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?
I always ask for Bipap and Vent settings and am always, always amazed at the responses I receive... mostly "I don't know. Respiratory deals with that down here." I don't understand how a nurse can feel safe not knowing what settings their patients are requiring.
My personal favorite was just the other night, hearing that a patient's been on 100% Bipap for nearing 12 hours with failed attempts of weaning down the FiO2. Are you planning on coding the patient on the way up or are we intubating before that happens?
My other favorite - "The patient's been fine on 100% NRB the past 4 hours." I'm sorry, what?
I always ask for Bipap and Vent settings and am always, always amazed at the responses I receive... mostly "I don't know. Respiratory deals with that down here." I don't understand how a nurse can feel safe not knowing what settings their patients are requiring.
My personal favorite was just the other night, hearing that a patient's been on 100% Bipap for nearing 12 hours with failed attempts of weaning down the FiO2. Are you planning on coding the patient on the way up or are we intubating before that happens?
My other favorite - "The patient's been fine on 100% NRB the past 4 hours." I'm sorry, what?
No way are you sending me those patients...
I work IMCU which is a stepdown unit. I got one the other night whose sats were in the 60's with 100% FIO2 on BiPap. She was a repeat CVA and they had made her a DNR. They had intended to take her to the unit till the family made the DNR decision, so they brought her to us instead. I couldn't figure out why because I expected her to go on my shift, but believe it or not, her Sats were 100% when I left at 0700. I don't know if they weaned her down or what, they had not tried on my shift.
Specializes in Emergency Medicine, Dr. Office, Psych.
i have to applaud all the active er nurses, i was once one myself, the number of things to remember is out of this world, (i loved it but they phased out lpn's in the er), i remember the same situation as was described in someones post, we had a gsw to the eye of an 8 yr old & we had a floor doc calling down yelling at us because the bag was up & was dripping w/out a machine? "don't you have units down there", i clearly to this day remember the rn supervisor in the er staying & i quote:
"we have plenty of machines down here, but right now we have an 8 yr old w/ a drunk mother & a gsw to his right eye, if you would like to come take care of him we would gladly get your patient who is dehydrated on a iv machine!"..... that was 1996 and i still remember her telling him how it was!!
Well, I call the ER for report when I am ready to get the pt. I try really hard to call them before they call me. I HATE IT when the ER pt shows up before I'm ready. I'm prob going to be with the ER pt for at least an hour anyways, and need to get my other pt tucked away for a bit.
I have never worked in an ER. I've been in ICU for decades. I don't want to hold them up in the ER, especially if the pt is really sick. The sooner I get the sick pts, the sooner I can get things in order. I don't expect the ER to do much of that. I don't know what's going on in the ER at that particular time. ABCs, treat pain, initial working diagnosis, start IV, send off some labs.
I want to know what they've done thats been ordered and what they haven't gotten to yet. Meds, labs, vitals, history, allergies, family, IVs. The second I get off the phone, I gather what I need in the pts room. I don't expect to get everything from report, I know how to read, and there are lots of places to get info from in the chart.
Well, I call the ER for report when I am ready to get the pt. I try really hard to call them before they call me. I HATE IT when the ER pt shows up before I'm ready. I'm prob going to be with the ER pt for at least an hour anyways, and need to get my other pt tucked away for a bit.
I have never worked in an ER. I've been in ICU for decades. I don't want to hold them up in the ER, especially if the pt is really sick. The sooner I get the sick pts, the sooner I can get things in order. I don't expect the ER to do much of that. I don't know what's going on in the ER at that particular time. ABCs, treat pain, initial working diagnosis, start IV, send off some labs.
I want to know what they've done thats been ordered and what they haven't gotten to yet. Meds, labs, vitals, history, allergies, family, IVs. The second I get off the phone, I gather what I need in the pts room. I don't expect to get everything from report, I know how to read, and there are lots of places to get info from in the chart.
Yep, I am learning that too. I don't mind getting a new trauma from ER but man getting a new medicine patient can be rough. We don't even get a verbal report any more. We don't have a unit clerk and the charge usually puts in the orders, but oooooh if she doesn't it can be a pain.
Thanks to everyone that responded! I learned a lot about all the different things I never thought about/have been given during a report. This question/post was not intended to diss on ER nurses of complain about what wasn't passed along. Sometimes some people don't think to tell you certain things that is helpful for you so you try to remember to ask for the information! Thanks for all the replies.
We fax report at my hospital too. I ALWAYS wait and then call to 1) make sure the fax went through and someone noticed it was there and 2) ask if the receiving nurse has any questions.
There are many times I have something to tell the nurse, but did not want to write it on the report. For example, something that still needed to be completed, family dynamics/ problems that happened in the ER, anything that had occurred that was out of the ordinary.
I know when I work the floor, I appreciate this type of report. When I work in the ER, I try my best to help out the floors.
As was stated above, the ER marches to the beat of a different drummer than the floors. My ER has a hand-off sheet that we usually fill out before we call report to the floor. Goes through the pertinent hx, dx, orders, labs, results, what got done, what didn't get done (nope, he didn't get that 10am lipitor) and anything else that might matter. Seems to work very well.
Mahage, LPN
376 Posts
I'm not clear on that one either, just policy as far as i know.
Mahage