pt report to ICU?

JessicRN · Apr 30, 2006

We give Name,age,dx,doctor,past medical hx, allergies. IV 's if any meds given if any, current set of vitals signs and O2 concentration if any (within last 10 minutes) anything that was not done or needs to be done (i.e blood,abx), Labs that are abnormal and why not treated if abnormal (low calcium MD aware no new orders) Troponin CKMB,K and aBG results even if normal. We report any other labs drawn I.E. UA cultures, blood cultures etc EKG results if any any procedures done and results if we know them. If the pt is on a vent we give all the current vent settings. If they want anything more they can ask the MD or resident because we do not learn the hx often, the residents do not share any new info with us they have the time to read the old charts and discuss amongst themselves. We deal with more then one critical pt at a time. They give us orders and we follow them and assess the PT for the effect, that is our job and we do it well. I had a great director in the another hospital that if she heard a lot of whining amongst the ICU and ER nurses she would float the nurse to the floor to see how it really was (walk a mile in my shoes). Any ICU nurse who has come to us was only able to deal with one critical pt at a time they paniced when told they had 4 pts with one going to the ICU (hey the pt going was not even on a respirator). We paniced when we went up there pt with arterial lines, central lines (we help put them in only)all the meds the pt gets (we start if they titrate them).Worked like a dream keeps the complaining down for a long while. :lol2:

teamlewis17 · Apr 30, 2006

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

As an ICU nurse for over 10 years and currently an ER nurse of 2 years, I understand both sides of the issue. Before I was in the ER I felt much the way you do. Unfortunately, in the ER it is rarely assigned pt load you can count on, as you never know what the next patient will be. In ICU you have one or two patients for a longer period of time. Your load is balanced more or less. In the ER we have 4 patients each. We may have 4 colds or we may have three patients, one a patient who is going to be admitted to PICU, one that is an MI, and one that is here with an ingrown toenail, and the next patient is a level one trauma and I'm stuck in the room for two hours and several trips to CT. Since we can't keep a patient in the ER when we have a bed available (with twelve to 20 patients waiting to be seen with a 2-7 hour wait) we have to move them out as quick as possible. On the floor we can say can you wait 20 minutes I just got a new admit, in the ER you get them sometimes 2 or 3 at a time depending on the discharges. If I'm tied up with my critical patient, whomever has a few minutes, or the CN will call report and take the patient up for me. They ask what is important from me and read the nurses and doctors notes. I understand the frustration on your side as I was there, but thats why it happens.

Lou Lewis, RN, MICN

teamlewis17 · 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.

I think you received bad information. Yes, our main focus is on the presenting symptoms, but without all the information you could make a very bad dx. An example with a new ER nurse. He came to me wanting to contact poison control about his new patient a 15 year old female that had been brought in by family for possible OD. Her presenting symptoms were syncope, weakness and ALOC. I asked why they thought it was an OD and he said she had previous SIA. I went to the patient was was pale, dry skin and not speaking. I asked her if she had taken anything and she shook her head no. I asked her if she had eaten anything resently and she shook her head no. Bottom line was she had tonsilitis so bad that she couldn't swallow, hadn't eaten and was weak and passed out.

Past hx can take you to the source of a problem such as being out of the country resently, change in diet, change in enviorment, etc. I check my labs personally and circle and abnormal labs with my initals and document it in my nurses notes that I brought it to the MD's attention and what was done to correct it or if that was normal for the patient (dialysis patient with chronic problems). It is very important to get the whole picture and address all the labs, rashes and current and past mental status to CORRECTLY DX a patient. Anything less is a lazy or incompendent nurse. Don't sell the patient short or yourself!

mysticalwaters1 · Apr 30, 2006

I think you received bad information. Yes, our main focus is on the presenting symptoms, but without all the information you could make a very bad dx. An example with a new ER nurse. He came to me wanting to contact poison control about his new patient a 15 year old female that had been brought in by family for possible OD. Her presenting symptoms were syncope, weakness and ALOC. I asked why they thought it was an OD and he said she had previous SIA. I went to the patient was was pale, dry skin and not speaking. I asked her if she had taken anything and she shook her head no. I asked her if she had eaten anything resently and she shook her head no. Bottom line was she had tonsilitis so bad that she couldn't swallow, hadn't eaten and was weak and passed out.
Past hx can take you to the source of a problem such as being out of the country resently, change in diet, change in enviorment, etc. I check my labs personally and circle and abnormal labs with my initals and document it in my nurses notes that I brought it to the MD's attention and what was done to correct it or if that was normal for the patient (dialysis patient with chronic problems). It is very important to get the whole picture and address all the labs, rashes and current and past mental status to CORRECTLY DX a patient. Anything less is a lazy or incompendent nurse. Don't sell the patient short or yourself!

Thanks I thought that didn't sound right. It just all depends on the situation at the time with signs and symptoms.

Dinith88 · May 1, 2006

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?

come to er with new a-fib...so why worry about a recent gi surgery?

NO-one here can speak for that particular icu-nurse...however, one reason i can understand why she asked you about this recent belly surgery is that in new a-fib, one major component of therapy will be to aggresively anti-coagulate the patient (heparin gtt, coumadin load, etc.) Now, if the patient had surgery for bleeding ulcers, perforated viscus, bleeding anything, etc., it becomes VERY pertinent for obvious reasons. ICU nurses are notorious for wanting ton know as much as possible...and for good reason. What is simply (to you) new a-fib, is just one component of what is happening with the patient.

scrmblr · May 2, 2006

come to er with new a-fib...so why worry about a recent gi surgery?
NO-one here can speak for that particular icu-nurse...however, one reason i can understand why she asked you about this recent belly surgery is that in new a-fib, one major component of therapy will be to aggresively anti-coagulate the patient (heparin gtt, coumadin load, etc.) Now, if the patient had surgery for bleeding ulcers, perforated viscus, bleeding anything, etc., it becomes VERY pertinent for obvious reasons. ICU nurses are notorious for wanting ton know as much as possible...and for good reason. What is simply (to you) new a-fib, is just one component of what is happening with the patient.

I understand why she wanted to know about the surgery. The problem was she DIDN't want to listen to me about the A-fib. She ONLY wanted report on this abd surgery.

erjulie · May 4, 2006

I've worked critical care all of my career, both ICU and ED, also briefly in Tele and cath lab. I understand all sides of the issue. However, it is a power game that nurses play when they ask questions about obscure medical symptoms/events etc. When I worked in ICU, even a very busy ICU, I usually had some time to sit (or stand) and read the previous charts on a patient. I never asked who the patient lived with and what their social situation was at home, then gave the "sigh" when the RN didn't know the answer. The only time this is relevant is if the person is in imminent danger of coding and advance directives are unclear. I have learned something from this thread, and that is to not respond with the freaking anger that I feel, but say: "I'm sure that you'll have time to read the chart to find out what the patient's ejection fraction was on his last admission." :madface: "Have a good shift!"

RNLex · May 6, 2006

We utilize fax reports - we fill in pertinent items on formed sheet and fax to ICU and other areas -