faxing report to the floors

ArwenEvenstar · Aug 2, 2008

I'm not a ER nurse, I'm the floor nurse. Your post caught my eye, because before I left the hospital several years ago, they had switched to the faxing of report. Just about all the floor nurses did not like it. Yes, "ripping the ER apart" about it like you said in your post. (Sorry!) I left the hospital a few weeks later so I'm not sure how it all was worked out...

My :twocents: . Basically, with a faxed report, there is just a lack of communication in general. With a phone report, you can ask questions and have back and forth discussion. Issues could be clarified. This is totally absent when report is faxed. I did not feel like I was getting a real "picture" of the patient with the faxed report. With a phone report, I felt like I did....

There are also things you just don't want to put in writing. Like, are you going to write in the fax report "this patient is a frequent flyer, with a history of drug seeking behavior, and is a real whiner/complainer!" Not likely!!!! Yet, in a phone report you'd be more likely to casually mention this or hint at it, to give the floor nurse a heads up...

Also....another issue at my hospital: the ER was faxing the report literally seconds before they transferred the patient. And the charge nurse on the floor may not have even had a chance to let the nurse know she was getting a admit from ER. So, sometimes the FIRST the floor nurse knew about it was when the patient rolled into the actual room!! (To an ER nurse this may seem normal...in ER patients just walk through the door and you have no idea what you are dealing with. But, floor nurses, please remember, are NOT used to that at all!! We are used to KNOWING what is arriving and when.) More time was needed between the fax and transfer... This did not happen with phone report for whatever reason.

Hope my :twocents: was helpful or maybe it was just worth two cents....

I am curious how my old hospital worked things out...

Nacki, MSN, NP · Aug 2, 2008

At my facility we have to fax report and then call to go over it. What a waste of time. The floor refuses report if the faxed copy is not at their nurses station when we call.

Altra, BSN, RN · Aug 2, 2008

We fax our actual nursing documentation. It's all there - meds given, vital signs, etc.

OP, can you get the floor nurses to tell you exactly what they feel is lacking? Should be simple enough to simply modify the format of the faxed report.

chicagobsn · Aug 2, 2008

At my hospital we do fax report, with an SBAR sheet. This is a page of hx, meds given in ER, med rec sheet, cc, and diagnosis, what room, the time report was sent and time pt will arrive, current vs, heart rhythm, a basic assessment of the pt, who the accepting md is etc etc. There is a ton of info on this paper. After I fax it, I call the floor to let them know I faxed it and a heads up on when the pt is coming.

To address the earlier comment...when we are slammed in the ER...and a pt is stable and ready to go...the nurses get pushed by the charge nurse and the docs to get the pt out of the room and up to the floor asap. Sometimes its literally like having a nagging mom on your a$$ to get the pt upstairs. I do understand floor nurses are used to knowing ahead of time what and who they are getting...and believe me I try to give some time before I fax report to time of transfer...but if there are 4 ems on the way and a waiting room full of ppl ...that stable pt has to go up asap! And Im guilty of faxing report, and 10 minutes later getting the pt upstairs. Its never done to frustrate other nurses...its to open up another room so we can get another pt in that needs to be seen asap, ie CP.

I fill out the report sheet completely and even put side notes on it for the nurses upstairs. But I know other nurses do not do the same...which gives other nurses a bad rep in the ER.

just my :twocents:

ArwenEvenstar · Aug 2, 2008

..... after i fax it, i call the floor to let them know i faxed it and a heads up on when the pt is coming.
this is a great thing to do! and would have helped a great deal with communication. too often the floor nurse getting the admit was the last to know. so...thanks for doing this!!
to address the earlier comment...when we are slammed in the er...and a pt is stable and ready to go...the nurses get pushed by the charge nurse and the docs to get the pt out of the room and up to the floor asap. sometimes its literally like having a nagging mom on your a$$ to get the pt upstairs. i do understand floor nurses are used to knowing ahead of time what and who they are getting...and believe me i try to give some time before i fax report to time of transfer...but if there are 4 ems on the way and a waiting room full of ppl ...that stable pt has to go up asap! and im guilty of faxing report, and 10 minutes later getting the pt upstairs. its never done to frustrate other nurses...its to open up another room so we can get another pt in that needs to be seen asap, ie cp.
yes, there are two sides to every story! :)
we also need a heads up to make sure the room is ready. i had to send er patients back to the er before, because the room was still dirty from the last patient and housekeeping had not cleaned it yet. but this was some other type of communication issue -with housekeeping and the room being reported as "ready" when it was not...
i fill out the report sheet completely and even put side notes on it for the nurses upstairs. but i know other nurses do not do the same...which gives other nurses a bad rep in the er.
again, it sounds like you give er nurses a good name! some of the faxed reports were pathetic - just bare basics, things left blank, and didn't really tell you much of anything...

