nurse looks over the paperwork and then called the ER when the patient can go to the floor.

the only catch is that we sometimes get a snag with patients not going up quickly. usually, this can be settled with a phone call from ER charge to floor charge. if the ER isn't in a terrible chaotic mess, i'll hold patients for as long as needed by the floor.

same goes for the floor, if we are hopping, they will take patients as quickly as possible. and a nice big fat chocolate chip cookie pie sometimes helps facilitate things.

ratchit · Nov 7, 2004

Personally, I want the opportunity to ask a few pertinent questions..but I'm a control freak ICU nurse too.

I'm with you. :) I've gotten a couple doozie reports- "fixed, dilated, unresponsive, and combative." Ummm, to quote a song from kiddy TV, "one of these things is not like the others, one of these things does not belong!"

I don't want to start an argument, but unless I have accepted report, I have not accepted responsibility for the patient. Faxing can be a nice way to get report, but until I say "Yes" it's not my patient. So faxing then showing up 15 minutes later would not fly for me in an ICU setting. Fax me report- I've seen a couple standard forms that were great, let me know what I'll need to have ready. But I insist on being able to talk to the nurse to ask questions before being handed the patient and 15 minutes might not be enough time for me to get ready- just because there is a fax on the machine doesn't mean I'm not pushing epi and doing compressions. (Yes, I had an ER bring me a patient in the middle of a code after being told we had 2 codes going on (10 bed unit) and could not take a patient right now. That patient went back to the ER- the family LOVED that.)

Yes, I know the ER is busy. No, I'm not trying to delay report. No, I'm not out for a smoke break or being proud of myself for not taking report. If I can take the patient, I do. If I can't, then I can't, and if a patient is delivered to the unit without me saying yes, the nurse who brought the patient can stay with the patient until it's safe for me to take over.

I've seen sats listed on report but no vent settings- and a patient delivered to the unit with no vent ready because no one told us the pt was tubed. Or no info about precautions- "didn't we tell you about the meningitis/TB/MRSA issue?" Umm, nope, and now this pt can't go in this room or be taken by this nurse because her other one is neutropenic. I am NOT saying the ER left those things off on purpose- they are very busy and just missed something. But I'm really big on preventing problems instead of scrambling for a solution.

You see what I mean? I love getting the basics by fax- saves time. But a faxed sheet can't be the entire report. There needs to be a "any questions?" "Nope, bring 'em on up" check in first. But that's one of the reasons I don't work ER- I hate the idea of a setting that uncontrolled. :)

reeniegirl1 · Nov 7, 2004

on atravel assignment we have used faxed rfeports. downside, the report may have been written on the day of admission, but the pt may have soent an additional two days in the ed. the report is old, the new ed nurse may not update the info.

caroladybelle, BSN, RN · Nov 7, 2004

We are thinking of trying to fax report to the floors. I was wondering if anyone else out there does it and how it's working.
Our sister hospital is starting to do that and it has been quite a struggle for them. Causing a lot of bad feelings all around. We are trying to avoid that.
We want to set up a task force of ED nurses and floor nurses to work on it together.
Any input would be appreciated.
Thanks.

Well, you need to include nurses from several departments other than ER on the task force, for one thing.

As they are the ones that will be receiving the reports and are the ones that know what they want in a report, they are the obvious parties to help create the format.

And make sure that it includes from varying groups (include MS, Onco, Ortho, Peds, as well as ICU nurses. Frequently, when only one type of receiving nurse creates the form, it is pretty useless to the other groups.

It also, tends to tick them off. If all have a hand in its creation, the other departments are more likely to be cooperative.

Make sure there is head to toe assessment. There is little more annoying than admitting a patient with "renal failure" that has 8 stage 3 or greater decubs, and a shortened and internally rotated leg....with nothing noted regarding those in the report (but listed buried in the MDs notes). This is a true story.

And please be aware of ID/cardiac concerns and question improper placement. Notify admitting that the patient MUST have an iso or a contact precautions room, ahead of time. Sending a Shingles patient to a known onco/burn semiprivate room...or a Nitro drip to a nontele floor should be nonbrainer, but I have had it happen in faxed report facilities.

caroladybelle, BSN, RN · Nov 7, 2004

PS. One has to wonder why the nurses on the floor are so busy that they cannot get report. Perhaps, you should be talking about proper staffing rather than faxed report.

