pt report to ICU?

[scrmblr]

I have had a few issues when transfering a pt to ICU. I have never worked in ICU, but I do know they work on a different planet then ER.

I recently sent a guy to ICU for new-onset afib. He had also had a recent GI surgery (within the last 2 months) I was trying to give the nurse his orders and she was all interested in his abd surgery. ( I only knew he had had it done, not what it was for or the doc who performed it:uhoh3: ) He came to the ER for something CARDIAC. Not GI and was being admitted for CARDIAC.

Tell me the basics of what to give ICU report on. I seem to ramble on and then they ask me something that I don't know the answer to. My charge nurse says to give them the very basics, and then say "We are on the way"

thoughts?

[MomNRN, BSN, RN]

I am fairly new to the ER, at least as a nurse, and I struggled initially in giving report. I wasn't sure how much info to pass on, etc. I have learned that different nurses on different floors want different info.

I appreciate the nurses who want the abbreviated version and say they will call if they have questions or can't find the info they need in the history. This great when we are backed up and need the bed.

If I am not sure of what they want to hear, I will just ask them to ask me what they want. I have learned a lot this way.

Regarding your individual situation, I would have just said that info was not pertinent at the time and we focused on the cardiac issue. In our hospital some of the ICU nurses like to try to trip you up. It is a personal issue with several of them and unprofessional. Another side of "eating the young."

[pricklypear]

Personally, I just want the basics: What they presented with, how treated in ER (treatments, meds, etc), what tests done and pertinent results if available, vital sign trends, brief history (whatever you know) and brief outline of orders (so I can have an idea what needs to be set up or what to anticipate).

Anything else about the patient's history I want to know I can find out from the patient, family or old records. Why should you have to waste your time telling me exactly how many hairs the guy has on his chest. I realize some nurses ask for every blessed detail in report - I get it all the time just giving report to the next shift. I figure I need to pass along pertinent, succinct info, and anything else they want they can look up themselves. Usually, when I come across people like that, I just don't let them get a word in edgewise - I give them my report and I'll answer relevent questions. I've been known to say "Sorry, you'll have to look that one up yourself."

I don't think a lot of ICU nurses realize what ER is all about. The focus is on the presenting problem. The patient shows up, gets treated, moves on. No time to take a comprehensive history except what is relevent to the immediate problem.

Good luck! And don't let anyone bully you!

[nursebewell]

I tend to give the same report whether it is to ICU or to the floor:

pts major complaint

name, age , dx, admitting md

past medical hx, past surgical hx

what was done in ER: labs with pertinent results, iv site, meds (including pain meds with pts response to such), ivfs, radiological tests and results, procedures

my assessment:lungs, heart sounds, cardiac rhythm on monitor, abdominal assessment, any edema, foleys, tubes etc, vitals, pt's orientation and usual state of health ( ambulatory, etc)

this assessment is thorough and straight forward, as ER nurses we don't always have time to delve into history, but if you give them an accurate and thorough account of what ocurred in the ER it is usually sufficient, and I've had many nurses including ICU nurses thanking me for such a good report

[traumaprincess]

I am an ICU nurse. We are definately from different planets. I agree with you all though. I here all the time from other nurses about how little info they get from the ER. It makes me laugh. I think many times it is an experience level. They don't even know what to focus on yet. I try to remind them that the patient just got to the hospital and it takes time to gather all the info they sometimes see as so important.

This is all any ICU really needs to know, why they came in, what you have done, what I need to have ready in the room when you get there ie: vent, etc. Mostly I want to get a feel for what to expect when the patient rolls in. It is also nice to know initial assessment for the presenting or abnormal issues like if they have a head injury I like to know what the initial neuro assessment etc....

And I get grilled for silly info during my report sometimes also, like to the next shift or when the patient transfers to the floor. Everyone has different things they get hung up on. I also tell people that they will need to find that information for themselves and I continue on with what is pertinent. I think humor is always good, maybe if you ever get really frustrated you should point out to the person on the phone that we do work in different worlds with different focus.

[Blee O'Myacin, BSN, RN]

or the ER, I want a description of what is happening to bring them to the unit (do I need to page respiratory - etc), any recent labs that were drawn (blood cultures, etc), what got ordered and not done, a brief medical history (age, diagnosis, anything recent surgery wise and since we are strictly oncology, what chemo they got last and how long ago)

I prefer to get report by system. Start at neuro and work your way down to GI/GU. Organize your thinking like this and you can rattle off a good report in under 5 minutes. Anyone stopping you for minutia can be politely told that its all in the chart.

