Floor Nurses: When medicating your new admission....

[RNcDreams]

what sorts of routines/practices do you utilize to ensure that the patient isn't double dosed?

I feel like my current facility has us set up to make errors.

1. Do you get a typed or phone report from pt's from the ED?

- We send typed reports, so unless the accepting nurse looks at the ER Nursing notes, she might mistakenly give a second dose of a med if the ER nurse forgets to type it into her report; this risk is especially present when there are delays in moving the patient, and things are rushed. ER nurse may medicate patient in ER and neglect to send updated report, but will have written in on her ER nursing note.

2. How do you handle medicating these people with routine meds (Coumadin, Lipitor, etc) if you get them at a wacky hour like 2am?

-It is generally accepted that the admitted patient becomes a lower priority when held in the ER for long periods of time, because new and unstable patients must be tended to first. If the ER nurse does not give these "daily" meds that would normally be 8a/8p, how do you reconcile everything so that they are on a normal med schedule? Do you just wait and start fresh in the morning, or will you give meds in the middle of the night and then bump them all ahead based on the initial time, or what?

3. Will you throw away all unlabeled tubing when the pt arrives?

-We don't even have the appropriate tubing labels in the ER, so I'll often use a piece of tape with the date, time, and solution of when the tubing went up, for the floor RN to base hers by. Is that helpful?

4. How many of you still use the tape strip on your IV bags with the hourly markings on it?

Basically, I'm trying to get a better perspective of what floor nurses need or find helpful when accepting ER admissions.

Any thoughts are appreciated!

[not now, RN]

I always look at the ED record to see what was given no matter how busy I am. The ED only charts on the computer so everything is in the report. I ask patient or family member when the last time they took all their home meds and what the "regular" time is to take those meds, then explain that times might get changed while in the hospital. If a patient can't talk I just start them at the next appropriate time. The only meds I worry about giving right at admit are the ones that are gonna treat what's going on right then. I'm not gonna worry about routine meds like Lipitor when their BP sucks.

With tubing I try to use it and label it if they came to the ED within the last 12 hours. Normally I have to switch all the IV cannulas to connect to j-loops or add extensions or the meds all get changed and I have to low port meds appropriately so I just change it all out.

I really have no problem with patients from the ED, I know they are busy and have different priorities. Everything can be fixed/adjusted so it's not a big deal. The few things I find mildly annoying are:

1. A Pt with a central line and blood was never cleaned up. I consistently get patients with dried blood all over the peri area so I'm down their scrubbing dried blood or off their neck/shoulder.

2. An IV cannula connected directly to tubing. When the infusion stops I can't just SL the thing, I need to add on a J-loop myself.

3. A Pt that's older than time who was waiting on a gurney for a bed for God knows how long and was never turned or had their heels floated. I've admitted patient who had large deep tissue injury's on their backside and family was MAD (understandably).

But like it said, ED is busy and have a whole other set of problems to worry about.

[UM Review RN, ASN, RN]

what sorts of routines/practices do you utilize to ensure that the patient isn't double dosed?

I feel like my current facility has us set up to make errors.

1. Do you get a typed or phone report from pt's from the ED?

Our ER reports are faxed. I refer to them mainly for a general idea of what's going on with the patient, but I almost always get myself a copy of the patient's lab and test results from the computer as soon as they hit the floor (or before, if possible) so I have a good idea of what to expect. In other words, if I find that the patient came in with an Hgb of 7.0, I'll have everything ready to give blood and keep the patient from walking around.

2. How do you handle medicating these people with routine meds (Coumadin, Lipitor, etc) if you get them at a wacky hour like 2am?

It depends. If their BP is high and they haven't had any BP meds that day, I'll go ahead and give them. I always find out what the ER gave and go by that insofar as things like aspirin, pain meds, and anticoags. If it wasn't given in ER, I give it on the floor -- lovenox, coumadin, plavix, aspirin, things like that. I always wait to see the chart for the pain med times because more than once a patient has insisted that nothing was given in hours, when they just had something before being sent to us.

3. Will you throw away all unlabeled tubing when the pt arrives?

I have a theory about unlabeled tubing -- it can never be older than the patient's admission date. So yes, I use it if at all possible.

4. How many of you still use the tape strip on your IV bags with the hourly markings on it?

I do wish more of our ER nurses would use that system or at least a drip valve because I really have no idea if that empty bag of NS ran wide open for an hour or for 12 hours when it's just on a roller clamp.

[txpixiedust]

We have an E-MAR, so I click back through the last day and count the number of pills they were given for certain drugs with limits per 12/24 hours, etc. I guess we're really lucky.

Maybe you can be the nurse to make a change in your hospital and make medication administration safer (not that you're not safe, but like you said potential for problems is there) for patients. :nuke:

txpixiedust:redbeathe

[cardiacRN2006, ADN, RN]

1. do you get a typed or phone report from pt's from the ed?

phone report and we have paper charting. so i simply go through the ed's paperwork to determine the pt's last dose.

2. how do you handle medicating these people with routine meds (coumadin, lipitor, etc) if you get them at a wacky hour like 2am?

depends on the med, but usually i give them at the next scheduled time.

3. will you throw away all unlabeled tubing when the pt arrives?

you betcha. i'll put up new tubing that's properly labeled.

4. how many of you still use the tape strip on your iv bags with the hourly markings on it?

still use what??? just kidding, i know what it means and the short answer is no. i haven't seen that since 2nd semester skills lab in nursing school.

usually, everything can be found in the eds notes. i'm icu so i'd like to get the i/os, vs, and sbar and that's about it for report. i don't need to know a whole lot. oh, and i'd like to know what radiology procedures they received too...