I had a patient code (and ultimately die) while in radiology. The patient had been off the floor, and out of my care for all practical purposes, for about 55 minutes prior to coding and was stable when he left my floor. Legally, would the patient still be considered to be under my care if I did not verbally transfer care to another RN? There was an RN in radiology, but is care of a patient assumed by that nurse simply because the patient is in that department? So far I haven't been able to find my hospital's policy answering these questions.
Just to answer a few questions I know will come up:
-the patient was stable when he left the floor, alert & oriented
-as soon as I heard the code blue announced overhead I called radiology to ask if it was my patient, notified the charge nurse, & immediately went downstairs to respond to the code
-the reason this is coming up is because staff in radiology apparently did not follow protocol & call the ALERT team when they became concerned about the patient & instead say they tried to call me, but I never got that phone call or a message saying they called
When we send people off the floor for tests...generally in the different departments there are not RNs..usually techs that run the tests. We would never get anything done if we had to call a report to the department they are going to. It was on radiology to call the rapid response or code.
Agreed.
Our responsibility as floor RNs is to ensure the patient is stable prior to leaving the floor, as the OP did. Everyone in the hospital is required to have BLS and know to call a code or rapid response. If the techs I radiology screwed the pooch and did not follow the protocol they are responsible for, that is on them. They are throwing you under the bus. Do not back down if the incident is investigated. Be confident in the fact that you did nothing wrong, and do not let them shake your confidence in that fact. You'll be fine professionally.
Yep. Most radiology areas dealing with routine tests don't have RNs staffing them. It would be ridiculous and a waste of time to call report on every patient going to Xray, CT, MRI etc. Additionally, it would also be inappropriate for a staff RN to leave her other patients to go code someone (even her own patient) in a different part of the hospital. What a cluster this was.
First part I agree with. Second part, I do not. It is very appropriate for a nurse to attend the code of her patient off the floor. Rapid response and code teams do not know the patient, so the primary RN will be the only one who has any history off the top of her head. I don't know why you would consider it inappropriate, especially considering the OP notified the charge of where she was going. It's not any less appropriate than taking a lunch break.
The OP did everything right and absolutely nothing wrong.
Specializes in Med Surg, ICU, Infection, Home Health, and LTC.
There has been several good responses. I would add that it would depend upon your individual hospitals policies and procedures. Such as: An ICU patient may not leave the floor to a procedure without an RN to accompany and remain with them, and if they are on a vent, a respiratory therapist. Dialysis patients must be handed off nurse to nurse and the floor nurse is expected to continue care if a pain med is needed or assistance with changing the bed etc. The medical floor nurses may have 5-7 patients a piece and they hand off the patient to a transporter but they call a verbal report.
This is an interesting question! I've been a nurse 1 year and these are the kinds of situations you don't learn about in school or even think about until it happens. Since the patient was stable and hopefully documented as such, then the RN should be ok, I think. If Rapid Response was called first then the floor RN, that is the correct order from what I understand.
I am not trying to highjack the OP's thread but this is more of what I see and maybe you do too, which is where it can go sideways:
I get report that the patient is stable at 7:15 am (looks stable sleeping at bedside report) then the night RN leaves at 7:30 am and I'm still in report with another RN, transport shows up to take that first pt to MRI/CT, etc. and I sign the Hallpass/Ticket to Ride stating pt is stable- even enough to go w/out RN and off they go. Our NA's don't start til 7 am so vitals aren't even close to being done, if even started yet. The last set was hopefully at 00:00 which I haven't even looked at yet, I can almost bet my life on it.
I can see several ways that I could be nailed against the wall if anything happens and justifiably so.
My errors:
-Signed a legal document stating that pt is stable but I haven't assessed the pt, looked at the last set of vitals or very possibly even spoken to the patient to introduce myself.
-Not considering the medically legal definition of stable more carefully for this long and what is the legal way an RN must come to that judgement to protect not just the patient but protect their license as I think that, I (and all on my unit) have left ourselves wide open here. More importantly, how long is a stable state good for? There are hundreds of factors that can mitigate that state. I need to research this more.
System errors:
-NA's should start at 6:00 am (I was an aid at a different place and we did with RN's in @ 7:00am) to get more vitals done before most of the routine tests begin at 7:00 am. That is on ongoing pet-peeve of mine anyway!!
