Report without Orders?

classicdame, MSN, EdD · Jul 26, 2011

and how would you know what to do with the patient without orders?

We have a form that the ER nurse faxes to the floor that passes as a report. They may also choose to fax the MD orders at the same time. Then, the receiving nurse has the option to call ER after getting report to clarify any issues. As you know, sometimes the two nurses play phone tag, so the faxed report and orders do help us with admits.

MunoRN, RN · Jul 26, 2011

Where I work the floors don't get the orders prior to report, there are times when there aren't even orders written yet when the patient is transferred. In ICU, the patient is transferred without orders being written yet about 1/3 to 1/2 the time. We're a long way from having orders in your hand when you get report, although it would be nice.

xtxrn, ASN, RN · Jul 26, 2011

Is anyone else expected to routinely take report and accept a pt from the ER with out seeing the admitting orders?
I just transferred from med surg to the icu; and I'm now forced to routinely take report on pts without the ER sending me the order. The med surg floor that I came from insisted that the orders be faxed before report was given and maintaining that prevented a lot of problems from ever reaching the floor or the pt. It seems kind of dangerous to me, but I was wondering what you guys think.
Thanks

Other than getting a verbal phone report from the ER, I never got orders 'tubed' (older days) or faxed before seeing the patient. Never. You got report- then got the patient. If lucky, the reporting nurse would tell me of anything weird- otherwise, it was just expect the standard orders for that patient (and if practical, have stuff ready), and know that with an admit, you just never know until you get them.......:)

miss81, BSN, RN · Jul 26, 2011

Where I work the floors don't get the orders prior to report, there are times when there aren't even orders written yet when the patient is transferred. In ICU, the patient is transferred without orders being written yet about 1/3 to 1/2 the time. We're a long way from having orders in your hand when you get report, although it would be nice.

Same situation in my hospital MunoRN. Sometimes the ER doc will write an order to admit to "Dr. So-and-so, he is aware of admission" and "Dr. So-and-so will assess pt in am."

colnurse · Jul 26, 2011

we don't get orders 85% of the time, down in the er it is decided whether or not to admit the patient to hospital on a form they fill out it is obs or inpatient. but orders rarely unless the patient needs to go right to surgery, then there may be orders already and sometimes not, sometimes the doc comes up right away because the hospitalist was informed we need clearance, but usually we get a faxed report from the ED and then when the patient gets to the floor we call the admitting doc, let them know they arrived to the floor to the admitting paperwork that needs to be done for all patients regardless of their admitting status and hope the doc gets there soon

xtxrn, ASN, RN · Jul 26, 2011

and how would you know what to do with the patient without orders?
.

We had to call the doc when the patient got there, and after doing a brief assessment, to get questions lined up for the doc in one call.. the ER doc had already seen them, so it wasn't like they were walking in cold...(well, some were a bit chilly )

Meriwhen, ASN, BSN, MSN, RN · Jul 26, 2011

I will take report from an ER on a pending patient without having orders yet; however the patient can not be admitted to my unit without orders.

amarilla, RN · Jul 26, 2011

We only get a SBAR form faxed up to us from the ED when the patient is on their way up. Tells us chief complaint, most recent vitals, IV site, and usually that's about it.

Protocol states that no patient may be admitted to a floor without (at least) interim orders, but a number of them are. Always the same offenders; docs that want the admission but don't want to be paged for orders in the middle of the night. With the others, we don't get a peek at the orders (labs, fluids, tests, etc) until the patient arrives. Makes your heart beat a little faster to not know what's en route, that's for sure.

missbutton · Jul 26, 2011

I didn't realize that that's the way it is at other hospitals. In my defense, the orders are the only official notice that we get, its the only thing that even has the pt's name and DOB. Thanks for sharing.

PediNurse3 · Jul 26, 2011

When I worked in the ER, I would never send a patient anywhere without orders, but that was because we couldn't. We had to have something along the lines of "Admit to impatient", diet, activty, vitals at the very least. Sometimes our doctors would write admission orders, other times they would wait for the hospitalists/surgeon/whoever to see the patient to write the orders themselves. Most of the time the intensivests would see the patient's in the ER and write orders before they were transfered up. The trauma surgeons were very passive aggressive about it sometimes...but I won't get into that.

I'm in the PICU currently and we get patient's with no orders all the time. They arrive on the unit and our doctor's write them all, or endocrine/ HO/ whoever. I believe the idea behind it is that less time in the ER is associated with a more favorable outcome so they want to get them up as quickly as possible.

xtxrn, ASN, RN · Jul 26, 2011

I didn't realize that that's the way it is at other hospitals. In my defense, the orders are the only official notice that we get, its the only thing that even has the pt's name and DOB. Thanks for sharing.

Our nursing supervisor would notify us of admissions. Then the ER would call report (sometimes hours later). They had talked to the doc who would have them on the floor, so when I'd call for orders, he/she at least had a clue. :) It worked for decades like this:) We didn't have fax machines until the mid 90s