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.

[Altra, BSN, RN]

Yep, within the same facility.

From the JC requirement:"Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. This reconciliation

is done to avoid medication errors such as omissions, duplications, dosing errors,

or drug interactions. It should be done at every transition of care in which new

medications are ordered or existing orders are rewritten. Transitions in care

include changes in setting, service, practitioner, or level of care.

From the CMS requirement:"The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. "

If ya'll want to do that with every location change of your patients, knock yourselves out.

No facility where I have worked, nor any individual provider, has interpreted "performing med reconciliation" with DISCONTINUING AND REORDERING the same ongoing maintenance meds. But if you like the extra keystrokes ... feel free.

[MunoRN, RN]

If ya'll want to do that with every location change of your patients, knock yourselves out.

No facility where I have worked, nor any individual provider, has interpreted "performing med reconciliation" with DISCONTINUING AND REORDERING the same ongoing maintenance meds. But if you like the extra keystrokes ... feel free.

Transfer med rec requires all current meds to be addressed, there are no interpretations that separate "maintenance meds" from other meds.

[Altra, BSN, RN]

Are you really parsing my every single sentence for the sake of argument? A few pages back ... you spent an entire post dissecting the semantics of a JC "citation" --- you didn't like my use of the term. And now, you appear to be attempting to enlighten me that the phrase "maintenance med" is not included in the definition of med rec.

Thank you, but that will not be required.

Perhaps I need to be more clear. Satisfying the regulatory requirements for med rec does not need to include "physically" (do I need to explain what I mean here?) discontinuing and reordering meds that are continuing to be administered, just because the patient is in a med-surg unit on day 1, moved to a tele unit on day 2, and then moved to the ICU on day 3.

[MunoRN, RN]

Are you really parsing my every single sentence for the sake of argument? A few pages back ... you spent an entire post dissecting the semantics of a JC "citation" --- you didn't like my use of the term. And now, you appear to be attempting to enlighten me that the phrase "maintenance med" is not included in the definition of med rec.

Thank you, but that will not be required.

Perhaps I need to be more clear. Satisfying the regulatory requirements for med rec does not need to include "physically" (do I need to explain what I mean here?) discontinuing and reordering meds that are continuing to be administered, just because the patient is in a med-surg unit on day 1, moved to a tele unit on day 2, and then moved to the ICU on day 3.

It does actually. If you don't take CMS funds however you would be exempt.

[Altra, BSN, RN]

I have not worked anywhere that did not participate in Medicare/Medicaid, so you can take that out of the equation.

Oh wait -- do I need to clarify further and explicitly state "not exempt"?

[MunoRN, RN]

All orders must be "rewritten", is the term that is used, so effectively orders that are not written on transfer aren't continued.

This discussion seems to be limited a total of 2 views, maybe another thread would help determine how often this is actually done.

[Altra, BSN, RN]

All orders must be "rewritten", is the term that is used, so effectively orders that are not written on transfer aren't continued.

This discussion seems to be limited a total of 2 views, maybe another thread would help determine how often this is actually done.

This has no basis in reality where I work.

All orders do not need to be and are not "rewritten".

All orders present at Time X when patient is in one location are not automatically cancelled when patient moves to location #2.

I picked a "maintenance med" (are we OK to be using this term now that I explained what I mean?) to illustrate what I thought would be the most obvious demonstration of why this would not be required.

To give another explicit example: Patient X initially comes into the ER in respiratory distress and is intubated. Initial orders written by the ER might include a Propofol gtt for sedation. In your world ... the propofol gtt would be discontinued and (unless another sedative agent is preferred) reordered --- same med, same dose, route, reason for giving, etc. I accept at face value that this silliness exists where you work.

Same thing with Patient X's Lipitor. Highly unlikely that *Lipitor* really has anything to do with his admission to an acute care hospital. But it will get ordered, because it's something he takes as a maintenance med. If, throughout the course of his hospital stay, Patient X's condition worsens/stabilizes/improves and he bounces between a few different units -- his order for Lipitor 20mg will remain.

[SionainnRN]

The inpatient orders are written in the ER by the inpatient physician, and the ER nurses are responsible for carrying them out until transfer of care is achieved. It is likely at my place of work that by the time the patient makes it upstairs the inpatient orders have all been completed or started.

Other than making sure abx are started we don't do any inpatient orders. We only do stat ER orders because that's all we have time to do. If the pt is a hold cause the house is full that's a different story.

[Catzilla]

This has no basis in reality where I work.

All orders do not need to be and are not "rewritten".

All orders present at Time X when patient is in one location are not automatically cancelled when patient moves to location #2.

I picked a "maintenance med" (are we OK to be using this term now that I explained what I mean?) to illustrate what I thought would be the most obvious demonstration of why this would not be required.

To give another explicit example: Patient X initially comes into the ER in respiratory distress and is intubated. Initial orders written by the ER might include a Propofol gtt for sedation. In your world ... the propofol gtt would be discontinued and (unless another sedative agent is preferred) reordered --- same med, same dose, route, reason for giving, etc. I accept at face value that this silliness exists where you work.

Same thing with Patient X's Lipitor. Highly unlikely that *Lipitor* really has anything to do with his admission to an acute care hospital. But it will get ordered, because it's something he takes as a maintenance med. If, throughout the course of his hospital stay, Patient X's condition worsens/stabilizes/improves and he bounces between a few different units -- his order for Lipitor 20mg will remain.

I see the validity of med Rec being completed with each transfer- within the same hospital. Med Rec will hopefully stop an anxious (non-vented) pt from getting that propofol infusion on the floor. Sound ridiculous? It could happen! The patient who comes in through the ED to ICU to step-down to general m/s is an evolving patient. The patient that comes in with vague sx/general malaise- whose home list of meds included the seemingly innocuous Lipitor- may be later found to have rhabdo. Now, maybe this wasn't identified in the ER- pt transfers to ICU- gets tx- md writes "transfer to floor with home meds". Boom. Back on the stupid Lipitor. Again, Med Rec prevents these kind of crazy scenarios from becoming real life crapsasters.

[nrsang97, BSN, RN]

We have to complete med rec upon admit, transfer back from OR/ procedure, a different level of care, and discharge.

will hopefully stop an anxious (non-vented) pt from getting that propofol infusion on the floor. Sound ridiculous? It could happen!

Only if the nurse is as stupid as Michael Jackson and his cardiologist.

Your seriously suggesting that nurses might use propofol drips for anxiolysis?

I hope I'm never within 10 miles of your hospital.

[plinytheRN]

Just a scary update on this situation, ER sent up a patient with no report. They came in for hyperglycemia in addition to something else (not my patient). They came at a time when the BG didn't have to be checked, but the receiving nurse knew better, and assessment tipped her off, and found them to have a BG of 27. no insulin was charted, there was no way to know what they had been given except to call and ask, which isn't going to happen when you are dealing with a BG of 27... Frequently the ER does not chart meds they have given. Not to mention a sticky situation that happened the other night when a pt was sent up at shift change, no one knew they were there (not sure all the details) and they coded and died. Scary stuff. Such a lack of communication and patient care suffers.