Doing Floor assessment in ED before admission

MassED, BSN, RN · Jul 19, 2008

How many of the ED's do the floor assessment on the patient before sending to their room. I mean the entire head to toe and psychosocial. I am really interested in Mississippi Rn's but would love to here from all. how do you work it in and not delay triage/medscreen or treatment on ED patients. Just wondering.

there are assigned floor nurses (who have taken the jobs b/c of injuries and can't pull clinical shifts) and they come down to the ER and try to do all of the admission stuff for the floor nurses. It doesn't usually get in the way of what we're doing, as by the time they come down, they're sitting holding anyway....

Altra, BSN, RN · Jul 19, 2008

Although I'm an ER nurse, I'm going to think like a floor nurse for a minute.

The patient is coming to my floor ...

I'm going to care for this patient ...

I want to do the assessment.

Don't I have to assess this new patient to care for him/her anyway?

Dixielee, BSN, RN · Jul 19, 2008

We have an "admissions unit" where we send all but ICU and trauma patients when they are open (generally 0700-2300) but they only have 5 beds. They do the necessary paperwork and then send them to the floor. We never do them in the ER, even when we are boarding patients when there are no rooms for them on the floor. We are already busy and stressed enough, I can't imagine throwing more paperwork in the mix. While we are holding floor patients, others keep streaming thru the front door or the ambulance bay, and we keep lining them up in the halls.

We can never say we are full just because our rooms are. Like the guy at the end of CSI Miami says, "We never close".

Burnt Out, ASN, RN · Jul 19, 2008

Although I'm an ER nurse, I'm going to think like a floor nurse for a minute.
The patient is coming to my floor ...
I'm going to care for this patient ...
I want to do the assessment.
Don't I have to assess this new patient to care for him/her anyway?

I work on a floor and while I do want to assess my patients head to toe when they come to me, it would be beneficial to both the patient and the nursing staff if IT (for those of us who do computer charting) could make it where all of the questions about history that was asked in the ER would show back up when we have to do our admission assessments. It can be such a battle to get patients to want to answer our questions after they have been in the ER. If I had a dollar for every time I heard "I've already answered these questions", I could retire. :up: :wink2:

We were promised this would happen when we went from paper to computer charting but of course have not seen it yet.:typing:banghead: :yawn:

MassED, BSN, RN · Jul 19, 2008

We have an "admissions unit" where we send all but ICU and trauma patients when they are open (generally 0700-2300) but they only have 5 beds. They do the necessary paperwork and then send them to the floor. We never do them in the ER, even when we are boarding patients when there are no rooms for them on the floor. We are already busy and stressed enough, I can't imagine throwing more paperwork in the mix. While we are holding floor patients, others keep streaming thru the front door or the ambulance bay, and we keep lining them up in the halls.
We can never say we are full just because our rooms are. Like the guy at the end of CSI Miami says, "We never close".

which is why there's a specific job for those nurses that do these admission assessments - talk about a nice job (though boring) - they float around and do all the admits on the hold patients... I think it's a PRN job, though...

northshore08 · Jul 19, 2008

We have an admission nurse/house supervisor during the days; they do the admits and assign the beds as well; so while this nurse is at the bedside of your pt completing the admission assessment, he/she is fielding calls from the docs and everybody else who is looking for a bed assignment.

:coollook:

Hmmm..don't know if I would like that job.

MAISY, RN-ER, BSN, RN · Jul 19, 2008

We do our own head-to-toe in the ER, usually with repeated focal assessments. This would only change if a patient had an occurrance that changed their condition body wide while under care.

The floor assessments are usually very indepth-I do not have time for that. Under our hospital's rules we only have to do the in-depth assessment if the patient is still in ER after 24 hours (after official admission). It takes way too long, when you have people coming through the door with emergencies!

also, I agree that if I am the floor nurse, it gives me the opportunity to check everything out. Not that I don't trust my colleagues, but I know first hand that while I may measure a cellulitis leg, or wound sometimes...others I just can't.

Maisy

LilgirlRN, ADN, RN · Jul 20, 2008

We used to have an admit unit too.... then we had a big meeting one day where everyone was invited to put their two cents in. I suggested that the admit unit go mobile. SO now they go allover the house and do the admission stuff on most of the patients. However, if I were a floor nurse, I'd wanna do the assesment myself too. How can you take care of someone without knowing what their baseline is like yourself?

CritterLover, BSN, RN · Jul 20, 2008

although i'm an er nurse, i'm going to think like a floor nurse for a minute.
the patient is coming to my floor ...
i'm going to care for this patient ...
i want to do the assessment.
don't i have to assess this new patient to care for him/her anyway?

though the op is calling it the "floor assessment"; i think what she is talking about is the admission assessment stuff -- which (as you probably know) is far beyond the typical shift assessment/flowsheet stuff.

you know -- the form(s) that ask stuff like medical history, family medical history, previous use of home health, screens for a bunch of stuff (like need for consults to pt/ot/dietitian etc), all allergies and the precise reaction that you have to the meds (itching? nausea? hives? rash? tinitus? hallucinations? oh, golytely gives you diarrhea?), religious needs, cultural needs, advanced directives, next of kin, preferred learning style, potential d/c needs, flu/pneumonia vaccine screens ..... all of this plus an actual assessment.

when i worked in the er, we used to have to "start" this crap within 8 hrs of when the admit orders were written (it had to be completed within 24 hrs). unfortunately, our er docs wrote the admission orders, so there wasn't any time lag. if we had an "ed hold," then we had to at least start the forms. (and most of us tried to finish them, too, rather than pass on the joy to the next shift -- i mean, if you have to haul the computer into the room and ask 50 questions, what's another 40?)

anyway, it is a huge, time-wasting mound of paperwork/screen of computer forms that don't really impact the care you are going to give in the er, but it sure will help out the case managers in the morning.

i would hope that the vast majority of floor nurses are going to want to do their own assessment, but would love to pawn the rest of the stack off on the er nurse (or someone -- anyone -- else).

(as a side note, taking the floor nurse's side in all of this, often times when the patient finally gets admitted, the family goes home -- after all, they no longer need to worry about being called back to transport their family member home. sometimes, when the family walks out, so does any hope of completing all of those forms. in that respect, it does make sense to have the er nurse fill out those forms. but only in that respect).

cactusj · Jul 20, 2008

Yes, you are right. It's the COMPLETE admission assessment. We are a 6 bed ED--rural, where 1 RN and if she's lucky, 1 LPN--no tech, no admission clerk, no triage nurse plus all 6P tp 7A calls are routed to Er for transfer to patient rooms or the appropriate person--not to mention, it's like any other ED with lots of non-urgents who demand instant attention plus oue share of urgent to emergent. Gets very mindbogging. You comments are so greatly appreciated. Now on the other hand the med-surg unit runs a census of 2 to 14--(we have NO specialities-peds,OB, Ortho, CCU etc--these all have to be transferred) and run 1 RN, 1 LPN and 1 CNA--are often sitting at desk wrapped in a sheet! We are all paper no computer forms!! :coollook:

TraumaNurseRN · Jul 22, 2008

I can't begin to imagine what a Mass Exodus an ER would have if they instituted admission assessments as a requirement for ER nurses. From the time I walk into our 65 bed Level II trauma center I am working my butt off, many times without a break or lunch. I personally feel a floor nurse should be required to admit as they currently do in my hospital and many big hospitals.

If I have a MI, Stroke or any high level admission I do not have time to stand there and ask that lengthy history. I am concerned of the primary complaint...not that they had hemorrhoid surgery 3 years ago. (As an example).