ER nurses not calling report anymore...

Nurses Safety

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Hey all, our hospital started a new policy where the ER nurses don't have to call report on the patients coming to our floor- they can choose if they want to call report. Most don't call report. It is up to us to find this patient and research all about them before they get to the floor, hopefully. Most of the time, they show up before we know they are coming. It is very frustrating and unsafe, we don't know anything about what we are walking into. I work on a medical telemetry unit, with usually 5-6 pts per nurse, it's hectic and busy no time to be clicking through a computer on a new admit. From what I understand this is a trial to test out this new policy, I am hoping it doesn't last. It seems the only one that benefits from this new policy are the ER nurses, it's definitely not ideal or safe for the patients... Anyone experienced this sort of thing? Thoughts? Thanks.

What they meant by inappropriate admit was one that should have been on a different unit. For example a pt admitted to a med floor and was on a levo drip.

One night ER didn't mark in the meds given and meds ordered section in their chart that a pt was on a pitocin drip following a fetal loss. This pt lost her baby at 24-26 weeks. On pitocin due to bleeding. There was no phoned report. Pt is septic. Upon getting notification that the pt was coming labs were checked and the pt had a critical WBC >30. ABX started No blood cultures done.

Upon arrival to the unit RRT activated immediately. BP in the toilet, pt pale, lips white. This pt should have been in the ICU not on a med surg tele unit. Preferably on OB , but her BP would necessitate a RRT call anyway. We have had pt come up non responsive intubated and immediately sent to ICU.

I am still shocked that DNV (we do not use JCAHO) allows this for handoff.

I'm curious to know if that's with the OP meant. Sometimes nurses at my hospital complain that the patient isn't sick enough for their floor.

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Specializes in PCCN.
What do you mean by "inappropriate admission?"

I mean they should be in the icu. the nurse that gets stuck with them ends up 1:1 them practically, and either the remaining nurses have to pick up the rest of her load, or he/she literally gives her other pts 5 minutes face time for the whole shift. Usually this includes no lunch for that nurse either. happens too often.

also have noticed a lot more psych pts being brought up- restraints and all, and no mention of it anywhere in the chart which we are expected to read before they come up. Something stupid like- came in for cough. makes you wonder if they even gave you the right pt sometimes, which means more researching into the chart. I dont have time for that stuff- I've got other sick pts to take care of.:banghead:

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Specializes in Critical care, tele, Medical-Surgical.

This is so very disturbing to me. Placing critically ill patiens on med-surg and not implementing hand off (report0 is literally a crime. It must stop. I would (and have) reported to the CMS and the Joint Commission. Please report this. It can be anonymous. The CMS will not reveal who made the report, but it is best to give a contact number. have the date, time, unit, and room number or patient name. It is not a violation of HIPAA to report to a regulatory agency.

You should also report to the agency that licenses hospitals in your state.

Here are the federal contacts for reporting a hospital: [COLOR=#003366]CMS Regional Offices - Centers for Medicare & Medicaid Services

How to report to the Joint Commission: [COLOR=#003366]http://www.jointcommission.org/about...s.aspx?faq#296

Hand off requirements: [COLOR=#003366]http://www.jointcommission.org/cente...hcare_tst_hoc/

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I mean they should be in the icu. the nurse that gets stuck with them ends up 1:1 them practically, and either the remaining nurses have to pick up the rest of her load, or he/she literally gives her other pts 5 minutes face time for the whole shift. Usually this includes no lunch for that nurse either. happens too often.

also have noticed a lot more psych pts being brought up- restraints and all, and no mention of it anywhere in the chart which we are expected to read before they come up. Something stupid like- came in for cough. makes you wonder if they even gave you the right pt sometimes, which means more researching into the chart. I dont have time for that stuff- I've got other sick pts to take care of.:banghead:

I agree that this shouldn't happen.

Someone said that they believe that they don't get report anymore because they ask too many questions. Appropriate questions are fine and necessary. But what happens almost every time I give report where I work is the nurses will ask things like who the admitting physician is, if they have a certain consult, if they have an IV (really? I just told them that I gave IV antibiotics!), including the gauge and location. These things and others are all supposed to be gotten from the chart and keep us on the phone when we have other patients to care for. They are asking US these questions in order to pre-chart on the patient and save themselves some time. Meanwhile, my other patients have to wait so that the floor nurse can save time.

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Specializes in PCCN.
Someone said that they believe that they don't get report anymore because they ask too many questions

That was me. I know I dont ask that many questions, or inappropriate questions. I just want to know history that would be related to their dx. I want to know what their rhythm is. Did anyone bother to chart it? No. Or it will be NSR, and they are in RapidAFib when they come up. Now I have to figure out- were they in af prior, are they PAF? Is this new? B/p is 90/60 - is this new? are they sx?or is it their baseline. The worst ones are the severe CHF who end up on bipap( which we don't do on our floor) I'd expect that the nurse may have actually talked to the pt before they came up to possibly know this. Alot of times a nurse may come up with the pt, but "they were only transporting; they dont know the pt's hx" Prior to the new way of doing things, we would be able to call supervisor and get pt directed to the appropriate floor. Now we cant do that . We have to stabilize them , then get them to icu.I always think then why bother having an ed- just send em all up.They want pts in a bed asap so they can get more pts thru the door.I guess every second a bed is unoccupied is a loss of revenue.

