Transfering pt to Long term facility

deeDawntee, RN · Aug 30, 2007

I think that the first question was reasonable that the nurse know if the patient would require IV antibiotics after transfer as it would determine pt's acuity.

Now the second question, of how long the patient was on IV antibiotics, I do think you were bullied. I imagine you just looked at the MAR and was able to tell her how long?

Aren't forms faxed to the facility before the patient is actually transferred? Do they not have most of that information available to them if they actually went and looked for it?

I would guess that these nurses are stressed out on their jobs and are taking it out on you. I would probably try my best to give them the information they needed if possible. It wouldn't surprise me if there is some antagonism there between hospital and LTC nurses. They probably haven't been treated too well by some hospital nurses either and are being defensive. That doesn't make it OK, by any means. If they were asking for a lot of unnecessary details, I may say something like that was already sent to you or it will be in the paperwork that is sent with the patient. (if indeed it is) I think that would be a reasonable response.

fultzymom · Aug 30, 2007

I work in a LTC facility and know that some nurses do this when taking report. And no, they should not speak to you like that. On the flip side of things, how come we can't get simple info like when was the patients last BM? And why do some of the nurses out at the hospital wait to send the paperwork to us when they send us the patient? We need that before we get the patient so that we can have everything ready when the patient gets here. I once got an admission at 8 pm and when he got here found that he was supposed to have a wound vac on?! I should have known that before he was sent to us as I have to order that and have it delivered.

**canoehead, BSN, RN** · Aug 30, 2007

It's not OK to yell, but those are reasonable questions IMO.

CoffeeRTC, BSN, RN · Aug 30, 2007

Lets not turn this into another us vs them debate. The LTC nurse was wrong in her approach. There are ignorant people everywhere.

Yes..the info should go to the LTC at transfer. (but it doesn't happen alot of times with a few hospitals in our area) A good DC planner or admissions person would have that info to the LTC nurses before transfer. Most LTCs are not connected to a pharmacy. It takes hours if not a day to get some supplies such as a wound vac, special wheelchairs, special beds, meds, IV or Oxygen pumps etc or special wound supplies. Knowing what the patient will be ordered will save time and allow for a smooth transfer of care. If the info (such as the length of IV antibiotics or the start date) wasn't supplied, I'm gonna be calling you anyway.

Again...there is always gonna be a few bad apples in every bunch no matter where you are.

TheCommuter, BSN, RN · Aug 31, 2007

I work on the short-term rehab unit of an LTCF, and I regularly receive telephone report from hospital nurses who are preparing to send me their discharged patients. While the receiving nurse was being rude and abusive, her questions were important.

LTCFs do not have the same resources as acute care hospitals. We must order our meds from an outside pharmacy, and wait hours for the medication to be delivered to the facility. If the med order does not reach the pharmacy by a certain time, the patient could go all night without meds. We must also order CPM machines, air beds, IV pumps, and other supplies from outside entities. Therefore, I am always going to ask the sending nurse about IV access, special diets, activity level, code status, continence, and anything else I can think of.

By the way, I have only had 1 antagonistic report call from a hospital nurse. She was furious because she had been placed on hold for too long. She had the nerve to state in a caustic tone, "I'm busy, and my time is valuable!" I'm busy too, Lady!

dria · Aug 31, 2007

i think that all the previous posters have made good points in their responses. obviously, it is never appropriate to be rude.

what i believe the issue to be is a disconnect between the the types of reports given in acute care vs ltc. now in most of the cases that i work, the acute pt is evaluated by the ltc 24-48 hours prior to the actual transfer so that the apporpriate meds, equipment, etc can be in place when the pt arrives. perhaps keeping report focused on the pts immediate care needs and pertinent info (excluding that which can easily be obtained from th transfer orders) would keep all involved parties happy....

