Shift change department transfer errors

purpleiris · Nov 17, 2008

How is it any safer for the pt to be in the ER during shift change, than it is to be in the CCU Stepdown during shift change?

I guess I thought it is safer because of the first 45 minutes before the change of shift when in the ED the patient will acutally have a nurse who knows them instead of a nurse who tucks them in to wait until the next shift.

Personally, I would rather get an admission 15 minutes after I start than get one who has been waiting over an hour to be seen and the patient and the family is ******!

Our Ed shift ends one hour before the floor shift starts, so they have a mission to get the patient to the floor before they leave. The last hour of everyones shift is already so busy a late transfer just seems unfair. Maybe it would be more effective for the Ed to start working an hour later than the floor nurses?

BrnEyedGirl, BSN, MSN, RN, APRN · Nov 17, 2008

Our Ed shift ends one hour before the floor shift starts, so they have a mission to get the patient to the floor before they leave. The last hour of everyones shift is already so busy a late transfer just seems unfair. Maybe it would be more effective for the Ed to start working an hour later than the floor nurses?

I really don't want to see this turn into an ER vs floor nurse bashing session,.and as I said earlier I have been on both sides of this debate. I honestly feel that it doesn't matter who changes shift when. The hospital must function consistently 24/7. Patient care cannot slack off a certain times of the day, certain days of the week etc. We must take the very best care of our pts at all times. If a pt has orders for admit and the bed is available the pt should be transfered.

Under most circumstances there are other pts in the waiting room waiting for that ER bed. Those pts in the waiting room are just that, our patients. Patients we are responsible for and must care for. Would you want your sick child/mother/father etc to wait an additional hour in the waiting room to be "fair" to the staff? How "fair" is that?

ICURN48180 · Dec 2, 2008

I came home just this morning from a hellish midnight shift in the ICU, ranting and raving to my husband how shift change transfers of critically ill patients are unsafe and putting my license in jeopardy! I have decided to protest but need some information/evidence to plead my (our) case.

For the second night in a row I received a transfer from the ER at shift change. They called report 10 minutes prior to my shift as I walked in the door, and hadn't even hung my coat up. I was pressured (ordered) by my charge nurse to take report, so I didn't have a choice. I requested both nights that they wait to send the patient so I could at least gather what I NEEDED for the patients arrival, and assess my other critical patient, and both times patient arrived to the floor within 10 minutes. In the meantime, I have ANOTHER critically ill vented patient trying to constantly extubate himself because for some reason we can't sedate the poor guy..... that I don't even have time to assess prior to the new critical admission.

The other nurses in my unit are GREAT however when there are two other admissions and two transfers going out to other hospitals because they are too critical for us to handle, they were busy with their own messes and help was somewhat limited. I was tied up with my patient with no blood pressure etc..., (she had already arrested and was coded for 45 minutes in ER, and was in cardiogenic shock) for easily 2 1/2 - 3 hours. Then had to leave her to take care of my other patient who was being transferred out to another hospital. Thank GOD he didn't extubate himself while he was being somewhat "babysat" by us all. As soon as he left the floor I had to pick up another patient. She was at least stable and not vented, but she was neglected for most of the night as well.

If I could have had just a 1/2 hour to: assess my first patient, run his strips, zero his line, make sure his IV's are correct and working etc... you know just a quick but NECESSARY assessment, and gather what I need for the crashing patient on the way it would make a HUGE difference. It isn't safe or fair to either patient to not have that time to devote to them. They are in INTENSIVE care for a reason. I can't tell you how many times I've followed another nurse and found drips hanging that were incorrect or running at the wrong rate etc... we all make mistakes. Imagine not being able to identify a mistake like that until three hours into YOUR shift, under YOUR license because you were too tied up with a shift change transfer to find it. THANK GOD AGAIN, that my patient's were fine and didn't have anything going on that I needed to fix!

If anyone can point me in a good direction to research policy at other facilities or evidence based practice on this topic I would greatly appreciate it!

Thanks for letting me vent!

purpleiris · Dec 2, 2008

I was working on a research paper that was requested by my level supervisor and just happened to coincide with a project due for my BSN. :typing I was hoping to find something to validate our thoughts and fears with this posting and with many internet searches -- all to no avail. I did not receive many responses that agree with me about the danger of shift change transfers. I have had many days like the night you describe and also I have had the transfer 30 minutes before shift change who has been waiting to be assessed for over an hour.... It just seems so unnecessarily dangerous to me. :banghead:

My intent was to prevent the danger I believe a patient is in with shift change transfers NOT to start a war between ICU & ED. :saint:

I have given up and am working on another project... :uhoh21:

ICURN if you find some information I would love to hear about it.