Garbage Report

Guest219794 · Apr 13, 2018

Absolutely HATE faxed report from the ER. Got a patient with a nitro drip not attached to the pump with the clamp wide open. No mention of the drip. Patient was just dropped off in the bed for me to find. Then I was actually overjoyed when I found the tubing to THAT iv tangled in his linen with the iv cath attached so it just free flowed into his bed and not him. The NS was clamped for transfer. That iv was still in the patient. Patient admitted with HTN. Nurse suffered a CVA on arrival to unit.

A couple of thoughts-

Fax??? Are they created on a typewriter? While state of the art in the 80's, there have been a few developments since then. Presumably faxes are used only in facilities that still paper chart. Or do I have this wrong? Are there places that computer chart that have ER nurses go through the computer to create a fax for the floor?

Regarding the above example: I don't think the chief problem there was the fax. No real reason to think that if report had been done differently, the details would have been any better. Stuff gets missed in verbal report as well. And, the real problem here is the med not infusing. Not knowing a NTG is running is annoying, but it generally won't affect care- unless the receiving RN doesn't notice it. BTW- which nurse had the CVA? I get annoyed at work sometimes, but have never actually stroked out.

Regarding verbal report: If you were to start from scratch and design a system (One that uses computers), there would not be two people, one of them verbalizing critical information, while the second hand writes it on a piece of paper. We do that because, well, that's how we were taught. In fact, it was the only way Clara Barton could inform the next nurse.

If it was a good idea, other industries would use it more. Picture in a nuclear power plant at shift change: "Got a pen? OK, so that valve over in bay 22 has been cranky all night. I am just so frustrated- no matter how I adjust it, the alarms keep bugging me. The refractory reciprocation levers are working great- not a problem all night....."

ER nurses regularly take patients from other nurses with little or no verbal report. That has nothing to do with being more capable, or needing less information, it has to do with how we get that information. EICU (Off site critical care) docs regularly make life or death decisions based on information they glean in 2 minutes off a chart. And they care for dozens of patients at a time.

Report is very much like the game of telephone that kids play. That game is based on the fact that information that gets passed on verbally invariably becomes inaccurate.

Rocknurse, MSN, APRN, NP · Apr 13, 2018

You wouldn't have been able to get away with a poor report in my ICU...we're all anal and will grill the heck out of you if you tried it. The worst condition I ever found a patient in was coming from the OR post open heart. They had had a difficult time during surgery and were on every drip known to man, a PA catheter, intubated, two central lines, two a-lines and a IABP. I have never in my life seen such a tangled mess of spaghetti. It took me hours to get them looking presentable. I actually kind of like untangling lines (it's the OCD in me) but that was off the charts. Stressful because the patient was unstable and I need to know where the heck my lines are so I can give them meds if things go pear-shaped.

ruby_jane, BSN, RN · Apr 13, 2018

this poor dead pt was covered in blood, reeked of urine (was still in urine-soaked bottoms and sheets) and some of the family was in the daggone room waiting for other family to arrive. Needless to say before anything else happened, that shift got started with completely bathing and changing linens for that pt so the family didn't have to see them like that. I could not believe they had the family sitting in the room with their loved one in that condition. Totally unacceptable.

You are a great nurse and a really good person.

ruby_jane, BSN, RN · Apr 13, 2018

"The patient is here because he's TFTB."

What?

"Too fat to breathe."

So, so ugly. And not informative at all.

I would stay if something happened at the last minute (like your foley).

audreysmagic, RN · Apr 13, 2018

"OH THANK GOD YOU'RE HERE!!!" From offgoing nurse. Um, can I forget I clocked in, turn around, and pretend I wasn't scheduled today???

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audreysmagic, RN · Apr 13, 2018

"Worst reports" in general for me are the kind that are just too vague... "Oh, it's all good" etc. Especially in psych! Sure, they're not in physical danger, but their specific behaviors are super important to me. Now, as Infection Control/Staff Education, the worst report is the one I don't get. Nothing I love more than someone asking me what I'm doing about XYZ situation and that being the first I've heard of it! The actual worst report I ever got, though, was from an ER. I know they're super-busy, and a lot of ERs are not about that psych patient life...so I tend to be a little forgiving. However, my facility is freestanding psych, and I was managing hospital-to-floor transfers at the time, so my job above all else was to make sure that a patient did not come with a medical device we do not manage. Anything with tubes/wires is too much of a safety risk for an acute psych floor with a setup like ours. Skin assessment was marked WNL on the faxed report. I called for my verbal nurse-to-nurse, and the RN I spoke to confirmed. Patient arrives...WITH A WOUND VAC. Ended up having to send the patient back, they threatened EMTALA, I had to get my supervisor to explain that EMTALA doesn't apply if you gave us wrong information because the wound vac makes us no longer the right level of care for this patient, their supervisor called us a "let's-pretend hospital" and made some fun comments about psych nursing...a great time was had by all.

The funniest report I've ever had, though, was by a behavioral tech. It wasn't my nursing report, of course, but at the time, that was supplemented by squares that the techs filled out. And some of them were pretty real about patient behaviors and didn't always conceptualize that they should write on those squares like they would in the charts. I'm reading the squares aloud to my team, as was the norm at the time... "Poor boundaries, intrusive...Patient would not stop grabbing his balls all day." Frank, to the point...if not exactly professional. At least it got us a good chuckle to start our shift! (And after I casually mentioned to that tech that you really need to treat the squares like a chart, we were good from that day forward.)

