ER nurses not calling report anymore...

[plinytheRN]

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.

[SionainnRN]

Do you get any type of report from the triage nurse orprevious shift? When patients arrive via ambulance do you receive any type of report from the paramedics?

Yes but it's usually one sentence and a set of vitals, the rest we figure out on our own. I'm amazed at how much detail the floor wants from us: not just they have an IV but where it is, their last poop, floor diet orders, etc. it's maddening sometimes.

[plinytheRN]

Appreciate all the posts, eye opening definitely. What it all comes down to was what is best for patient care, and the rationale for implementing this system? After reading through all this, it's hard to have a concrete answer when we all come from different situations, laws, states, and hospital systems. So yes, there is a lot of variety and something that may not be a big deal one place is against policy at another. My main frustration is the lack of time to prepare, we are slammed all the time and I am lucky if I can take the time to navigate through the chart, which in some cases the H and P isn't even put in yet. Not super helpful. But with enough warning and time, it's ok. Our ED gives meds and doesn't document in the MAR, that is a detail they would give in report. It seems like so many things can get missed. Also like someone mentioned, sure I can call with questions but chances are there isn't a whole lot of time to try and find the person that sent up the patient. Just have to figure it out as it goes I guess. As far as IVs go, I start them very frequently, it's not a matter of not being able to do it it's a matter of having fluids and IV Abx due, not having access if this patient codes and the time constraints of starting an IV sometimes.

[SionainnRN]

Appreciate all the posts eye opening definitely. What it all comes down to was what is best for patient care, and the rationale for implementing this system? After reading through all this, it's hard to have a concrete answer when we all come from different situations, laws, states, and hospital systems. So yes, there is a lot of variety and something that may not be a big deal one place is against policy at another. My main frustration is the lack of time to prepare, we are slammed all the time and I am lucky if I can take the time to navigate through the chart, which in some cases the H and P isn't even put in yet. Not super helpful. But with enough warning and time, it's ok. Our ED gives meds and doesn't document in the MAR, that is a detail they would give in report. It seems like so many things can get missed. Also like someone mentioned, sure I can call with questions but chances are there isn't a whole lot of time to try and find the person that sent up the patient. Just have to figure it out as it goes I guess. As far as IVs go, I start them very frequently, it's not a matter of not being able to do it it's a matter of having fluids and IV Abx due, not having access if this patient codes and the time constraints of starting an IV sometimes.[/quote']

In the ER we never see a H&P yet we're able to treat the pt. and how is it possible for a nurse to medicate a pt and not chart it?? It would show up as an overdue med.

[MunoRN, RN]

In the ER we never see a H&P yet we're able to treat the pt. and how is it possible for a nurse to medicate a pt and not chart it?? It would show up as an overdue med.

In every ED I've worked in, meds to be given aren't entered into the EMR by Pharmacy, and more importantly, none of the ED's I've worked in used the same EMR as the inpatient EMR, so floor Nurses didn't have access to any ED charting typically until 8-24 hours after the patient left the ED.

[MunoRN, RN]

Yes but it's usually one sentence and a set of vitals, the rest we figure out on our own. I'm amazed at how much detail the floor wants from us: not just they have an IV but where it is, their last poop, floor diet orders, etc. it's maddening sometimes.

These seems to be a frequent argument for why the receiving RN should expect much information: "I didn't start out with this patient with much information, so why should you?

It should be sort of obvious that we do a better job when the plan of care and patient information progresses from one caregiver as opposed to just starting over every 8 hours.

Continuing with that rationale, there's no reason why any information should need to be accessible in the chart or EMR, it just needs to be a place to enter information, not to access it.

[jmll1765, ASN, RN]

Wow, this has kinda turned into an ER vs Med-Surg thread! I'd like to add my two cents. Anytime there is a change in procedure there is usually a period of dissent among the staff before it's finally accepted. A verbal report from the ER doesn't have to take more than a couple of minutes. Even if I don't have time to do the admission, I can at least take report, get the pt to the floor, and give them the once over, as long as they are stable I can finish what I was doing and then go back to my new admission. I have 12 hours to get the admission questions done and if I don't have time, well there's another shift at 7am. While I'm receiving report, I'm also looking through the chart, checking labs, ect...if I have a question I'll ask the ER nurse. Having a verbal report forces the floor nurse to stop and take report..to actually look at the chart before the pt comes to the floor. Our handoff process has had some issues but for the most part goes pretty smoothly. We try to take report in a timely manner but sometimes a delay can't be avoided. If that's the case and the ER desperately needs to clear the room, we'll have the supervisor take report for us. I like the idea of cross training..the whole "walk a mile in each others shoes"..None of the ER nurses where I work have ever worked the floor and none of our floor nurses have ever worked the ER except when we get floated. I have a healthy appreciation for what ER nurses do and I would hope that ER nurses have the same for floor nurses.

