Giving Report and IV Access

[thehipbonesconnected]

During handoff, in a telemetry unit, the nurses I give report to all want to know where the IV is. What is the point of this? My thought is, it’s either in the right or the left. Probably a 20, and if there was an issue, I would have mentioned it!  Yet they all expect me to say location, size and ‘saline locked’. Why??

[turtlesRcool]

On 1/23/2022 at 7:50 AM, hherrn said:

ER nurse perspective here:

It's silly and annoying, but I generally know where and what the IVs are, so I pass it on.  To the floor.  In the ER, when we pass this on to each other, it is generally as a joke, right up there with last bowel movement.  If, somehow this information is relevant, and not charted, we actually will pass it on- "She has a 20 in her AC, and the pump keeps occluding, so I am running ABX on gravity." Bowel movement would get passed on if the PT had an abdominal issue, possibly related to last BM.

But, this outdated tradition of verbalizing IV information is part of a bigger problem:  Verbal report.  Verbal report developed in an ERA in which hand written information was kept on pieces of paper, and it might be difficult tor retrieve. I can 100% guarantee that by using Epic, I can get the general situation, and any details I find important, much faster by reading than you can pass it on by talking.  

I think the OP was more about floor nurse to floor nurse. ER is a whole different beast. Our ER doesn't even do verbal report to the floor.  We use an SBAR form that has limited use, so I mostly look at the chart before a patient comes up. 

That said, some things like last BM are really useful on the floor. I realize that most patients are not in the ED long enough to worry about if the patient is having BMs or not, and I don't expect to hear about it from you.  But as a floor nurse, it's helpful to me to know if a patient who has been there for a few days is pooping or not. I want know if I should pull that PRN miralax with the morning meds to save me a trip back to the med room. Lots of people get off their routine because they're not up and moving as much, and a lot of them are on opioids. Also, the BMs are often charted by the CNAs, and some of them just...don't. Or they had a busy shift and haven't finished their charting, so the info isn't in the EMR yet. The information you find useful for you to care for a patient for a few hours in the ED is different from the information I find useful caring for a patient over several days or weeks.

I think the type of EMR used also plays a role. I don't know about Epic, but Cerner can be cumbersome, and the IV info isn't with the rest of the assessment. Personally, I don't really care beyond knowing if there's working access or not and central vs PIV. But it actually is a lot faster if the off-going RN tells me than if I have to look it up.

Finally, our shift reports became bedside shift reports a few years ago because someone somewhere decided they increase patient involvement and satisfaction. I find them to be a pain and a time suck, but if I'm forced to do report verbally, I at least want it to contain the info I need so I'm not doing verbal shift report and then having to go looking through the chart. It already takes an hour to do hand off (because we are supposed to to 2 RN skin check on each patient as well), and I guarantee I'll get a phone call or someone wanting to know something about a patient before I'm finished with that, and I haven't had time to comb the EMR also.