Btw, I am on an IMC/PCU floor, not med/surg.But there are a lot of times lately we get the pts from the med/surg who should have never gone there in the first place either.

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Specializes in Critical Care.
I agree that this shouldn't happen.

Someone said that they believe that they don't get report anymore because they ask too many questions. Appropriate questions are fine and necessary. But what happens almost every time I give report where I work is the nurses will ask things like who the admitting physician is, if they have a certain consult, if they have an IV (really? I just told them that I gave IV antibiotics!), including the gauge and location. These things and others are all supposed to be gotten from the chart and keep us on the phone when we have other patients to care for. They are asking US these questions in order to pre-chart on the patient and save themselves some time. Meanwhile, my other patients have to wait so that the floor nurse can save time.

I also get annoyed by the "where is there IV?" question, (it's the brightly colored thing taped to their arm), but I wouldn't consider that anywhere near enough reason to avoid a verbal report at all. You've got other patients, but the patient you're giving report on is also one of your patients.

The question of what consults have already been arranged is an important one, since MD to MD consults are rarely documented anywhere. The majority of patients that come up from the ER in the 2 main ER's I've worked at go up with 'temporary' orders written by the ER doc, or without orders at all (the admitting Doc will write orders on the floor), so it's also very important to know who the admitting Doc is. It can be very frustrating, and potentially dangerous to have a patient come up with no idea who is supposed to be writing orders on them.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I know the floors are stressed but as a supervisor I found them filling out admission paper work while getting report from the ED....never a good practice.

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Specializes in Critical care, tele, Medical-Surgical.
I know the floors are stressed but as a supervisor I found them filling out admission paper work while getting report from the ED....never a good practice.
NEVER a good practice.

I'm pretty sure you made sure to let them know.

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That was me. I know I dont ask that many questions, or inappropriate questions. I just want to know history that would be related to their dx. I want to know what their rhythm is. Did anyone bother to chart it? No. Or it will be NSR, and they are in RapidAFib when they come up. Now I have to figure out- were they in af prior, are they PAF? Is this new? B/p is 90/60 - is this new? are they sx?or is it their baseline. The worst ones are the severe CHF who end up on bipap( which we don't do on our floor) I'd expect that the nurse may have actually talked to the pt before they came up to possibly know this. Alot of times a nurse may come up with the pt, but "they were only transporting; they dont know the pt's hx" Prior to the new way of doing things, we would be able to call supervisor and get pt directed to the appropriate floor. Now we cant do that . We have to stabilize them , then get them to icu.I always think then why bother having an ed- just send em all up.They want pts in a bed asap so they can get more pts thru the door.I guess every second a bed is unoccupied is a loss of revenue.

Btw, I am on an IMC/PCU floor, not med/surg.But there are a lot of times lately we get the pts from the med/surg who should have never gone there in the first place either.

Yeah, this kind of stuff shouldn't happen and it blows me away that it does. I guess I don't know for certain that it doesn't happen where I work but I can't imagine any of the nurses where I work doing this, or that the ER docs wouldn't address something like rapid a-fib before going to the floor.

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I also get annoyed by the "where is there IV?" question, (it's the brightly colored thing taped to their arm), but I wouldn't consider that anywhere near enough reason to avoid a verbal report at all. You've got other patients, but the patient you're giving report on is also one of your patients.

The question of what consults have already been arranged is an important one, since MD to MD consults are rarely documented anywhere. The majority of patients that come up from the ER in the 2 main ER's I've worked at go up with 'temporary' orders written by the ER doc, or without orders at all (the admitting Doc will write orders on the floor), so it's also very important to know who the admitting Doc is. It can be very frustrating, and potentially dangerous to have a patient come up with no idea who is supposed to be writing orders on them.

It's not that I don't think that knowing the admitting and consulting physicians is important, but both of those pieces of information are on the computer printed admission order that comes up with the chart, and I put it right on the top of the rest of the copied ER chart. If it's something that's not in the chart, then by all means ask, but it's frustrating to have my time taken up with questions that have answers readily available.

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I forgot to mention that asking if my patient has an IV is particularly annoying given that it's our policy not to admit a patient without one. I have never sent a patient to the floor without an IV, even if the only access I could get was a 24 gauge in a knuckle. This is another one that amazes me when I see others post that they get patients without an IV. How does that work when the vast majority of patients get some sort of IV medication in the ER? I just don't get how that happens.

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Specializes in Pediatric/Adolescent, Med-Surg.
I forgot to mention that asking if my patient has an IV is particularly annoying given that it's our policy not to admit a patient without one. I have never sent a patient to the floor without an IV even if the only access I could get was a 24 gauge in a knuckle. This is another one that amazes me when I see others post that they get patients without an IV. How does that work when the vast majority of patients get some sort of IV medication in the ER? I just don't get how that happens.[/quote']

I have on very rare occasion sent a pt upstairs without a line, if the pt refused. It was documented and communicated to floor nurse. And of course I tried to reason with the pt

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