I think that they are still working out the details of this new system. We got a memo stating that we call the floor and alert the unit clerk that we are going to be faxing report on the patient going into 420. Then we fax report, ( we have a totally computerized charting system specific to the ED) all of our ER nursing notes go to the floor, from triage information to in er treatments and medications given. After that the floor has twenty minutes till the patient arrives. We carry phones with us, so we give our name and portable phone extension so if the floor nurse has any questions they can contact us. I don't know how to fix the dilemma that came up with me on the first night. I didn't see patient that the floor nurse had questions about. However, the questions she was asking were things that she just needed to look for, however if it was a question about baseline or medication administration or something then I probably would not have been able to help her anyway. Which can happen even when a report is called. However, no we do not at this time need to confirm with the receiving nurse that the patient is being moved.
We do not fax report to any of our ICU's or our Rapid Admissions Unit. We still call report to them. We are supposed to be expanding our rapid admissions unit soon. We do not send a cover sheet though and I think maybe we should. Our management thinks labs can be looked up by the floor nurse, as well as x-rays. If the house Doctor has seen the patient then we fax their orders as well. We try to initiate any orders the house Doc has given. If I was the nurse receiving report I would like to know if the patient has a high k+ or something without having to look it all up. I send the lab results anyway. I think a cover sheet would be good to, just to give a little baseline nursing observation. "The patient has been comforatable, or is anxious, may be a little stoic you may want to ask him about his pain etc.
There has been many changes since I started working at this Ed. We went from a 30 bed Er seeing 80,000 patients a year, to a brand new 50 bed er not including fast track. On top of this major move, we went live with an all computerized charting and tracking system specifically designed for an emergency department however the catch is "we are this new company's beta site." So, they are working out their kinks with our ED. I was completely overwhelmed at first, but it is getting better. Our computer system in the ED is separate from the rest of hospital and there were major issues to deal with. We are now interfaced with the lab so that is a great improvement, but we are still not interfaced with radioloy which is our weakest link right now.
During the early summer we had so much hate mail via editorials from the community, morale became very low. Complaints were mostly about wait times which could be up to 6-8hrs. Plus we had many staffing issues. They have improved on staffing issues and are now hiring paramedics (god bless our medics, and techs) which has also helped greatly.
Holding patients is another issue. Our beds fill up fast and the hospital is currently building an addition which will house two more ICU units and I think more monitored beds. We have three ICU units now. CICU, MICU, and SICU.
I think the worst part is not moving patients though because the family wants you feed them, do all their meds, etc. and really doesn't understand that we just can't do all that when the code or trauma is in the next room. Some families understand but, most don't you tell them we have a critical patient and their retort is well you should have enough people to help because our family member is critical too. What can you say to that?? Our patient ratio is 5 to one and most assignments include a trauma room. This is a big improvement however to the not so long ago past when we would have to cover for lunch and have 10 or a little more patients to look after. When we would have a trauma then the rest of our patient's were fending for themselves however that was more of a staffing issue.
Whew, I went off on a tangent, but it feels good to get all out. It is getting better and the floors are still not happy with the faxed report but, I think it will take time to adjust. I know that one good measure I think from being a floor nurse is that, they will not have to come to the phone to get a report from the Er and can continue that med pass or endo-tracheal suction they were doing. I remember that I hated to be called to the phone, when I was trying to push multiple crushed meds through a g-tube or suctioning a vent patient.
Thanks for listening,