Blee

[JMBM]

At our hospital, a few of the receiving nurses like the "I don't know" game. Essentially, they'll listen to report, then ask questions, each more obscure than the next, until you say "I don't know." Then, they win and report is over. ....... Seriously, when you are new at it, it helps to grab some scratch paper and jot down an outline of what you'll say - just a few words to keep you on track. Room destination, name, age, Dx and doctor - why and when they came to ER - Brief history - what you've done in the ER, notable labs, tests - quick assessment, LOC, airway/breathing/breath sounds/O2 sats - circulation/BP/heart rate - any disabilities. Any stuff they need to get ready - pumps, PCA, vents, etc. Just the facts and maybe a wish for a better evening.

[SKT686]

I really do thin experience has a lot to do with what the icu nurse wants to know. For me I need to know why their here, any major test results, access and resuscitation they haave recieved....But while we are venting...My pet peeve is at my hospital the nurse who calls report or transport the patient si not necessarily the patient who has been caring for the patient in the ED and therefore can not answer any questions that we may have. I know they are just trying to help each other out, but I need to talk to the person who has been caring for the patient.

Sheila

[pickledpepperRN]

Often the nurse calling report did not care for the patient so can only read from the chart.

I truly appreciate actually getting report from the nurse who had the patient. And knowing what was done.

Recently our "exacerbation of COPD, respiratory failure" was having an MI with CHF.

The doctor must have seen this guy with COPD so often it became a habit. A 12 lead was done but clearly not looked at.

Goes to show why each nurse MUST perform data collection, observation, and analysis of such to come up with a nursing diagnosis.

[hrtprncss]

Like everyone has said, there's no way you can please everyone. I'm one of the ICU nurses that ONLY want the bare essentials. Everything else can be found in the chart, including things that were done in the ER. I want to get my admission done as soon as possible, and a long report just takes time and prolongs the admission process. SO just keep doing what you're doing, some will be happy, some won't...c'est la vie...

[susi_q]

I agree ... report should be short, sweet and pertinent!!!

As to the OP situation though ... new onset afib will be anticoagulated ... recent GI surgery could get ugly really fast if not handled carefully. (Unless you like the smell of a good GI bleed in the morning ... mmmmmmm)

[dorimar, BSN, RN]

In defense of the ICU nurses, I think some info is pertinent to ask for. I do agree that some ICU nurses can be very rude (as can any type of nurse really). But, sometimes i get report for GI bleed and the ER nurse doesn't even know the H&H or coags, and I think it's wrong to get upset because I expect the ER nurse to know or at least find out. Many times they don't even know vent settings or how much dopamine the patient is on. I DO expect a medical history and I really don't think it was wrong to expect to know what GI surgery the guy just had (it could have been anything from a simple hernia repair to total colectomy or worse not even GI at all but AAA). And i am sorry, but all that IS pertinent. New onset afib involves anticoagulation and if the guy just had surgery for perfed bleeding ulcer then I do want to know. Also on night shift, many times the families leave from ER or as soon as the patient gets tucked in, and many times the only info we have is what you guys obtained(if the patient isn't all there). One of my big pet peeves is that the patient or family often times will bring a bag of medication bottles to the ER, and ER will write the med names but not dosages and frequencies, & then send them home with family before they get up to us. Also, many times an 88 y/o little old lady will come in with the report that they were DNR @ home or whatever care facility, but ER will not give DNR and paitent is unstable.

Also i have to agree with the posters who talked about the nurse giving report that didn't even have the patient. I don't get that at all. The whole point of report is for information, & if you don't have that you aren't the one who should be giving report.

Now, I am not saying it is ok to be rude. I am sorry that all ICU nurses get a bad name because of some of the rude ones. But I have had ER nurses get angry at ME for asking what I think are pertinent questions, and believe me I am not asking to test you or make you look stupid or get an "I don't know" out of you. Many times when the paiteint is admitted to ICU they are very unstable and I don't have time to study the chart before acting.

What i like to get in report is: What brought them in, pertinent tests and results, VS, Brief head to toe assessment, treatments and how they responded, medical history and medication history. Also if any consults were already called from the ER is helpfull to know.

Hoping not to get flamed for this post, really not trying to offend. I am hoping these discussions help us learn from each other. I think that's what this forum is for. I see many people get angry when others disagree with them, but it is an open forum made for open discussion.

Doris