lunch break handoffs

kiszi, RN · Apr 10, 2017

I work nights, and it's rare for a nurse to be off the floor for more than the time it takes to grab food from the cafeteria. When one of us does leave, "report" ranges from a quick "can you listen out for 10 and 12" to a brief rundown of current drips and potential needs, not anything near a real report. More like "I'm letting you know I'll be off the floor." The assumption is that the nurse's time away will be brief. Fortunately I work with a good group of people who I know will jump in if my patient crumps, and the charge nurse is there for backup as well.

How sad that the nurse who took responsibility wouldn't step up. We generally note in the chart when handoff is given and to whom; would that work for lunches perhaps?

bookel · Apr 10, 2017

I suppose making a note who you hand off to is good. Except, the other nurse could still deny you gave them report. Yes it is sad.

ClauICURN · Apr 10, 2017

Thankfully I work with a very good team, and have never had a situation like this. Usually I just ask another nurse who has patients close to mine to watch over them while I go buy something, but I always come back and eat lunch in the staff lounge. If a patient is on multiple drips I always let them know which ones and that the bags are full, or just any relevant information in case they need to intervene so it's kinda like an informal short report. Also, I always make it a habit to let the secretary and the charge know who's covering me when I'm off the unit.

Greenclip · Apr 10, 2017

We have that in our PACU but not in our ICU.

bookel · Apr 10, 2017

Greenclip, what is it you are referring to when you say "we have that in pacu"?

Greenclip · Apr 11, 2017

The PACU nurses have a signed handoff report that is completed electronically when a nurse hands over a patient within the PACU, whether it's a permanent handoff (the first nurse doesn't expect to care for the patient again, for whatever reason) or a temporary one like a lunch break. There would be a brief verbal review of systems before the handoff.

I think this is because the expectation around staffing and break times is completely different in the PACU. A PACU float might have your patient for 25 minutes before you arrive for shift at 10:30 am. She hands off to you and takes another patient, or helps. All lunch breaks are taken outside the PACU.

ICU is another story. Handoffs are like what others have noted, "Can you watch 6 and 8, 6 is on levo, titrating down, we just rounded and Dr X is getting the last few orders in. 8 has transfer orders to tele, probably won't have a bed for a while, I just updated his wife." The nurse is gone for a brief time, and usually eats lunch at a computer while catching up on charting or reading through notes.

I'm not sure what the sentinel event was. If it's a critical event that happened suddenly, then yes I'd expect the covering nurse to catch it, but in that case probably several nurses would be around to see it on the monitors too--for example, if my patient's sats dropped into the 70s. If it had been building for a while, I might expect the primary nurse to own it, especially if she had been careless, for example, not watching a cardiac rhythm carefully, or a patient climbing slowly into tachycardia. We had a patient who had been on levo most of the day. The nurse covering while the primary was getting food, got the patient cleaned up after a BM and found two fentanyl patches stuck in a skin fold. The primary had not done a good undress and assess.

Ruby Vee, BSN · Apr 11, 2017

Anyone here have a facility that uses a hand off note for lunches and breaks that requires the nurse taking report state or sign off in some way showing they have agreed to watch the patient while the primary nurse is on lunch or off unit?
We recently had a nurse on lunch break give report to another nurse. Unfortunately the patient had a sentinel event while the primary nurse was on lunch. The nurse who took report and agreed to care for the patient isn't owning up to being in care of the patient. We need a way to hold each other accountable in situations like this.

I cannot imagine! Back in my first ICU job, I reported off on my patient when I went to lunch. While I was paying for lunch, I heard a code called in my unit. I rushed back in time to see the charge nurse (to whom I'd given my patient) at the bedside, pushing drugs in a full blown code. It was before we had "sentinel events", but it certainly would have been one. The patient had extubated herself despite wrist restraints, and the team was unable to get her re-intubated. Very sad outcome. The charge nurse and I were both kicking ourselves even though there was probably nothing either of us could have done differently. I will never forget the guilt I felt for being at lunch when my patient extubated herself, and that charge nurse (who was right outside the room looking in) was berating herself for not being closer, for taking her eyes off of the patient for a moment to talk to another patient's family member . . . .

I cannot even conceive of someone lying and saying they weren't responsible! I just can't.

calivianya, BSN, RN · Apr 11, 2017

Hard to imagine nurses not looking out for each other... if we don't have each other's backs, no one does. It doesn't even matter if the two nurses in question hate each other - you never know when you're going to need that person's help, so it's best to watch out for their patients exactly the same way you'd watch for your favorite coworker's patients.

romantic · Apr 11, 2017

On our floor we don't have anything to prove that you were on you brake except clock in and out, which works for your first half-hour; for the second half-hour, your word against the meal brake nurse. I would expect one to be honest-- we own it to one another.

But I also expect you to give a good report to the nurse who will keep an eye on your patients. I want you to tell me: any concerns about any of your patients: "watch this one-- can be restless; can pull IV, etc, can get up and fall; this one can desaturate without NC; low BP in room 200 and doctor knows; etc"

One time, I was helping on the floor. One nurse left for the meal brake and didn't tell me about low BP in one of his patients. Doctor called in 5 minutes asking about the patient. I was embarrassed, angry. How can you leave for your brake without telling me about low BP! Nothing bad happened, but could...

Julius Seizure · Apr 11, 2017

It doesn't even matter if the two nurses in question hate each other - you never know when you're going to need that person's help, so it's best to watch out for their patients exactly the same way you'd watch for your favorite coworker's patients.

Not even that. You watch out for them the same no matter who the nurse is, because it isn't about the nurse - its about the patient.

kevler · Apr 11, 2017

Transfer of accountability is ideally the same information you would give to the ongoing nurse and should be done in SBAR. In my unit we are assigned partners for breaks, our first break we give hand off, and head to toe report. For lunch because its same nurse, we give updates of the patient. (this is an ICU where staff ratio is 1:1 or 1:2)

When I was in cath lab in the middle of the procedure depending on the role, we would give history of patient, what procedure we are doing, what part we are in procedure.

If we were scrub nurse we would do a hand off count in addition and point out all sharps.

Christian