[CodeteamB]

In every ED I've worked in, meds to be given aren't entered into the EMR by Pharmacy, and more importantly, none of the ED's I've worked in used the same EMR as the inpatient EMR, so floor Nurses didn't have access to any ED charting typically until 8-24 hours after the patient left the ED.

Sounds like the ERs you have worked in are vastly behind the times. Our records are the same in the ER as in the rest of the hospital and the MAR certainly carries over. Reading the OP again, I really think this is a hospital systems issue.

In my ER a patient gets admitted and a bed request goes to admitting. The admitting supervisor receives the request and finds an appropriate bed, she then informs the unit of the name, demographics and diagnosis of the patient. Once the bed is empty and clean the unit clerk/charge informs bed control who allocate the bed. Hopefully by this time I have entered report in our system so all that is required is a quick phone call. It works really well.

If, on the other hand we were just turfing patients willy-nilly upstairs with no notice for the unit it would not work well; however, this isn't a matter of ER vs Floor. Hospital admin needs to get their act together, whether it be joining the 21st century with their charting system or sorting out the bed control policy. Written report can be done safely!

[Esme12, ASN, BSN, RN]

just for the sake of argument...I have worked at very "current" facilities who have accidentally bought systems that don't talk to each other......grant it that is a mistake but it doesn't mean that they are behind the times.

[Altra, BSN, RN]

Muno has spoken before about systems issues where s/he works -- such as all orders entered in the ED being cancelled once the patient is admitted. Regardless of whether the systems were purchased last week or in the last decade -- those are some pretty big flaws.

[MunoRN, RN]

Sounds like the ERs you have worked in are vastly behind the times. Our records are the same in the ER as in the rest of the hospital and the MAR certainly carries over. Reading the OP again, I really think this is a hospital systems issue.

It's actually pretty common and there are some posts in this thread that refer to the same problem. Regardless, I think you're confusing how things should be with how they actually are, and it's how things actually are that determine the safety issues that affect patients. This is just one of many examples where systems aren't perfect, making some sort of verbal component to report all the more important.

In my ER a patient gets admitted and a bed request goes to admitting. The admitting supervisor receives the request and finds an appropriate bed, she then informs the unit of the name, demographics and diagnosis of the patient. Once the bed is empty and clean the unit clerk/charge informs bed control who allocate the bed. Hopefully by this time I have entered report in our system so all that is required is a quick phone call. It works really well.

So your report does have a verbal component?

Written report can be done safely!

There's a lot of evidence that it can't be done as safely as including a verbal component to report. Do not believe the evidence? Find it to be insignificant? What sort of adverse events are required to buy 3 minutes of your time?

[MunoRN, RN]

Muno has spoken before about systems issues where s/he works -- such as all orders entered in the ED being cancelled once the patient is admitted. Regardless of whether the systems were purchased last week or in the last decade -- those are some pretty big flaws.

That's actually a Department of Health requirement; Orders must be re-addressed when a patient moves to another level of care which means all previous orders are D/C'd when new orders are written or when the patient transfers to a different level of care.

For instance; if the patient was receiving dilaudid in the ER, and they come to me on the floor or ICU, I can't keep giving dilaudid without a new order. That's true in every hospital in my state.

[Altra, BSN, RN]

Then it is a quirk of your state DOH regs and doesn't add much to a discussion among nurses ranging all over the US and beyond. Nonsensical when you think about it. "Different level of care" ... so the ICU patient's order for Lipitor, prescribed because he's been on it for a decade and unrelated to the ICU critical illness that resulted in admission ... needs to be reordered when that patient has sufficiently recovered to be moved out of the ICU to the floor? Wasteful.

I'm not seeing where the Dilaudid example has much validity -- surely working in the ER you agree that pain med orders in the ER are overwhelmingly one time dose orders.