I work midnights on a general Surgery/Med-Surg/Tele unit in a +400 bed suburban hospital. Our unit does not have any negative pressure rooms, though there are negative pressure rooms on other units in the hospital that also have telemetry.
Lately, we have been getting patients from the ED that should not be sent to our floor, such as rule-out TB and rule-out meningitis, both of which are airborne precaution situations. We have tried arguing against receiving these patient with the ED, who states "well, they're just ruling it out", and going over their heads to the Hospital Nursing Supervisor...only to be told we have to take the patient. Our hospital has portable HEPA filter units, but they typically aren't sent up to the floor for several hours AFTER the patient has arrived, not for lack of repeated phone calls to the appropriate supply department, and we still feel this is inadequate since the room is not negative pressure.
Inevitably, whatever physician is on consult for Infectious Disease will see the patient on day shift the next day and puts in an order for the patient to be transferred to another unit with a negative pressure room. We have even tried calling the ID physician as soon as the patient is admitted to try to have the patient rerouted before they even get to our floor, but the ID physician (if they even return our call) will usually just state that they have not yet evaluated the patient and will refuse to place any orders until they do.
Has anyone else had to deal with this type of situation? Our staff feels this is putting our other patients at risk and is unacceptable, not to mention preventable if the ED physicians would just put in an order for the patient to be admitted to a negative pressure room from the start.
We are taught in nursing school to advocate for our patients, we should be able to refuse admits that are so obviously inappropriate for our unit! Does anyone have any suggestions for dealing with this sort of problem?
i am an ed nurse we care for all kinds of pts.sometimes we don't even know the pt should be on precautions.the nursing homes don't always give us appropriate info.but i don't admit the pt the ed dr does.the ed dr puts diagnosis and type of floor for admit after he has talked to admit /accepting dr.it is the nursing supervisor who assigns where the pt gets admitted to.if the floor has an issue it is the supervisor they need to call .if the pt should be in neg pressure room but is not in one on your floor then file incident report tlk to supervisor call your manager at home go up the ladder talk to chief of medicine call id report to osha call your union if you have one .but stop blaming the ed we don't pick the floor /room .its not in our control .we have to move the pts .there are always more people who need our room.
I really dont see ANYTHING in the original post that is Blaming the ED. I worked my last shift in an ED in April 2012. (So I'm not that out of the loop yet). While we might not have known about precautions for meningitis, or the flu, the Tb screen that is usually done in the ED should let you know that pt needs precautions...no need for a physician to tell you. I totally understand the need to move pts, but we also need to DO THE RIGHT THING for the patients...when we fail to do the right thing, just to move bodies...we often end up creating more work for everyone in the process.
Not only right for the patient, but right for the staff and community!
I really dont see ANYTHING in the original post that is Blaming the ED. I worked my last shift in an ED in April 2012. (So I'm not that out of the loop yet). While we might not have known about precautions for meningitis, or the flu, the Tb screen that is usually done in the ED should let you know that pt needs precautions...no need for a physician to tell you. I totally understand the need to move pts, but we also need to DO THE RIGHT THING for the patients...when we fail to do the right thing, just to move bodies...we often end up creating more work for everyone in the process.
sauconyrunner
553 Posts
I really dont see ANYTHING in the original post that is Blaming the ED. I worked my last shift in an ED in April 2012. (So I'm not that out of the loop yet). While we might not have known about precautions for meningitis, or the flu, the Tb screen that is usually done in the ED should let you know that pt needs precautions...no need for a physician to tell you. I totally understand the need to move pts, but we also need to DO THE RIGHT THING for the patients...when we fail to do the right thing, just to move bodies...we often end up creating more work for everyone in the process.