Ruby Vee, BSN · Apr 13, 2018

Years ago, I was floated to a Neuro floor to do charge. I was a new grad, about one month in, and protested -- I was willing to float, but not to do charge. "Don't worry," said the supervisor. "Their LPN is really experienced, and there's an agency NA that works there all the time, but we have to have an RN for Charge." So I trotted off to the Neuro floor. The report I got was: "In the first bed is Mrs. Glio -- she's sleeping. She's been sleeping all night. In the next bed is Mr. Epilespy. He's been seizing off and on all night, but he's OK. In the next bed is Mrs. Surg -- she just got back from the OR half an hour ago; we don't know what she had done." Worse, this report was taped. When I darted out of the report room to ask for more details, the previous shift had already left. Three call lights were going off, and there was a patient on the floor. The shift truly sucked.

brownbook · Apr 13, 2018

This is the opposite. I worked ambulatory surgery the last 17 years. These are relatively "minor" surgeries on patients who do not, cannot, come here if they have serious, uncontrolled, health issues.

We have the resources to keep patients overnight if needed. Often "plastic" cases stay overnight. Not even sure why? Plastic surgeons are very picky? Their surgeries can take 6 - 8 hours? Plastic patients are very weird?

We dreaded giving report to the evening nurse. She would question everything in our verbal report and go over our charting with a fine tooth comb, as if she was taking over a fresh open heart!

A nurse from ICU floated to our unit occasionally. He gave her report then left to go work in the ICU. She called him about 1/2 hour later to ask why the patient's I & O didn't add up correctly, it was "off" by 50 ml.

Don't even know if or why the surgeons would care about I & O they probably don't! We don't even do I & O on patients going home the same day! Just a very "rough" approximate in IV fluids and "patient tolerated fluids and voided qs." We don't even use IV pumps on any patients, everything is just to gravity with a standard clamp on the tubing to control rate.

He righteously told her she was out of order to call him away from his patients in the ICU to return to our unit to fix 50ml discrepancy and hung up.

**LibraSunCNM, BSN, MSN, CNM** · Apr 13, 2018

My least favorite reports, as others have echoed, are those that claim everything is fine, and then you go in the room and it looks like a bomb went off and you're catching up on stuff all shift. I am NOT someone who grills other nurses in report, truly mostly the opposite, I'm willing to let a lot of stuff slide if I know you're usually a team player, and appreciate when others give me the same grace. But those that are just lazy and you know they're lying outright or by omission in report kill me.

We had a travel nurse on the mother/baby unit where I worked who was one of those nurses who's skillful in maintaining a super-competent facade, while actually being incompetent, if that makes sense. She gave me report on a fresh C/S mom of twins, and spent most of the time talking about how much she liked her as a person and what they had in common. I went into the room, it was as if the aforementioned bomb had gone off (not that neatness and tidiness are more important than actual nursing care, but come on...help organize tubes and lines and toss unnecessary trash when you settle a new patient), and the family was peeved at ME that her epidural PCA had run dry and she was in pain, and had no breakfast. A couple other things had been missed as well. I confronted the nurse about the issues when I gave her back that night...her excuse for the PCA was that "we do PCA checks every four hours, which I did." Yes, she did, but she spaced them out so that the last check was 3 hours prior to shift change, whereas standard practice on the unit was to do a quick check within an hour of shift change, even if it wasn't technically due, to prevent incidents like the one that actually happened, from happening. She had a glib excuse for everything. I discussed what had happened with another nurse in private to vent and get her advice on whether I was overreacting, she confirmed that the nurse sat at the desk all night talking everyone's ear off, and when she covered her for a break, she was constantly finding patients being neglected.

I left soon after when I graduated from midwifery school and found out she had been brought on as staff and promoted to assistant nurse manager :roflmao: One of many reasons I was happy to leave staff nursing!

Neats, BSN · Apr 13, 2018

I clocked in one time on a Sat morning at 7 AM. The nurse going off shift literally runs out the door before I can stop her and says all is OK I left a written report. There was one patient who I knew was near death and I checked on that patient first. I got the written report and went into the patients room thinking they may have turned the corner and beginning to get better...I was wrong. They were semi reclined in bed with their food try on the side table...expired and from the look of it had been for at least several hours.

Lesson learned ...I do not clock in until I connect with the nurse first.

On the other side of this reporting in the military we used what is called SBAR...Situation, background, Assessment, Response- very brief but filled with useful information. We could do a post surgery (Stable) ward report with 10 patients in less than 20 mins. I still use this SBAR. I also use Problem, Solution, Discussion (PSD).

Susie2310 · Apr 13, 2018

I left soon after when I graduated from midwifery school and found out she had been brought on as staff and promoted to assistant nurse manager One of many reasons I was happy to leave staff nursing!

Another example of appearance being more important than reality.

pixierose, BSN, RN · Apr 13, 2018

I work per diem in a ped psych ED where most times we get a patient for a few hours, stabilize, and then the patient either goes home or goes IP.

There's one IP psych unit that I dread giving report to. Mind you, we typically have these patients for a few hours. I know allergies, meds, the CC, critical psych/med hx and issues, family background (i.e. abuse, dynamic, who can visit and who can't), whether they've been IP before, SI/HI/AH/VH, voluntary or PEC.

But this one unit will get me on: mom's pregnancy, labor and delivery, siblings? Have they ever smoked a joint before in the past? When did they first receive an immunization - was it when they hit 2 weeks old? Two days old? When did they first receive their MMR vaccine?

If they have a drug hx, I'll tell them. But JFC, I don't know when they first received their MMR vaccine and frankly that's not a question we ask, just if they're UTD.

I like to think I give fairly good reports but sheesh ...