nerdtonurse?, BSN, RN · Aug 2, 2008

We fax at our facility, and a lot of our reaction depends on who's sending the patient, not how we get the data. If I see one nurses's name on a pt coming in from a NH, then I know "skin warm dry and intact" means just that -- no breakdown. If I see another nurses' name, I know "skin warm dry and intact" means "I didn't look." I've literally had a patient come up to the floor with their back and sacrum so bad my charge thought the patient had been a victim of a chemical spill/burn, but the fax said "skin warm dry and intact" -- not when it's peeling off in sheets it's not...

Honestly, I'd rather have a fax with a 30 second "is there anything else?" phone call, but the floors are "strongly discouraged" from any other communication with the ER.

Altra, BSN, RN · Aug 2, 2008

I truly want there to be good rapport between the ER and the floors.

I just can't figure out why this is such an issue. A typical scenario when I get to work is ... see that there are 4 patients I'm assigned to in beds 8 - 12. Behind curtain of #8 is the nurse I'm relieving. Tracking board says Jane Doe, 78, SOB. Judging by the sounds emanating from there, I can surmise that a foley is being inserted. This tells me that Jane Doe is probably a CHFer. I can already anticipate her course of treatment in the ER.

Bed #9 is a middle-aged female who is completely dressed, looking out into the hallway like she's anticipating something, and her husband is pacing. That's a discharge. As soon as I can, I'll see if her discharge instructions have been generated yet.

Bed #10 is a young-ish intubated male. A glance (from a distance) tells me that he's in a normal sinus rhythm and breathing spontaneously over the vent, BP is acceptable for someone on a Diprivan gtt, and he's not moving so he is sufficiently sedated for now. Most likely an overdose. Appears stable. Two tearful female family members at bedside.

Bed #11 is a middle-aged female. She's got a c-collar on and the backboard that she came in on is still leaning against the wall. The remnants of a suture tray are on the table next to her and her L leg is dressed & Ace-wrapped from the ankle to the knee. It's either a bad fall or an MVA. If her radiologic studies clear her c-spine, she'll most likely go home.

Bed #12 is a young adult female moaning, "It HURTS!" while clutching her abdomen. Since we try really hard not to birth babies in the ER, I can guess that she's here with abdominal pain unrelated to L&D. :chuckle I can see a saline lock, so she's probably already been medicated but needs medicated again. I'll need to find out whether we're CT-ing her, pelvicizing her, filling her bladder for an ultrasound, or whatever else. I hope she's already given a urine specimen.

And here's the triage nurse walking back a young adult male to hallway bed 12. She tells the patient she'll get a CXR ordered. This is probably a nonfebrile productive cough.

My point is ... before I even see the nurse I'm relieving I already have a plan of action. My "report" time with her for these 5 patients lasts about 3 minutes, 1 minute of which is discussing the outcome of a patient from the previous day.

I just have a hard time with all the drama associated with transferring a patient to the floor. As an experienced floor nurse, I am confident that if I communicate to you "Jane Doe, 78, CHF, Lasix 80mg given, no infiltrate on CXR, Foley has put out 400mL so far, last VS are 154/84, 88, 22, 92% on 4L of O2" ... you'll have what you need to know to hit the ground running. I have absolutely no problem calling you to give you a heads up about something unusual (i.e., both current & ex-husband are present, pt. currently contemplating DNR, etc.) but please tell me so that I understand ... what else do you need to know that you're not going to ask yourself as part of your admission assessment??

