ER nurses bringing pts to the floor soiled

SubSippi · Dec 29, 2013

At my hospital it's not patients coming up soiled but all the AC IV sites. The patients have other sites, but the AC is an easy stick to send the person up and fill the bed again. There's no way every patient has an MI or stroke behind them. No offense to the ED RNs or anything, I might even want to work there some day, but whatever is perpetrating this quick-fix, gets-the-job-done mentality needs to stop. "Oh the floor nurses have all the time in the world they'll figure a new IV out when this AC site infiltrates 30 minutes post placement."[/quote']
I hate IVs in the AC! My patients always whine about them because they start getting irritated from all the bending, they blow, AND all the beeping from occlusions! I know sometimes you can't find them any place else but...not usually.
I'm a fan of the forearm, myself...

cardiacfreak, ADN · Dec 29, 2013

I've received soiled patients from the ER too, but I have never had the nurse leave without helping me clean the patient. If the nurse starts to head towards the door I always say, "Don't forget a new gown while you're getting us the bath wipes." They always get my drift.

Having an IV in the AC is troublesome at times, I either change the site or get an arm board. After so many years in nursing I have resorted to picking my battles and an IV site is not one of them.

OCNRN63, RN · Dec 29, 2013

i can see your point but the situation begins to seem unfair when it happens alot to nurses on different units. it appears sketchy when the pt arrives to the unit with bundles of blankets as a way to confine the smell. i just dont like getting report on a patient and then they arrive with a pleasant surprise while moving them from the stretcher to a clean bed. Sometimes these pts are in the ER for hours and you can tell old poop and old urine

I frequently bundled up my patients when I worked in the ED, not to confine the smell, but because the patients were frequently very cold.

amoLucia · Dec 29, 2013

Well, it does provide the recipients a good opportunity to do an admission body check while the pt gets cleaned up. (Am being sarcastic here!)

It happens - probably as often as ICU receives pt transfers from the floor who are messy also.

Esme12, ASN, BSN, RN · Dec 29, 2013

At my hospital it's not patients coming up soiled, but all the AC IV sites. The patients have other sites, but the AC is an easy stick to send the person up and fill the bed again. There's no way every patient has an MI or stroke behind them. No offense to the ED RNs or anything, I might even want to work there some day, but whatever is perpetrating this quick-fix, gets-the-job-done mentality needs to stop. "Oh the floor nurses have all the time in the world they'll figure a new IV out when this AC site infiltrates 30 minutes post placement."

I wouldn't assume that the ED nurses do this to anger the floor nurses. The problem with IV's in the ACF....is that many of them are started in the field when the patients are cold, anxious, vaso-constricted, dehydrated and the ACF in the only place available that you can find a vein.

Once they are warm, treated and hydrated it is easier to find one. Facilities I have worked for have a policy that IV sites started in the field must be restarted once another site is obtainable. Even still....once they are hydrated and ready for the floor it is very possible that the veins have just joined the party.

In the ED's I have worked and managed....leaving a patient in their clothes is NOT allowed and disrobing is insisted upon by the EDMD's. I am curious how the EDMED performs a complete physical/assessment when the patient remains clothed.

I can partially understand that the patient may soil themselves on the way up...however...I don't think it is that often and so NO the patients should NOT arrive soiled. Period. If I was the manager I'd be finding out why this is a common occurrence. When I have a patient the soils en-route I will stay and help clean up unless a trauma is coming to the ED.

I am a lifetime ED nurse and I find that there are really no excuses for leaving patients soiled.

squatmunkie_RN · Dec 29, 2013

Happens ALL the time. We expect it as floor nurses now. I've also had transport drop the pt off in the room (while I'm with another pt) and not hook up the O2 to the wall. They literally just leave the pt... and I get tp the room and the o2 is in the 80s...pt has a cannula on their face but it's not hooked to the wall. Really???

Or confused pt's come in with all their street clothing on, the disposable sheets from EMS, the sheets from ER, plastic caps and paper from syringes all in the bed. Dirty diapers... But the ER skin assessment says "no breakdown" Um, just how the hell did you figure that one out???

squatmunkie_RN · Dec 29, 2013

I frequently bundled up my patients when I worked in the ED, not to confine the smell, but because the patients were frequently very cold.

"not to confine the smell" LOL. I never thought of that as a possibility.

ADeks · Dec 29, 2013

I do my best as an ER nurse to keep my patients clean. I do have a tech with me and together we usually keep the pt clean. So if it's a normal thing I would contact your charge and manager for them to start communicating to the ER manager that this is a problem.

For the IVs though. Sometimes it's the EMS line which in my hospital is good for 48 hours. Also a lot of patients don't want an IV and will dictate they must have a butterfly (which my hospital doesn't have) or they are really particular until they know 100% that they're staying the night. They tell us one stick only. And for the patients with chest pain/sob I always go for the one that may be used in a ct angio. I do my best to go lower and grab a forearm, but it depends on the patient.

rnmi2004 · Dec 30, 2013

The AC in the IV doesn't bother me-- there are many reasons for it as was previously mentioned. In addition to the ease of access in a dehydrated patient, plenty of admitting dx carry the possibility of a CT with contrast. Abd pain, anyone?

If you're noticing a trend in patients being brought up soiled, you may need to write it up. Do you get any kind of report from ER? You might need to start asking them to check for soiling before transport to the floor. I get that accidents happen, but you can tell if someone hasn't been checked on a while. We had a period of time where we'd get pts who had obviously been sitting in stool for a while -- as in dried & crusted to their backside -- and a few write-ups plus manager-to-manager intervention helped reduce this. It's beyond disrespectful to the patient to leave them soiled.

Cardiolyte · Dec 30, 2013

Sadly, this is normal for pt's coming in to my unit (MICU). We expect it actually. We are considered negative Nancy's if we complain to management. THEY do not want to hear it.. :no:

0.adamantite · Dec 30, 2013

I also have learned to expect that patients coming from the ED will be desperate to use the toilet. They will scramble off the stretcher and barely be able to wait for us to organize lines, get them footies, etc. There have been falls related to this, especially with the elderly who can't and won't wait for the extra staff it may need to help them from the stretcher to the bathroom. Even my younger patients will often fill up the hat in the toilet.

I wonder if this has to do with the amount of boluses or IVF they get in the ED?

SwansonRN · Dec 30, 2013

This has rarely happened to me lately and when it does I just shrug it off. They get cleaned and get the good old ICU fluff and buff as soon as they get to the unit anyway. I have only complained once and this patient came up drenched in urine. Their entire gown was soiled, they were sitting on a wet brief just opened up in front so a foley could be inserted. I totally understand that things get crazy and there are priorities, but I just think that's cruel to roll the patient around the hospital like that. Change their gown and at the very very least take the half second to pull out and throw away the old brief.