pt report to ICU?

RunnerRN, BSN, RN · Apr 5, 2006

I'm also a pretty new (9 months) ER nurse. Because we deal with "the here and now" there are a lot of things we don't think about. How many times how you given report to the floor or unit and been asked for the last BM. As the ER nurse, I really don't care when the last BM was except a)the pt had it all over the bed; b)the condition of the pt has some bearing on BMs (GI bleed, abd pain, constipation, ostomy placement). I have found at our hospital that sometimes the unit nurses will just go down their assessment sheet and fill it in during report....."What are the labs? Ok, now give me every medical problem this 81 year old person has had since birth. What color are their eyes?" Etc Etc Etc. I use similar formats for my report to the unit as were posted above....just go system by system, hit the high points, and tell them what we did in the ER. As was said above, usually the unit nurse just really needs to have a picture of how the patient is currently so they can prepare in advance. Just the same way it is nice to know if the EMS pt with a 5 min ETA is having chest pain or a cough.

JMBM · Apr 6, 2006

I usually try to start my report calls with a simple question, "how's your night going?" . Just an attempt to connect on a personal level. The reason is that telephone report is one of those times when conflicting interests seem to give rise to rudeness, misunderstandings and plain hard feelings. Let's see, why does that nosy ICU nurse ask all those silly questions? Well, because they aren't silly from her point of view. She's about to take responsibility for a critical patient and her only source of info is you. Okay, why does that rude ER nurse call to give report on a patient that he didn't even care for? Well, because that patient's ER nurse is working a code and ambulance is pulling up with another one and the calling nurse has to clear that room fast. Why didn't they write the dosages/frequency of medications? Well, because all we had was a hand-written list from the patient's purse without any dosages on it. If the patient can only say he takes a "little pink pill", that's what I write down. Why won't that lazy floor nurse take my call for report? Well, because she is in the midst of suctioning a patient's trach and its kind of hard to hold the phone with no hands. Why doesn't the ER nurse know the H&H? Well, because he has 5 other patients, 3 of which have abnormal labs and its going to take a minute to look it up again. My point is that while there are some rude souls out there, most cases just involve someone getting slammed. So, how is your night going?

jetsetter · Apr 7, 2006

I love this post... It's great.

So, OK. I work ER and ICU..... so.....

Our hospital has changed to a faxed report. One page form, filled in with the pt sticker and few deets....... thats all we get.

There are places on the form for A & O, confused, o2, wounds.

But most of the time the only thing they fill in is dx, brief ( and I mean brief, 8 choices to check a box on) history, IV's running, and critical values. I need more info.

Are they alert and oriented or confused. I need to know if it's safe to put them at the end of the hall or next to the station.

Can they walk? I need to know what scale to use to weigh them. I know their weight isn't ER's main priority. But I have to have ht, wt and allergies before our computer will let us do ANYTHING. Will not allow any of the templates we use start w/o this. Since most of these are cardiac pt's and on daily wt, an accurate weight is essential.

Wounds. Do I need an air mattress? try to get an air mattress under a 250 lb. incontinent grandma is 'stressful', So much easier to just tell me she needs one and let me put it on the bed in the first place.

O2. Really, how hard is it to mention they need O2 setup? But that little deet gets missed routinely.

Continence. please mention this.

OK, from the ER side of things.

We send up the faxed report after notifying house supervisor of impending admission. They give the floor the heads up to watch fax machine. Floor is supposed to call ER when fax is received and decision on room placement is made.

And then we wait......... and wait.

Now, cause I work there, I know what's going on. They're arguing (politely) about who has to take the admission. ( " no! not that person again! or I have one more pt than you do...) you get the idea.

So after a bagillion years, we call up and say "what room is he going to". and they say "I'm sorrry, didn't we call ages ago?" no you dork, you didn't.

"well, send them up in 15 min or so, I'm just too busy right now".

Yes, I know your busy. I'll tell the guy who's bleeding out down here to hold on to that last pint of blood he's got so it's a little more convenient for you.

Solution: I don't have a clue. Except maybe we should just remember we all on the same side, working toward the same goal.

Ruby Vee, BSN · Apr 7, 2006

i have had a few issues when transfering a pt to icu.
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. quote]
as an icu nurse, what i want to know is the presenting problem and what you've done about it so far, a brief review of systems noting anything out of the ordinary, and a brief history. (i'd like to know he has right hemiparesis from an old stroke or that his pupils are irregular from cataract surgery if you've already learned that, but his appy 47 years ago or her c sections in the 70s aren't worth dredging up except in passing, if that.) if he's diabetic, he may not have chest pain even when he's ischemic. if he's coming up with 4 pages of orders and you've already done the cxr, ecg and labs, i'd like to know that. (or if you haven't and i need to.) if the labs were sent, his k+ is 2.1 and you've already given him a bunch of kcl, please mention that, too. sometimes the resident absconds with all your notes and i can't look it up to see if you've already given it. the last dose of any important home medications is important, too. if he took his oral antiglycemic and is going to be npo, i know i need to watch his glucoses closely. but i can look up or ask him about his vitamins, etc.
if you know that he's in town for a convention and his family is 3000 miles away, or that his wife is on the way from across town or that his obnoxious teenagers are camped out in our waiting room, please mention that briefly as well. nothing like having a family come in all irate because you haven't come to get them to see dad when you didn't even know they were there. but none of that is worth dwelling on. i've had er nurses tell me that the wife is coming in on flight 111 from sante fe arriving at dulles airport at 2203. i don't need to know all of that. just tell me she'll be here around 2300. (on the other hand, if you know there are two or more wives and they need to be kept apart -- please don't let me find that out the hard way!)
there are nasty icu nurses who will give you a hard time regardless; try not to let that bug you. i try real hard not to let the nasty er nurses out of whom every nugget of information must be dragged bother me!

