PICU questions from PediED

tryingtohaveitall · Apr 21, 2009

My two cents is to do a decent history and assessment before calling report. I can't tell you how many times I get report from someone who hasn't even assessed the child! Or the child with some significant issues (1/2 of which weren't reported to me). When I talked to the mother a bit more, I found out the child had a syndrome that no one had reported to me. I'm pretty sure they didn't know because they didn't have/take the time to talk to mom for a bit.

Good luck and I am impressed by your effort to learn!

Pediatric Critical Care Columnist · Apr 21, 2009

It's a pet peeve of mine that the nurse who brings the patient up might not have ever laid hands on the child. It's unfortunately the nature of the environment sometimes, but it is helpful to have some insight into how the kid reacts to strangers, and to handling. Oh, and don't harrass me about when you can bring the kid up; I might have to move another kid, have a room cleaned, change an assignment, the nurse may have to set up the room on her own because we don't have a service worker on, there may already be a crisis going on in the unit that requires a lot of manpower... I'll call you as soon as I can.

ER-to-PICU hand-offs at my hospital are often less than optimal for a number of reasons. For one thing, the charting is completely different and it takes many minutes of searching to find out when meds were given, how much fluid the kid's had, what diagnostics have been done and so on. If the nurse giving me report is able to tell me, "Joey had 2 - 20mL/kg saline boluses, the last one about 40 minutes ago and BP stabilized, an LP and blood cultures then a dose of ceftriaxone at 2145 and went for a CT of the head just before we came up. Oh, and Dr Smith wants him to have some Solumedrol at midnight," I'm happy. When my medical staff comes to the bedside I know what has already been done and when.

I don't expect the patient to be clean as the driven snow when they arrive, but I do expect that any trauma x-rays will have been done, because we don't take patients back downstairs for them and many of them are not doable with portable equipment.

Any information you can pass on about the family dynamic is good. Who's the primary caregiver? Is there animosity between the parents? Who brought the kid in?

Congratulations on your new career. And kudos to you for wanting to begin as you mean to go on.

RNNPICU, BSN, RN · Apr 21, 2009

At the hospital where I work we do a system by system report, so when the ER calls up and give report I try and get the RN to give report that way, sometimes the ER RN gets mad, but it helps me to focus and prioritie. By the way this is not a new system report it has been done this way for years (at least 10). When an ER nurse can give me report in a clear conscise way it makes the transfer so much easier. I realize that sometimes the ER nurse giving report is not the same as who first assessed or triazed the pt, but I have asked some basic questions regarding mediations vital signs, boluses and have heard the nurse giving report yelling down the hallway to see if anyone knows. Please try and have as much info that you can have ready when you call report.

Thank you so much for taking an interest in this. It is always great when we can smooth and ease any transfer. Good luck to you.

PedsER/ICU · May 7, 2009

I think EVERYONE that works in an ER should have some ICU or floor experience. I have only worked ER this far but when I graduate I am purposefully leaving the ER that I have loved for 5 years to do a PICU internship. I think it will help me be a better ER nurse. This was really helpful. I have seen so many nurses that have to call report to the floor and they have never even seen the patient. Unfortunately, that is just how it works, as awful as that sounds. With this I also think every floor nurse should have some experience in the ER. It is a different beast that can't be learned but by experience. I think if ER nurses knew how the floors ran and floor nurses knew the insanity of the ER and all parties gave a little slack there would not be so much strife between the units.

ttucowgirlnurse · Jul 1, 2009

Definately give system by system report. That's how most units function for report and it's nice to know how the kid is over all. Also know where your IV is and the size if the kid even has one. Really not nice to send a kid without an IV. And PLEASE PLEASE PLEASE know the size of the ETT, and don't lie. I had this happen recently. A kid was transported to us and we were told it was a 3.0 ETT in an 18month old child. We discovered the tube was really a 2.5 ETT cuffed after we tried to suction the kid. Really not a fun morning.

Good luck in the Pediatric ED. I loved working Peds ED for the short time I worked it.

MachoNurse, BSN, RN · Jul 3, 2009

Congrats on the new job, SpunkyAggie! Where did you get hired? I'm out here in the Bay Area and it's slim pickins!

DavidNurseEMT · Jul 9, 2009

"Oh, and don't harrass me about when you can bring the kid up; I might have to move another kid, have a room cleaned, change an assignment, the nurse may have to set up the room on her own" It's ok.. I don't mind explaining to parents why their extremely sick child is being cared for on a stretcher in the middle of the hallway, because we are boarding an ICU patient. This is why I love when other nurses (it was even mentioned in this post) think that all ED nurses should have ICU experience, but no one ever thinks that all ICU nurses should have ED experience. Please remember that when your 8-10 beds are full, you don't have to accept any more patients. When our 13 beds are full, we have to put kids in the hallways. We CAN'T stop ambulances from bringing sick children in. That is why I do, and will continue to harass the ICU about bringing the child upstairs.

Pediatric Critical Care Columnist · Jul 9, 2009

Please remember that when your 8-10 beds are full, you don't have to accept any more patients. When our 13 beds are full, we have to put kids in the hallways. We CAN'T stop ambulances from bringing sick children in. That is why I do, and will continue to harass the ICU about bringing the child upstairs.

Totally not true. Our unit is NOT EVER allowed to refuse an admission. We push beds over and admit a second kid into a single room. We have 15 beds but often run 19 or 20 patients. We've had intubated kids in the hallway on an portable vent/O2 cylinder with no suction. And we've had kids waiting to go to the OR on stretchers in the hallway being cared for by the bed coordinator because there was no one else. Oh and before I forget, there are lots of our admits that never even slow down in the ER. Naturally you wouldn't know about them. Those ones we get a 10 minute heads-up on from the helicopter... but I still might have to move a kid, get a bed space cleaned, rearrange assignments and set up the room. If we had a treatment room where we could stash them until all that is done, it would be great, but we don't. The hallway it is. Things are tough all over.