Completely innaccurate report!

[Rocknurse]

You're not going to believe what happened to me tonight! As soon as I walk in the door tonight I am told that I have to take report on a new admit from PACU. I take the report and am told that this is a gentleman who went for a hernia repair, and when they opened him up he was riddled with cancer and so they just did an open and close case. I write down all the info and accept the patient. I'm running around trying to care for 2 post op patients and the APRN and doc have the chart so I can't read a history or op notes. I photocopy the orders to work with them and eventually the surgeon comes up. I tentatively asked him what he told the family and he just said "oh patient is fine". I question him further about whether the family know about the terminal cancer and he looks at me as if I am crazy. He said "what are you talking about? The patient doesn't have cancer!". The PACU nurse had given me a completely untrue report!

I was so embarrassed and horrified I called PACU straight away for an explanation. The PACU nurse was very defensive and angry and I explained that her report could have changed my care of the patient and she just didn't want to hear it. I couldn't believe I found myself justifying my phone call. I told her that it was unavoidable that I filled in a incident report and she just retorted that she was fed up with the unit and the hospital and I should do my worst. I'm not the kind of person to complain about someone, but what if I had said something to the family? I go cold when I think of what might have happened! Maybe if her reaction was different I would feel less inclined to fill out the form, but this is serious. She told me that she got that information from the anesthesiologist and was just passing it on, but I told her she should maybe have read the notes and history before calling a report. What do you guys think?

[Lawnurse]

Rocknurse, you did exactly the right thing by calling the PACU nurse (in case there was some reasonable explanation) and then writing up an incident report, esp. considering she did not take the blame for her mistake.

Whether or not the incident report will truly solve the problem is not your primary concern- after all, NO good will come out of not writing one.

Who knows why the PACU nurse gave such an inacuate report? There's a small chance its a sign of something really going on with the reporting nurse (cognitive deficit, "impaired nurse" syndrome, actual incompetence) which you may have shed light on.

Good for you for standing up for yourself! IMHO, nurses standing up for themselves more frequently is one of the things the profession needs the MOST. :1luvu:

[Tweety, BSN, RN]

Actually, you know I really wasn't. I was trying to be calm and professional and explain exactly why it was important that I received accurate information, but she seemed bent on arguing with me which I found odd. She really did sound burned out, and to honest I felt the same too. We have to deal with too much BS and in a way I sympathise with her, but at the end of the day, I need to cover my butt and that's what I did. Something like that must be documented because I do not want to be part of the fallout should it come back on me.

I'm glad to hear that your were calm and profressional. I presumed it was that way. Sometimes these kinds of phone calls can get out of hand with the judgements, and passing back for forth.

Burned out or not, this nurse could be dangerous if she is so out of touch with and confused about her patients.

[pricklypear]

Rocknurse, your story doesn't shock me at all!! If we lived in the same country, I'd swear we work at the same place!! I work nights, and we have just learned to take PACU reports as entertaining fiction, if we get a report at all. The OR staff usually is feeling very put-upon if they have to stay late or, God forbid, come in on call to do surgery. We have received patients without ANY report, they just come rolling onto the unit. We have received crashing patients who were reported to be stable 5 minutes ago. I have received totally unresponsive patients who were reported to be "groggy." I have received emergency open hearts with this report from the CRNA, "3 grafts, everything went OK" poof, he's gone. Had a patient who supposedly had a femoral central line, turned out to be an art line - with meds going into it. Need I say more?

[Lisbeth]

I agree that you handled it correctly. I would have talked to the nurse who gave me an incorrect report, and then I would have written it up (especially if she didn't have a good explanation or if she didn't seem conscientious about it). If it is a problem with the system it needs to be looked at so it can be prevented. If the problem was the PACU nurse, it also needs to be looked at because we have to rely on each other at work. We have to trust other nurses, even though we eventually verify the information by checking the chart. This situation also brings up a good reason to not say anything to the patient or family about diagnosis or prognosis until the doctor has discussed it with them.

[pricklypear]

:imbar Oops, I guess we do live in the same country!!

[Rocknurse, MSN, APRN, NP]

Rocknurse, your story doesn't shock me at all!! If we lived in the same country, I'd swear we work at the same place!! I work nights, and we have just learned to take PACU reports as entertaining fiction, if we get a report at all. The OR staff usually is feeling very put-upon if they have to stay late or, God forbid, come in on call to do surgery. We have received patients without ANY report, they just come rolling onto the unit. We have received crashing patients who were reported to be stable 5 minutes ago. I have received totally unresponsive patients who were reported to be "groggy." I have received emergency open hearts with this report from the CRNA, "3 grafts, everything went OK" poof, he's gone. Had a patient who supposedly had a femoral central line, turned out to be an art line - with meds going into it. Need I say more?

Yikes!!! I thought my place was bad! I think I'd have a nervous breakdown if I worked where you worked!

[fergus51]

Unfortunately I suppose we all need to verify our info. I have also had to copy orders on new admits because the docs had the charts, but now I realize that if I can copy the orders I can copy the history at the same time.

[mattsmom81]

Rocknurse, your story doesn't shock me at all!! If we lived in the same country, I'd swear we work at the same place!! I work nights, and we have just learned to take PACU reports as entertaining fiction, if we get a report at all. The OR staff usually is feeling very put-upon if they have to stay late or, God forbid, come in on call to do surgery. We have received patients without ANY report, they just come rolling onto the unit. We have received crashing patients who were reported to be stable 5 minutes ago. I have received totally unresponsive patients who were reported to be "groggy." I have received emergency open hearts with this report from the CRNA, "3 grafts, everything went OK" poof, he's gone. Had a patient who supposedly had a femoral central line, turned out to be an art line - with meds going into it. Need I say more?

Sounds like we've worked in the same ICU Pricklypear! I can sure relate. I always take a verbal report with a grain of salt as I've been burned too many times. BUT when its totally innaccurate, I do tend to followup as the OP has done, for the sake of good patient care and interunit trust. I've been fortunate to work with good PACU nurses 99% of the time who have a critical care attitude and do a good asessment and report.

(except for the time I found a cold pulseless LE on a fempop reported to have palpable pulses...forgot about that one...my followup revealed she didn't actually check the pulses...'the surgeon told her the pulses where there so she didn't bother' in PACU. Hmmm) We DID write that one up.

The worst come straight from OR IMO. It gets to be a sick game with some anesthesia providers, I've found, as they roll their 'stable' patient into ICU while emptying mystery syringes into the lines and grinning 'Now they're your problem...they were stable for me."

[pricklypear]

The worst come straight from OR IMO. It gets to be a sick game with some anesthesia providers, I've found, as they roll their 'stable' patient into ICU while emptying mystery syringes into the lines and grinning 'Now they're your problem...they were stable for me."

I hear ya, a little bit of epi will get a patient over to the unit and in the room before they crash. Anesthesia: Gee, she was fine, a little tachy and hypertensive, but otherwise OK!

Never could prove it~:angryfire