I am looking for ways to improve hand-off reporting from Triage nurse to L&D nurse. A little about our unit: We have a 5 bed Triage area staffed with 1 RN and a CNA from 7a-7p and 1 RN From 7p-7a. Our L&D has 9 beds with a staff of 4-5 RN's during the day and 3-4 RN's at night. We cover our C/S and recover them as well. We have a scrub tech dedicated 24/7 most of the time. We start mother-baby care at delivery (barring complications) which means we do most newborn transitions in L&D. We do have bedside/desk surveillance.So here's my question. When a labor or Antepartum pt needs to be admitted to L&D, how do you efficiently make the assignment to the nurse and make sure that report gets given when things are (always)busy? Often, I am sure stuff gets lost in the shuffle or too much time is wasted trying to find out who is supposed to get the next pt. I have been on both ends of this, and am aware of the frustrations and pitfalls on both sides of the coin. Anyone have any ideas on how to make the hand-off go more smoothly and safe for the patients?
Oct 17, '12
Umm--what are your barriers or issues with this process right now? Every unit I've ever worked on, an incoming patient is assigned to an RN and that RN is responsible to go to AP or Triage, receive a verbal report and transfer their pt to a labor room.
If we're busy, sometimes another nurse or our charge nurse will settle a stable, not active patient to the room and show them the call bell, the primary RN then being responsible for obtaining report from the person who brought them in and/or the originating unit.
Oct 18, '12
Currently, whoever has the lowest acuity pt assignment at the beginning of the shift is assigned to take the next admit. But that can change on a dime if there are deliveries going on or epidurals being started. I guess what I'm asking is, how do you keep up with who gets the next one? Also, once you figure out who that is, I need some good strategies for for getting them to actually accept care of the pt in a timely manner. If the tech simply takes the pt to an LDR, I am still responsible until we can track down the person who will be accepting care. This can be time consuming, because most of the time we don't have a charge nurse in L&D. Sometimes the secretary knows who, but not where the lucky person is. Meanwhile, back at the ranch...I may have 2-4 other triage pt to deal with.
Oct 18, '12
Ahh--that's tough--we had a charge nurse at both of my bigger facilities and she kept a rolling list going. Sometimes that meant that if you were the only person without a patient, you got what came next regardless of when or what your last delivery was. At my current facility we're quite well staffed so we don't often get back to back admissions but it happens!!
Quite honestly I've never dealt with a nurse refusing to take a patient before-we all come to work to work, and we work as a team, so refusing would just be screwing someone else over. And we also don't have techs so I've never run into that.
It sounds like you're busy and understaffed and have a lower morale if people are routinely refusing patients. I feel for you but I don't have any good advice--maybe making a case for better staffing and involving your manager?
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