CoffeeRTC, BSN, RN · Aug 31, 2007

Not always true for us. A lot of times a referal is initiated by the hospital social worker. They get all the info from the chart or patient or their family. They send us the info. Our admit co ordinator takes this info. If we are lucky the IDT talks about it and a nurse would review it and give input. Most often, they see a diagno$i$ they like or a warm body to fill a bed and keep our cesus and acuity high and take it. Before we know it the patient is rollling in on a stretcher. The only time I would have good info on the patient is during a nurse to nurse report from the hospital.

BTW, this is what I really need. Why admitted at hospital, pmhx, brief run down of what brought them to the hospital. On going labs or abnormals (pt/ inr, positive culture) LOC of patient, any behaviors, last BM. If they have a good IV site (picc or Midline, or central line) I'll ask them to keep it it if they can. Any O2 needed? Any other issues we should know about? Sometimes if we get report early enough I will ask them to fax the orders ahead of time. 99.99% of the time I get all of this info with a nurse to nurse report. The wonders of being nice to other professionals, huh?

txspadequeenRN, BSN, RN · Aug 31, 2007

i am a ltc nurse and this is one of my pet peeves. while the nurse on the other end should not yell or be rude, she was not wrong in asking for that info. those questions are ones that any nurse should know about his/her patient. the one i really like is when i am getting a transfer from the hospital and they are on abt, but nobody knows why.

i guarantee when i get these orders verified by our house doc he will ask why the patient is on iv/po abt and there i am looking dumb if i don't have all the answers. not only that, do you realize how long it takes to get the equipment for a iv in ltc.

BlearnRN · Sep 2, 2007

Thanks for replying.... Your comments have definitely made me open my eyes. I think my problem is that I was not taught a good way to give report to a LTC and it has just been a trial by fire. Learning by my mistakes.

When I come to think of it, the last two times with these transfered have been a hurry hurry rush thing. I am not sure if the discharge planner is faxing all the info beforehand to the LTC. That bit of information would definitly be helpful to know before I give report to the LTC. I definitely have more to learn. I am not trying to turn this into a us vs. them type of thing. I am just trying to find a better way to communicate.

Long Term Care Columnist / Guide · Sep 2, 2007

Other things that are good to know are diagnosis (you wouldn't believe how many times D/C planners don't give us this basic information!) and ADL status---I don't expect you to know the pt's baseline functional level, but you ought to be able to tell me or fax me some notes on how they transfer, whether there's been PT/OT/ST, if the resident has a Foley or other drainage system coming with them, if there are med changes, and if there are any skin issues. Nothing upsets me more than having a resident come back to my ALF at 5 PM on Friday with a brand new pressure ulcer that I don't find out about until Monday morning!

For what it's worth, I think it's better to OVER-report than to not give the receiving nurse enough information. And BTW, that nurse was unjustifiably rude to you........very unprofessional and certainly not necessary.

Daytonite, BSN, RN · Sep 2, 2007

learn to give back answers that are just as assertive as theirs.

example #1 the receiving nurse getting loud with me that i didn't know if the doctors planned on continuing iv fluids at the facility and actually made me get the doctor on the phone.

"no, let me finish my report and i'll check with the doctor about this after we get off the phone."

example #2 the receiving nurse getting loud with me that i did not know off the top of my head how many days my pt was on iv antibiotics and even went as far as telling me "well you should know!"

this kind of nasty comment i would just ignore and continue on with my report. she's just being intimidating and it's a ploy to get you to join in her little game of one-upmanship where she will rip you to shreds and it's not worth getting into a battle over. intimidating people can spot a patsy miles away. don't participate in their little game because it's all about them feeling better in a very dysfunctional way and at your expense.

here are links to information on assertiveness:

http://changingminds.org/techniques/assertiveness/assertiveness.htm - assertiveness
http://www.dlsweb.rmit.edu.au/toolbox/fmi/content/tutorial/assert/assert00.htm - this is a really nice online assertiveness tutorial from australia. click on the links to proceed through the tutorial. includes sound clips of examples.
http://www.gp-training.net/training/leadership/assertiveness/index.htm - assertiveness for doctors. an interesting site that links you into information about being assertive. includes a list of books with information on assertiveness.