UM Review RN, ASN, RN · Nov 8, 2004

PS. One has to wonder why the nurses on the floor are so busy that they cannot get report. Perhaps, you should be talking about proper staffing rather than faxed report.

Yep, you've totally nailed the problems that we have with ER admissions. I don't blame the faxed reports, per se, because I realize that the ED can only do so much for a patient.

Even though our staffing is OK, my particular problem is with coming in at 11 and having an LPN with a full assignment to cover, 6 patients of my own, most of them wanting pain/sleepers. Completing the rest of my assignment, I get a transfer and an ER admit, all at the same time when I first come on duty. Happens a lot. Freaks me out. Is there a solution to that?

I mean, how would you ED nurses feel if you had all that to deal with as soon as you walked in the door?

I realize that's a bit OT, and I don't want you to read it as a complaint, it's not. But it's a problem, and I'm sure there is a solution somewhere, if we just had the time to have a discussion about it without pointing fingers.

mcmike55 · Nov 8, 2004

We fax ED reports to the floor before all admissions.

We are a small hospital, and I normally work OR, but help out in ED, so I really don't know how they came to this system, but it seems to work.

The report has name, diagnosis, critical labs,ekg, etc, and interventions to the time of report, IV's meds, etc.

The report is faxed up a minimum of 20 mins before we transport, and after it is sent, someone calls up to tell the floor a fax is there.

A short verbal report is given after the pt is put to bed, usually consisting of critical information review, and anything that took place since the time of the fax. It seems to work for us.

RNin92 · Nov 9, 2004

We definitely are including the nurses on the floor in the discussion. I don't think we would fax to the ICU though. Seems to me that an ICU patient needs a face-to-face bedside report.

I am sure that the floor nurses are very busy...I was when I worked the floor. But "busy" is really not the issue. EVERYONE is busy...but there is still a patient that needs the expertise of the nurse on the floor and there is a patient in the waiting room who needs the expertise of the ED nurse.

We hope that faxing report speeds up the process.

We'll see.

Thanks for the words of wisdom!

meownsmile, BSN, RN · Nov 9, 2004

We fax report from ED to the floor. They usually make a quick call before they bring the patient to the floor to find out if we actually recieved the fax and if we are ready. It has been fine so far, we have to do the admission anyway so any little details that werent included in the ED report we get on the admission anyway. When ED calls they dont necissarily talk to the RN who is getting the patient, just whoever answers and finds out if the fax was recieved there.

I will admit it helps to know before the patient gets there if they are confused etc. but either way you are getting the patient so its a moot point except as far as maybe room assignment goes.

RN92 · Nov 9, 2004

We use this system, also. We tried the fax but oddly enough, the floor claimed they never got the faxes..so we started tubing report and calling ahead of time. once we verify they received it, we have to wait 15 min before we send the pt up. We couldnt send the pt up unless they got report first.

Our floor nurses were notorious for not taking phone report. We spent so much time trying to give report, it was rediculous. This system (tubing report), has worked well because they cant avoid it anymore.

sheilagh · Nov 9, 2004

We receive fax on my tele unit from the ED but my gripe isn't the incomplete report or the illegible handwritting, but if they bring the patient up and leave without waiting for the nurse to come to the room and I walk in unbeknownst to me to a patient who has been on the unit for who knows how long and may or may not be in distress; to top it all off if I do happen to "catch" them bringing up my admission the nurse is never with them it's always a transporter or a nurse doing the other a favor and they know NOTHING about the patient. I do not like the fax reports, they are short, incomplete, and do not paint an accurate clinical picture, but that is just a gripe, I do think that sending a patient up to a cardiac floor often with only a transporter in attendance and then the patient is not "passed" onto another nurse but may be sitting in a bed unmonitored and possibly without anyone knowing they are even there is ETHICALLY, MORALLY AND LEGALLY NEGLIGENT.Both nurses (ED and receiving nurse) should make an effort to meet for 30 seconds when the patient arrives to see the fax matches the face ! :rolleyes: