I made an "Oopsie", need some pointers

Specialties Emergency

Published

Hi!

I am a new graduate in a small community ED. I'm 3 months in to orientation and hanging in there. I feel like all I do is make mistakes, but my preceptor and NM think I am super duper... which is all well and good, but I still need some advice.

I realized last night after I was already in my bed half asleep that I sent a patient up to the floor (medical bed) without orders.

I'm just curious, in the grand scheme of things, how horrible is this mistake, and what are some pointers you have to help me remember it?

I know it's a logical thing that you need instructions on how to care for your patient, but in my (currently) one track mind, I have orders from the Emergency Doc and I (without guidance) occasionally forget that I need a set for the floor to follow.

Yesterday was also extremely busy, with all 30 something beds full with wall beds, and they were DYING to get people out and into beds or home.

Would the floor treat him like a boarder waiting for a bed?

--Also, I was actually in a meeting with my preceptor and NM evaluating my progress, and one very ... I'll say "enthusiastic" (code for kinda pushy) tech wanted to know why he wasn't on his way yet, and my preceptor wanted to know if the chart was copied and I said yes... and by the time I was out of the meeting, he was gone.

Eeeeek!

:o

Specializes in ED.

in my er we don't even get a room number until the orders are recieved. I think that helped.

Specializes in Trauma ICU, MICU/SICU.
we don't have to .we are not a teaching hospital so our attendings have to come in and see pt and write orders .we try not to take tel orders.

O.k. so let me get this straight. You get a pt. at night, send to floor with NO orders and don't take telephone orders. So WHY is the pt. in the hosptial? Do they have to wait until morning for pain meds, diet, and activity orders? Why don't you take telephone orders? That sounds insane unless I am misunderstanding you. Please enlighten me.

Specializes in Trauma ICU, MICU/SICU.
in my er we don't even get a room number until the orders are recieved. I think that helped.

That sounds like a floor nurses dream, but your ED must fill to overflowing.

Specializes in Tele, ED/Pediatrics, CCU/MICU.

Thanks for all of the input!

I'm starting to think it's a system flaw. We use MediTech, and report is typed in. Report is not called RN to RN unless we are admitting the pt to ICU. Our ER docs are very good (all attendings) and I can never tell if I'm supposed to ask/wait for orders from them, or if the doc theyre being admitted to is coming down, or what the heck is going on!

Ahhh, what a learning process......

Specializes in CT ,ICU,CCU,Tele,ED,Hospice.
O.k. so let me get this straight. You get a pt. at night, send to floor with NO orders and don't take telephone orders. So WHY is the pt. in the hosptial? Do they have to wait until morning for pain meds, diet, and activity orders? Why don't you take telephone orders? That sounds insane unless I am misunderstanding you. Please enlighten me.

first i did not say we don't take any tel orders .i said we try not to take alot .ie i don't have time in my er to take 2 pages worth of tel orders on 1 pt .we take basic orders diet activity pain med nausea meds am lab work that kind of thing .what the pt will need immediately and thru the noc till am .the dr is expected to come and see the pt unless its middle of the night.so no the pt doesn't wait for anything.but some of the time the pt goes to the floor and the dr has not given us orders so the pt goes to the floor and the floor nurse calls for the orders .if the dr is oncall then thats his job regardless of what time of night it is.our ed drs donot write admit orders.

Specializes in Trauma ICU, MICU/SICU.
first i did not say we don't take any tel orders .i said we try not to take alot .ie i don't have time in my er to take 2 pages worth of tel orders on 1 pt .we take basic orders diet activity pain med nausea meds am lab work that kind of thing .what the pt will need immediately and thru the noc till am .the dr is expected to come and see the pt unless its middle of the night.so no the pt doesn't wait for anything.but some of the time the pt goes to the floor and the dr has not given us orders so the pt goes to the floor and the floor nurse calls for the orders .if the dr is oncall then thats his job regardless of what time of night it is.our ed drs donot write admit orders.

Got it, that sounds reasonable. :)

Specializes in Emergency.

In my hospital, we often recieve pts from the ed with no orders or minimum (O2, fluids, bloodwork, diet, vital signs). We usually have an order to call the MD on arrival to the floor. If it's a hospitalist, they will come to the floor to assess and write orders. If the pt is assigned to an MD who does not have an on call that is at the hospital 24-7 (usually a specialist), they will access the pts database online, and ask us for the assessment info we did. Not the best way to deal with a new pt, but it occasionally happens. I had a pt admitted like that last night. All I had were our standing orders for pneumonia. Called MD and told him what I had, He said Great, call if her condition changes, otherwise we'll see her first thing.

If your hospital requires that there be floor orders prior to leaving the ed, then yes, probably, the receiving RN was annoyed. BUT in the scheme of things, it's more of an inconvenience than anything. I would have mabye called the RN and asked if she had the orders, and if not, apologise, and try to help her get what she needs to care for the pt.

Amy

Specializes in Emergency.
Thanks for all of the input!

I'm starting to think it's a system flaw. We use MediTech, and report is typed in. Report is not called RN to RN unless we are admitting the pt to ICU. Our ER docs are very good (all attendings) and I can never tell if I'm supposed to ask/wait for orders from them, or if the doc theyre being admitted to is coming down, or what the heck is going on!

Ahhh, what a learning process......

Perhaps you could ask your preceptor if there is a way to find out if the pt will be seen on admission to the floor, or if you need to get orders written in the ed, or if there is a protocol to follow.

Amy

Specializes in ED.
That sounds like a floor nurses dream, but your ED must fill to overflowing.

It absolutely fills to the brim and we make use of our hallway beds most nights. We have to receive the orders, either by telephone or in person, we then get a bed if there is one to be had, then we have to write a faxed report, fax it to the floor, wait at least 20 minutes to give the floor time to call with questions (in theory), and then up we go. Unless its an ICU or psych patient then its a verbal report.

Specializes in ER/EHR Trainer.

Horrible! To have an ER plugged up like that for lack of orders is crazy! I can't imagine working that way! We too are overloaded and have many holds, but lack of orders would never stand in the way of moving a patient to an available bed.

Generally, our ER attendings do the million dollar workup-so all a receiving nurse needs to get (orders) is a basic outline or further testing orders. Our hospitalists and admitting docs try to see their patients in ER prior to moving upstairs and usually write orders. This is ez since the floors keep their discharges all day and claim they have no room.

We do not have a discharge policy for patients-I would like to see one implemented so that ER patients can be moved up to their rooms in a timely fashion, and we can continue to serve those very sick people in the waiting room.

So back to your original post-don't worry about it, if there was a problem you'd have heard already.

Maisy;)

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