Need ER nurse feedback

[gomernurse]

I am trying to devise a succinct, comprehensive, informative transfer form to replace our current form which no one fills out anyway. When I send you grampy/grammy who is in trouble, I need to know what YOU need to know. Granted, trying to make sensible changes in an LTC is often akin to pulling molars from a meth-crazed hippo....but, with your input.......who knows!!

I always send you copies of the face sheet, MAR, H&P, DX list, advance directives, and recent labs.

On the transfer sheet, do you need to know more than his name, the doc, our facility, code status, allergies, v.s., sats (if applicable), chief complaint with presenting s/s, and any special precautions, i.e. MRSA.

Do you want to know when he last ate? If family notified? Last time pain med given (if applicable)? etc., etc.

Incidentally.....I do do alwyas give you a call to give you a heads up!!!

Any ideas happily appreciated.

[ERNurse752, RN]

I liked the analogy to the meth-crazed hippo, hehe.

All the things you listed were good. I apologize in advance if I repeat any of those things down below in my reply; I'm eating lunch at the same time, and my mind is only half here.

Knowing whether the family has been notified or not and are they coming to the ER would be very helpful. Whether or not the ECF doc has been contacted would be as well. Baseline mental status is good to know, and also whether the pt is ambulatory at all. Any interventions already attempted at ECF.

Time of last meal or any intake would be good to know if surgery is a possibility.

That's all I can think of right now. Good luck, sounds like a good idea!

[FNP grrl]

i'm impressed! we need more gomernurses like you--- you are totally on the ball!

i might repeat something too, but here's my input:

i admit ortho patients from the ER and probably 50% of my admits are hip fxs from LTCs who need surgery. knowing baseline ambulatory status, ADL ability, continence, baseline mental status, diet, last PO intake, DNR status, and yes! please! any info you have about family ETA/wherabouts, all would greatly help the providers who are admitting these folks (along w/ meds, H&P, dx list, etc of course).

thanks for asking!!

i wanna go to your LTC when i'm a gomer. put me on the waiting list, ok?

[kevro1013]

It sounds like your facility is already ahead of the game! I must say though one of the most challenging type of pt in the ER from LTC is a chief complaint of altered mental status with no base line to compare to and also when the symptoms were noticed. A nurse to nurse report always helps before the transport (if possible since by the time the pt arrives the nurse who transfered the pt from ltc may be gone) and transfer forms are good at summing up basic data. (again sounds like you are on the ball here) On the other end I always try to call a nurse to nurse when the pt will be returning (or be admitted for an update). h&p is good if you can read it, emergency contacts for family are helpful, code status sheets are a necessity of course. I think it needs to be simple and spell everything out since the form is actually for another facility to read. Btw thanks for trying to make our job easier!

[traumaRUs, MSN, APRN]

In our area - (maybe its just our area?) the LTC use the same transfer form...and none of them put the name of the facility with phone number on any piece of paper. That would be very helpful. Also - phone numbers for family, legal guardian is very important - sometimes even when they don't come in - if their loved one starts to slide downhill - we want to call them ourselves.

BTW - I have to say I want on your facilities' waiting list too! You are doing a wonderful job...

[gomernurse]

Thanks so much for your input. Incidentally, I have room 225 reserved for myself, but I'll be glad to share if you don't snore, burble, gurgle, or talk to people I can't see.

[CoffeeRTC, BSN, RN]

I would love to have a new form for our facility..there is little room for anything. I always try to include, even marking it in red, the residents behavior or mood problems. Or special needs.... Ie never call Mr Bob Smith Bob or he'll deck your... he likes to be called Chuck:D I also include date of last hospital/ ER admit... we have a few frequent ones...Noticed now some ERs are asking for Soc sec # to pull up old records in advance... Also will give the ER an ETA, just so they will be prepared Never though of adding last meal to the list, but of course we have a section for last BM:eek:

[FNP grrl]

Originally posted by gomernurse

Thanks so much for your input. Incidentally, I have room 225 reserved for myself, but I'll be glad to share if you don't snore, burble, gurgle, or talk to people I can't see.

would you mind if i occasionally borrowed your dentures or hid your walker?

[neneRN, BSN, RN]

You know what I would LOVE to have on the transfer sheet? A list of current meds (not the MAR, which can have a bunch of meds that have been d/c'ed but you can't tell when or the meds have been chopped off by the copy machine or the whole thing is just plain unreadable)

It makes things so much easier when a copy of the MD's dictation from the last hospital visit is attached- most of the LTCs send this and its wonderful when they do, as the MD tends to dictate everything from head to toe assessment, history, allergies, meds d/c'ed with, etc. When they send this, I don't even really need anything else- the medic gives report on the reason for today's visit.