Things I have learned to ask for when getting report from ER

Usually you receive a great report from the ER when getting new admissions but here are some things I have learned the hard way to ALWAYS GET THE ANSWER FOR. Besides the obvious (vitals, history).

- Ask if there is an order for them to be on fluids. I have been yelled at by an MD because the patient did not come UP on fluids. Make sure they get it started in the ER. Especially if they have been sitting down there a while and the order was written some time before they come up.

- What was the patient's O2 saturation? I've had someone come up with a sat of 86% on room air and a heart rate of 125 and I was told they were perfectly fine downstairs. (I know things can change fast, but come on. They were pneumonia pathway and I should have thought to ask this ANYWAYS).

- Is the med recon form done????

- What meds were given and why.

What else can you think of to add that you have learned?

As a new ER nurse, I will gladly start the fluids for you if I have them. We only stock NS and LR, everything else has to come from pharmacy. I do not have time to hold the patient in the ER while waiting for some fluids to come down so I can start them. :wink2:

Make sure you ask your patient's baseline and current mental status. I see this overlooked in report many times and not knowing this can cause some poor outcomes if things change quickly with the patient

Ask if they have family/social support with them and/or available. I have had nurses call back down for this info several days later when the patient was getting ready to be discharged and there was nobody to drive them home. I don't remember anything about the patient for more than a few minutes after I send them up, so be sure to ask!

If you work in an ICU, be sure and try to get the picture of how fast this patient crashed/became critical. It will give you an idea of how quickly they may turn sour on you.

I don't envy your ER nurses having to do the med recon forms :) We only have to the intial ER recon form, and the floors do everything else.

Last of all, remember that we are extremely busy and have different priorities than you do. We may ask you to hang the fluids on a stable patient so we can deal with the GSW to the chest that just walked in the door and up to the desk while we were talking to you. We will try and return the favor and help you all we can!

If the 2nd set of Trops and Myoglobins have been drawn. If not-- when are they do? (Policy is 3 hours after the first set) Believe it or not, this is the most neglected thing. A lot of NSTEMI's have been diagnosed long after the required 3 hours when they've been in the ER for six. It makes the attending very upset.

Did the ER doc sign ICU/PCU protocols? If not, they can't come to our floor. This is also neglected.

Rhythms.

Which primary doc was assigned to the patient. Were they notified upon admission?

Do you have an off Tele order to transport to the floor or are they coming up on tele?

I always ask if they have family with them and for the ER nurse to tell the family to come up with the patient...especially those who are not A&O. So many patients have come up and don't even know their full name and the family is no where to be found. Also, family sometimes bring bags of meds which I want to see. Then too, it's nice to have them take all valuables (esp jewelry and money) that the patient has home with them.

And another thing I always ask..."When are you sending them up?" There's nothing worse than getting a patient that you aren't prepared for.

What amazes me is that some pts come from ER with all labs done, fluids hanging and catheters in place after being there only 4 hours, others come up after being there 24 hours with no pump, just the bag, field sites still in, no family, no data base and screeming for pain meds! I don't know how the situations can be so different. I guess it may be what else is going on in the ER at the same time. I have been told stuff was done in report but it would not be such as labs and catheters etc. Now the ER is not even required to call us report, they just fax it to us. We have to deal with what we get, like it or not.

Mahage

I've learned to ask about any recent labs, as sometimes ER labs don't so up in the computer for a while.

I've learned to ask if they have more than 1 IV, especially if they are running fluids AND needing frequent lab draws.

I always ask if family is with the pt

If I'm not busy, I always ask if the ER minds if I come and pic up the pt.

What amazes me is that some pts come from ER with all labs done, fluids hanging and catheters in place after being there only 4 hours, others come up after being there 24 hours with no pump, just the bag, field sites still in, no family, no data base and screeming for pain meds! I don't know how the situations can be so different.

I would think that the patient not "all in order" was probably the most stable patient the nurse had at that time. I've had several critical patients at the same time and had to quickly determine who would die now. That person was my priority until he was stable enough to survive for a little while, then onto the next unstable one.

Imagine juggling bowling balls with one hand while someone throws another one at you just as you drop one. That's ER nursing.

When I work in the ICU, my patients are all clean, their lines all in order and my background knowledge on the patient has been researched prior to giving report to the next shift and handing the patient off. This just isn't the case in the ER.....there are plenty of times I'll get a patient from another nurse, keep them for about 30 minutes and then transfer them to the floor. Not a lot of time to do what I do in the ICU or floor!

What amazes me is that some pts come from ER with all labs done, fluids hanging and catheters in place after being there only 4 hours, others come up after being there 24 hours with no pump, just the bag, field sites still in.

This is the norm at my facility. I never thought twice about it. In fact, I think that it is policy. They have a pump if they have critical meds hanging, but not for NS, LR, or D5W. We change the field site on the floor because we have less patient to staff ratio.

I honestly didn't know it was done any other way.

Why is the field site changed? I assume you're talking about the IV site? Just wondering...

I would think that the patient not "all in order" was probably the most stable patient the nurse had at that time. I've had several critical patients at the same time and had to quickly determine who would die now. That person was my priority until he was stable enough to survive for a little while, then onto the next unstable one.

Imagine juggling bowling balls with one hand while someone throws another one at you just as you drop one. That's ER nursing.

When I work in the ICU, my patients are all clean, their lines all in order and my background knowledge on the patient has been researched prior to giving report to the next shift and handing the patient off. This just isn't the case in the ER.....there are plenty of times I'll get a patient from another nurse, keep them for about 30 minutes and then transfer them to the floor. Not a lot of time to do what I do in the ICU or floor!

YEs, I would think that would be the case in most situations but the time difference is the kicker. But as I said when coming from the ED we deal with what we get just as they do. I know that it has got to be stressful down there.

This is the norm at my facility. I never thought twice about it. In fact, I think that it is policy. They have a pump if they have critical meds hanging, but not for NS, LR, or D5W. We change the field site on the floor because we have less patient to staff ratio.

I honestly didn't know it was done any other way.

I guess it is different at different facilities. It is understandable when pt is only in ED a few hours but sometimes we get them after 24 or even 36 hours in ED with out these things, but other times the pt is all done up, labs done, etc. when we get them after 4 hours. I think it just depends on what else is going on.

Why is the field site changed? I assume you're talking about the IV site? Just wondering...

I'm not clear on that one either, just policy as far as i know.

Mahage