Safe patient hand-off

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Specializes in Public Health, TB.

My latest pet peeve at work has become the "shift change transfer". Now all you ED folks, don't flame me, please, as I'm am not speaking about patients coming from your department. I understand that you have little control over MD dispos, traumas coming in, and what not. I am referring to transfers from unit to unit.

Background: I work on a cardiac tele floor with the usual get 'em, get 'em out kind of patient flow. We get patients from cardiac recovery, EP lab, other units for cardiac issues, and ICU, as well as ED and direct admits. As soon as they are deemed stable they are discharged or transferred off ASAP to make room for more, which I understand is the norm. We turn over our census (29 beds) between 70-90% in a 24 hour period. I work the 3-11 shift, and it is not unusual to get 4 or 5 admits/transfers right after 3, and then 3 or 4 at 7, and 2 or 3 just before 11. Do you see the trend? Everyone is coming at shift change!:bugeyes:

Problem: ICU, who sends us OHS pts, insists that patients come at 3 or 7. The docs write the orders in the am on morning rounds. ICU calls report 30 minutes prior to arrival, then a tech brings the patient. This usually results in the off-going nurse getting the report, then passing it on just as the patient arrives. If the oncoming nurse has a question, the sending RN has usually gone already. Our safe patient hand-off guidelines say the sending nurse should be communicating with the receiving nurse, but the transfer at shift change makes this next to impossible. The sender and receiver also supposed to double check any titrated gtts (like insulin) and temporary pacer settings, but this doesn't happen because the sending nurse doesn't come with the patient. We have been firmly instructed that OT is to be avoided, so the sending nurse must stay in ICU to report off on her patient, then leaves.

So my question is, how do other places do it? Or is this the norm and I should just suck it up?

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We tend to get a lot right around 6 - with shift change at 7. It's annoying, but at least there's time to get a full report and do an assessment, even if the receiving nurse doesn't have the pt for long. You're right, JCAHO wants us to have standard handoff reporting, with the opportunity to ask questions. This would be something you might want to bring up in a nurse practice forum, or with management if you have that kind of relationship. Obviously it might happen occasionally by chance, but it shouldn't be the norm.

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Specializes in Cardiac, ER.

Wow,..we do transfer at all hours,...but techs are not allowed to transfer anyone on a monitor or a titratable gtt, those pts must have an RN transport.

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My latest pet peeve at work has become the "shift change transfer". Now all you ED folks, don't flame me, please, as I'm am not speaking about patients coming from your department. I understand that you have little control over MD dispos, traumas coming in, and what not. I am referring to transfers from unit to unit.

Background: I work on a cardiac tele floor with the usual get 'em, get 'em out kind of patient flow. We get patients from cardiac recovery, EP lab, other units for cardiac issues, and ICU, as well as ED and direct admits. As soon as they are deemed stable they are discharged or transferred off ASAP to make room for more, which I understand is the norm. We turn over our census (29 beds) between 70-90% in a 24 hour period. I work the 3-11 shift, and it is not unusual to get 4 or 5 admits/transfers right after 3, and then 3 or 4 at 7, and 2 or 3 just before 11. Do you see the trend? Everyone is coming at shift change!:bugeyes:

Problem: ICU, who sends us OHS pts, insists that patients come at 3 or 7. The docs write the orders in the am on morning rounds. ICU calls report 30 minutes prior to arrival, then a tech brings the patient. This usually results in the off-going nurse getting the report, then passing it on just as the patient arrives. If the oncoming nurse has a question, the sending RN has usually gone already. Our safe patient hand-off guidelines say the sending nurse should be communicating with the receiving nurse, but the transfer at shift change makes this next to impossible. The sender and receiver also supposed to double check any titrated gtts (like insulin) and temporary pacer settings, but this doesn't happen because the sending nurse doesn't come with the patient. We have been firmly instructed that OT is to be avoided, so the sending nurse must stay in ICU to report off on her patient, then leaves.

So my question is, how do other places do it? Or is this the norm and I should just suck it up?

Refuse to take the transfer if it is within one hour of shift change. Either they get the patient out by Six or they can wait until eight. We had the same problem with the ER when I worked as a tech. The nurses dedicided that they would not take report while they were doing report. The manager backed it up. What usually happens is that the nurses keep the patient until shift change. They don't want to give report so they try to transfer right at shift change. If they transfer earlier they get another assignment. If you have a policy that the gtss and pacer setting are checked then follow the policy. If the nurse doesn't come over have your manager talk to theirs. Report is supposed to be person to person with opportunity to ask questsions per the JC. If they are not following this ask why.

David Carpenter, PA-C

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Specializes in Public Health, TB.

Thanks for your replies. We have spoken to our manager, and she agreed to speak to the ICU manager, but so far these suboptimal transfers continue. I thought I would check in with the Allnurses community to see if I am being out of line before pressing the issue.

BTW, when I resisted one of these transfers last night citing a need for a safe hand-off, I was told I was being unreasonable, and that " we (the ICU) have a policy that allows the techs to do transfers".

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i am very interested in what nurses say makes a good handoff. if you are a nurse who has participated in shift change reports (patient handoffs), i need your help! please take a few minutes to answer some questions about the best or the worst handoff that you can remember.

what you and other nurses say are important characteristics of a shift report is the focus of my doctoral dissertation research in communication. please help by linking to this site for more information:

http://comm.uky.edu/streeter/survey

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Specializes in Rehab, Med Surg, Home Care.

Med-Surg/ Tele floor here; we also get change of shift transfers (like arriving at 1845) waaay too often for it to be a coincidence. We are lucky enough on weekdays to have an eve Unit Coordinator to do orders, if not the Charge makes every attempt to do them. It works out if we get one transfer/ admit; we can handle that. When they send us a parade of 3 admissions arriving 10 min apart, that's when things break down. The charge nurse is trying to do charge hand-off report; the oncoming nurses have all their other new pts to assess and start the eve med pass. Orders don't get written or consequently acted on for like an hour or 2 before the dust settles. Dinners, blood sugars and meds are missed or at least late. Little details like the patient will be on an insulin drip do not get mentioned. We are setting ourselves up for disaster, IMO it is a matter of time before we see a sentinel event that should have been totally avoidable. And THEN we are supposed to parrot what a good hand-off we do as part of our policy! Yeah, right. Scary!

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Does anyone have a tech to tech report sheet? IF so please send me a message we're thinking of starting that trend on myy floor..

thanks in advance

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i am very interested in what nurses say makes a good handoff. if you are a nurse who has participated in shift change reports (patient handoffs), i need your help! please take a few minutes to answer some questions about the best or the worst handoff that you can remember.

what you and other nurses say are important characteristics of a shift report is the focus of my doctoral dissertation research in communication. please help by linking to this site for more information:

http://comm.uky.edu/streeter/survey

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