Nurses' handoff to EMTs

[jleigh9369]

I am a nurse shift supervisor at a 122 bed free-standing psychiatric facility. Today, a pt dc'd about 11am from our CD unit and was waiting in our lobby for a ride. He remembered he had brought in home med of Ambien on admission and asked for it to be returned to him. I got it from pharmacy, checked that MD had given him a Rx for it, and gave it back to him around 12pm (his ride still had not arrived). About 1pm, his wife arrived to pick him up and reported that he told her he had taken 3 of the Ambien 10mg tabs while waiting for her to arrive. I called his SW who came to the lobby and he and I escorted the pt and his wife to a conference room where we could talk. She did not want to take him home, as he appeared drowsy and confused. I reported the sitution to our DON who told me to call 911 (as we were not sure how many pills he had actually taken). I called 911, reported the pt's hx and current situation and, when the 4 EMTs arrived gave them report once again and gave them copies of his dc meds, h&p, face sheet. The SW was in the room with him, along with the 4 EMTs and I stepped away from the situation, as I had duties for current inpatients I needed to attend to (and I only had 30 minutes til my shift ended). When my relief arrived, I told her the situation, did an incident report, and called director of risk management to inform her of the situation as well. The EMTs were actually still on our premises, so I suggested that my relief check on the status of the patient who was still in lobby being assessed. When I got home, I recieved a text from my DON stating that SW had reported me to CEO for not staying with the patient til he was taken away by ambulance. Should I have stayed? Technically, he was no longer our patient and my current inpatients were my priority

[NOADLS]

1) Why is the SW reporting you to the CEO and not the DON?

2) Do you have any internal policy which forces you to remain with the patient right until the EMT leaves the building with the patient?

All EMT's aren't alike and some will be resist taking the patient. I always ask the EMT a loaded question which forces them to make a statement that they've assumed care of the patient. After the EMT has answered in a satisfactory manner, the patient is in the care of the EMT. At this point, I can attend to other duties.

Ultimately, I would ask the DON to discuss conflict resolution with the SW as going to the CEO is definitely a step too far regardless of whether you were right or wrong.

[jleigh9369]

Thank you so much. Everything you said made perfect sense. I also questioned why she went directly to CEO. As far as the policy, I'm sure we don't have one. Most of the policies that I have viewed (I've only been there a month) are outdated. I have called this to the attention of both the DON and CNO, and they just blow me off. I really want to improve the quality of care for patients here, but I'm meeting a lot of resistance. Again, your response was VERY helpful to me. Thank you again

[casi, ASN, RN]

I work in LTC so I have a lot of interactions with medics. I give them report, most times I'll stay through their initial assessment or collection of history so I can advocate for my patients, this isn't long at all. Then I'll ask "Is there anything else you need from me?" and go on my merry way.

Is the social worker newer at their job? Sometimes social workers don't really understand the nursing assessment and process. She also may have no understood that you handed over all care. Also the patient was discharged at 11am. He was no longer a patient of the facility, so you really weren't his nurse anymore.

[jleigh9369]

Thank you, Casi. That's exactly what I did. I appreciate your response and your support. When the DON texted me about this, I told her that I wasn't going to explain myself via text and to please call me is this matter needs further discussion...she never called.

[canoehead, BSN, RN]

You gave report, they accepted report (I assume). That's it, if the SW wants something else done she should have spoken up, or approached you privately.

[jadelpn, LPN, EMT-B]

The patient was discharged, and no longer your patient. 911 was called per the request of the wife who "wouldn't take him home". I would have excused myself from the get-go as far as being the nurse giving report--as a supervisor, you needed to deal with a person in your lobby whose family member stated that he took some medication he shouldn't have. But when a patient is discharged, they are no longer a patient.

When you give report, you are assuming responsibility of some kind, I would think. You did it as it was the nice thing to do. You could have easily said "this person's wife reported to me that he has had a change in mental status due to apparently taking Ambien." It is then up to them as far as obtaining consents, assuming consent due to the mental status of the person, that kind of thing. Should the EMT's not receive consent to transport, and in their opinion the person can give consent after their assessment, then you have an issue in your lobby that may require security.

It is an experience that may need some policy--specific to what you are to do with a patient who has a potential of having no where to go, an unsupportive family, or a spouse that doesn't want the patient back home. In other words, the time to find out that the spouse doesn't want the guy in the house is well before discharge. So your discharge planning process needs to be refined. OR family meetings need to happen just prior to discharge, so everyone is on the same page, the ride is in house, etc. There are people who are, in fact, told to leave the premises upon discharge. Also policy on home meds are to be taken home upon the completion of the admission paperwork/med rec.

That his ride did not come for an hour, the dynamics that created this situation, or the gamey nature of the discharged patient is no longer your issue beyond this person leaving the premises upon discharge.

The continuity of such was handed off to the EMT's when you provided information. Which you had no obligation to do, as the patient was discharged. But what could be in your realm as a supervisor was to be sure that people who are not to be in the lobby, are asked to leave the premises.

[iluvivt, BSN, RN]

Also you no longer can provide any nursing care ONCE the patient is discharged from your facility.This could put you in a legal bind and you did the right thing! . A lesson to take from this is wait until the ride arrives and then give them any medication they came in with,unless you urgently need the bed.