nerdtonurse?, BSN, RN · Aug 4, 2008

The charge nurse will often use the fax to determine which nurse gets which admit, especially if we're being slammed and everyone's got a high patient load. We've also got 4 brand new outta school nurses. Now, if we get a fax that says the pt is coming in for pneumonia, but uncomplicated other than that, it can go to the "newbie." If they actually are a pneumonia with a stage 4 decube the size of a cantelope, CHF with ejection fraction of 12%, COPD, on 100% rebreather, Sats in the 88-89% range, FSBS routinely over 350, D-Dimer 7.16...that's not so good for a newbie -- and don't think that's an exaggeration, I had that very patient about a month ago -- we ended up airlifting my nice "stable pneumonia" pt out with a PE. We heard back that she coded and passed. I wouldn't have wanted her when I was 1 week off of orientation with a full load of other patients...

If we're all pulling a heavy load, but Nurse "A" has more walkie talkies (or at least ones that can call for help if they're non-tele), and charge gets report that we've got a train wreck coming in, that's fine, we know that nurse A can handle the load. If Nurse "B" has 5 train wrecks and is expecting a walkie-talkie, they don't need a 6th train wreck.

ernurse1993 · Aug 4, 2008

Thanks for the replies. We do have a meeting scheduled for the end of the week with all the departments involved. Right now we have the pt's c/c, initial assessment, meds given, last set of vitals,monitor rhythm, code status, infection control issues, admitting Dr and dx, We still give phone reports on the complicated pt's and pt's going to ICU & CVU. There is also an area to free text any pending tests, surgery, or special needs. Hopefully we can work it out. Because it saves us 20-30 minutes of phone tag trying to call the floors and find a nurse willing to take report.

ACRN06 · Aug 5, 2008

I've been a floor nurse for 2.5 years now. I never did like the faxed report.

The problems

1. Like someone already pointed out, the floor nurse is sometimes the last to know about the admit until the patient is rolling into the room. You give the "*****!" stare, go to the fax machine, and lo and behold. Report. *sigh*

2. The "report" that is faxed is about as helpful as a kardex. Sure it tells you the basic info. It even has the last round of VS and other info. But its just different.

It would be like a floor nurse coming on to shift and having a written report on her patients instead of verbally passing it on.

Everyone has their little bits of information they like to know about a patient to feel ready to take on the care for them.

HOWEVER

On the flip side, I really do understand why the ER's are wanting to switch to this method. Its convinient, its easier, is quicker.

I've seen nurses put off taking report from ER... sure they've got stuff to do, but if you think that you can wait til everything slows down to take report, you're never gonna take it! I think its safe to say the ER is pretty dang busy too!

I also feel for the ER nurses who have to give report to a floor nurse who expects a 5-star-thourough-complete-down to the patients freakin eye color and room temperature preference!

Ok...exaggeration. But I just don't expect the ER to do a full skin assessment on the NH patient in for dehydration. I'm not saying they don't do one, but thats something that you can figure out when the patient gets up to the floor. I hear nurses up on the floors taking report and asking all sorts of questions that I'm just like "really? do you really need to know that NOW? aren't you going to assess the patient yourself??"

Blah. Ok I'm ranting. I'm just ready to get off the floors.

I guess my main point is, I understand why they want this system to work. But theres just no way in heck you're gonna be able to develop a system that'll please everyone.

Nurses don't like change when it comes to the way things are run in the hospital. We each have our own ways, systems, habits that are our "control" in the equation of the chaos we face.

When our control group is thrown off, our system is thrown off... our tried and true gets-us-thru-the-shift system...

So we get mad.

I personally need some change. Hence why I'm getting off the floors. They've served me well... I've built a great foundation, I need to change it up----

Hope any of the above made a lick of sense :icon_roll

AC

FERN-tastic · Aug 5, 2008

We fax report to the floors, along with the med rec form now (which I don't understand because it's filled out by the RN and not signed by an MD). I also fax the orders for the patient.

In theory it seems like a time saver, but it never is. The floor never gets the fax, and even if they do I end up giving a phone report anyway because the report form never seems to have the info the floor nurses want. I actually much prefer to send pt's to the unit because it's a phone report with none of the phone/fax tag we play with the floors.