gassrn · Apr 7, 2006

I am an ICU nurse who really will just go with the flow. I tend to like to know the abc's of a pt and any extras I get is just icing on the cake. In my 3-4 yrs of experience in ICU I know that if the ED is getting slammed, it's about to come my way. Now if the night/day was a calm one down there in that Hole(ED)I might expect a few more details. Overall if I can be ready for whats coming my way than I'm OK. I work in a busy level one trauma/surgical ICU so I like to know if my pt is crashing and/or needs massive resuscitation so I can have critical equipment (level-one rapid infuser, vent, or blood products) on hand. For the most part quick and concise report will do I have found that if you feel like you are fumbling for info to give just ask do you have any Q's?

traumaprincess · Apr 7, 2006

Jetsetter, I loved your post!!! You did such a great job seeing both sides. I think report is just another way we as nurses take the opportunity to be hostile or act superior, rather than trying to understand that the nurse on the other end of the phone is just as busy and stressed as you are. It may be a different kind of busy or stress but they are still just as busy. We are nurses. We work hard. Our job is not easy. And really the only thing that makes it easier is when we all try to be compassionate and kind toward each other.

One hospital I worked in had a pre printed form for the ED nurses. They could fill it out and it was the generic report sheet. Some of the ED and ICU nurses got together to create this form so that everything that was really pertinent was on it. It seemed to work pretty well. The hospital I am at now is doing that with the OR also. ICU nurses are very detail oriented. They are suppose to be. But sometimes they seem to not understand that other areas have different functions and therefore a different perspective.

I am usually in charge and I hear so many rediculous complaints about report. If you have time to whine about the info you did not get you have time to research and get the info you need. If I am REALLY WORRIED about the lab results I can look them up on the computer before the patient even gets there. And what is to worry about? If you are worried about the H&H maybe you should be more worried about the BP, HR, etc..... Is the patiet symptomatic??? And are you going to call the dr for orders before you even get the patient to your unit? No, so find out the info you did not get when the patient arrives. I personally would rather just get the patient in as soon as possible so we can start doing our thing. I have been known to meet the ER nurse in CT or in the ER and help them transfer a patient if they are too swamped because if it is a really critical patient they need the attention an ICU nurse can give. I would rather not make them wait until someone is able to transfer them.

Maybe we should worry more about the patient then the nurse giving us report? They are doing the best they can.

scrmblr · Apr 10, 2006

great advice. I think it really helped me see both sides of things!

wooh, BSN, RN · Apr 10, 2006

Transferring a pt from M/S to ICU one night, after report I got a snotty, "Is that all you know on him?" I responded back with, "On him yes, would you like to hear report on my other 7 patients too?" After that, they never again got snotty with me. I think ICU nurses tend to forget that outside the ICU, you've got to stay way more focused because you've got more than 2 patients to keep up with. Give report (basics and what they'll need to set up, and the little family issues that you don't chart), let them get whatever else they need from the chart. It's what I do when I get report from ER, they're just as capable of reading the chart as I am. Not to mention, they probably won't trust the info you just gave them, so they'll look it up anyway.

Palamejo · Apr 20, 2006

I usually try to start my report calls with a simple question, "how's your night going?" . Just an attempt to connect on a personal level. The reason is that telephone report is one of those times when conflicting interests seem to give rise to rudeness, misunderstandings and plain hard feelings. Let's see, why does that nosy ICU nurse ask all those silly questions? Well, because they aren't silly from her point of view. She's about to take responsibility for a critical patient and her only source of info is you. Okay, why does that rude ER nurse call to give report on a patient that he didn't even care for? Well, because that patient's ER nurse is working a code and ambulance is pulling up with another one and the calling nurse has to clear that room fast. Why didn't they write the dosages/frequency of medications? Well, because all we had was a hand-written list from the patient's purse without any dosages on it. If the patient can only say he takes a "little pink pill", that's what I write down. Why won't that lazy floor nurse take my call for report? Well, because she is in the midst of suctioning a patient's trach and its kind of hard to hold the phone with no hands. Why doesn't the ER nurse know the H&H? Well, because he has 5 other patients, 3 of which have abnormal labs and its going to take a minute to look it up again. My point is that while there are some rude souls out there, most cases just involve someone getting slammed. So, how is your night going?

Love your outlook! I wish more nurses could have this point of view. Most of us are just trying to do our best under not-so-best circumstances, after all.

mandymoo21085 · Apr 30, 2006

There Is Nothing Worse Than To Be Right In The Middle Of Your Report And The Nurse Say " How Do You Spell Their Name". I Have Been In The Er For 14 Years And Have Only Came Across A Few Icu Nurses That Dont Give You A Hard Time Giving Report. They Are In Their On World Over There

LeahJet, ASN, RN · Apr 30, 2006

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. .......

That is so funny and true............

and yet sad in the fact that some people rely on silly infantile games to better their self esteem.........

mysticalwaters1 · Apr 30, 2006

I'm going from Med surg to ER and this is a problem I'm going to have. An Er nurse told me one of the difficult things in ER from med surg is you only focus on the presenting symptom. Yet, if there is a problem with another thing that should be addressed I thought. I would get upset on med surg when pt from ER the K is 2.8 and nothing done about it. Is that resonable to ask them if something's done about it? I'm confused? Where is the line drawn? For ex I know if the pt presents with pneumonia or cellulitis usually the ER would start one of the abx but at the same time if other issues like labs off shouldn't that be addressed? I can see having to move people out of ER to make room for others but at the same time? NOw this same ER nurse told me also if they are in with one major thing we don't want to hear about the rash the pt had for 3 weeks that they can follow it outpt so this confuses me. The idea is it's an Emergency room.