-In our tech-savvy world, it shouldn't be a surprise that a patient needs to go somewhere ever but my hospital isn't very tech-savvy. We do have landline phones though!! Another pet peeve that we don't have portable phones. We are supposed to be getting iPhones. At this point I'll an old Spectralink phone I had as an aid at another system or even crappy Vocera!!!
-Another ongoing pet peeve is some departments call the RN and call transport, others call the unit but the RN has to call transport, still other don't call and transport just shows up.
You guys are assuming the Rad nurse was involved. Was the Rad Nurse involved? Many patients come down to radiology for a scan and they have zero contact with the Rad nurse as they are in interventional exams. The patient may have been down for a CT, US or X-ray. Unfortunately a rad tech or US tech isn't going to know what to do and should follow the protocol which is call a Rapid Response. Protocol is not to try and find the rad nurse.
If your patient was stable and off the unit you were on, it's not your problem really.
When I worked the floor, I had to transport patients more often than not for tests. Why? Cardiac monitors. For most tests, MRI, CT, CTA, MRA, etc - we'd just go with the patient and stay. If we were really lucky, we'd convince the radiology folks to schedule patients first or last (during our shift change) and the off-going nurse would take the patient at like 7a for testing. We had several types of testing only performed at our other facility six blocks away that required EMS transport. We documented we gave report to EMS, they documented on the patient in transport, gave report to the nursing staff in that patient care area on our other campus, and vice versa. A lot of the CTs I transported for were stat head CTs for rule out re-bleed, etc, so we rarely had to wait, and generally ditched the line.
If we sent a patient to IR, the OR, dialysis, etc - we gave report to the department staff, pre-op nurse or anesthesia staff (depending on patient acuity/time of day), documented it as such, and if the patient returned to our floor report was documented as being given to our staff (charge or primary nurse).
Speaking as a nurse who works in the OR? We don't notify the floor if a patient codes in the OR. We don't overhead page codes in the OR (we do, within the OR only, not house-wide).
I could see why maybe asking you to go help with the code because of your knowledge of the patient was a fair request but to blame you? If the radiology staff knew something was wrong (demonstrated by their suggestion that they called you/didn't reach you) they should have utilized the most concise way to get the care the patient needed - which was probably to rapid response them. Calling you would have provided more info, but it's not like you could have given them orders...
I think we dont know enough here to judge. What kind of proceedure was it did it involve conscious sedation. Was it indeed a bleed?? Ir Rns (most) are either experienced icu or ed nurses so they usually know what to do with a fail on a patient. If it indeed was the Ir nurse uktimatley responsible that will come out if any inquiries. All this talk of Rns throwing each other under a bus is what makes this proffession week at time. Be more proffessional and don't dictate blame til you know.
The patient was off the floor for 55 minutes when the code was called.
I wouldnt be surprised if this is a case of a rad tech ignoring a symptomatic patient, and then claiming "I tried to call the nurse and she didnt answer."
I would want to know what number did he call and when and if anyone else saw him make that call.
Just because they wear scrubs and operate machines doesn't mean they know a thing about patient care.
I think we dont know enough here to judge. What kind of proceedure was it did it involve conscious sedation. Was it indeed a bleed?? Ir Rns (most) are either experienced icu or ed nurses so they usually know what to do with a fail on a patient. If it indeed was the Ir nurse uktimatley responsible that will come out if any inquiries. All this talk of Rns throwing each other under a bus is what makes this proffession week at time. Be more proffessional and don't dictate blame til you know.
The patient was there for a CT of the abdomen, history of pancreatic cancer.
This happened to me over the summer...I got a phone call from Nuke med saying there was something "wrong" with my patient - instead of calling the code or RRT. I ran down 5 flights of steps to find my pt with no heartbeat and only THEN did they call anything! I truly don't think it would have made a difference considering she had metastatic CA but still - is it really that difficult?
dudette10, MSN, RN
3,530 Posts
Agreed.
Our responsibility as floor RNs is to ensure the patient is stable prior to leaving the floor, as the OP did. Everyone in the hospital is required to have BLS and know to call a code or rapid response. If the techs I radiology screwed the pooch and did not follow the protocol they are responsible for, that is on them. They are throwing you under the bus. Do not back down if the incident is investigated. Be confident in the fact that you did nothing wrong, and do not let them shake your confidence in that fact. You'll be fine professionally.