Verbal Hand-off Reports - Are they no longer necessary?

Nurses General Nursing

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I work as an acute care Med-Surg float nurse and my hospital has implemented a new process where patients are being transferred to units from other units, ie. the ED to the floor, ICU to the floor, and from affiliate hospitals to our hospital without having to call and give a verbal report. I find this practice outrageous and an accident waiting to happen.

The reason behind this new policy is to expedite patient transfers and open beds faster. All I ever learned is how important patient the hand-off is, and now we are actually no longer required to give report to the next nurse who will be taking care of the patient.

Apparently now that we have the EPIC system to do our patient charting, the decision-making people feel that verbal reports are no longer needed. However, I have had several instances where EPIC contained very little patient information and virtually no history, so I literally had to ask the female patient, who was busy vomiting, why she was even admitted to the hospital. The fact that she was a stage 4 CKD patient with only one remaining kidney was nowhere to be found on EPIC. She needed pain meds, but her current medication reconciliation had not been completed, delaying her receiving any medications.

And I must also stress the last Magnet hospital I worked at did the same thing by getting rid of verbal report for patient transfers. Has anyone else been experiencing this practice, and if so, how do you deal with the huge safety risk? What happened to placing patient safety first?

ok...since you keep asking....here is a good one. An ED nurse gives 4mg of morphine but forgets to chart this off in the EMAR. Patient arrives to our unit in agonizing pain. Floor nurse gives the ordered PRN dose of 4mg of morphine... AGAIN.. not realizing the ED forgot to chart it off. the aptient stops breathing. RR is called. Now do you get the idea?

Here is another good one...morphine is given in the ER, and is appropriately charted. Verbal report is given, but the ER nurse forgets to report on the morphine. The floor nurse, who doesn't review the chart, gives more morphine when the patient arrives. Is the floor nurse going to be off the hook because it wasn't reported over the phone that the patient already recieved morphine?

Where I work, meds are accurately scanned and thus charted 97% of the time. Can you say verbal reports you receive are that accurate?

We could play if's and but's all day. The examples you are giving are when someone doesn't do their job, or the process is messed up. It's not a verbal or no verbal report issue.

you illustrate my point, exactly.

Specializes in Med/Surg, OR, Peds, Patient Education.
I don't find this problematic necessarily; though I think if there are questions there should be someone available to call for clarification. What more needs to be explained on a new admission besides diagnosis/reason for admission, history, labs/tests and pending procedures, IV access, skin issues, mobility, orientation, isolation precautions? You'll find out everything else you need to know once the patient gets to the floor.

I like my report short and sweet, just the pertinent info.

You are correct, if all pertinent information is given to the nurse who will be caring for this new patient. However, as the writer stated, not all needed, and pertinent information was given to the nurse who received the patient for whom she was now responsible. "Short and sweet," must, also, be "complete."

I guess that is why we are a democracy. I respectfully disagree with your point of view.

Specializes in Orthopedics/Trauma/Med-Surg.

In EPIC, go to the blank field (or search area) in Patient Summary and type in "ED Encounter Ed Only". This will bring up all the emergency department information on a patient you could ever need. My hospital used EPIC for years before someone stumbled upon this area.

I work on a MedSurg floor and I think it's been about 2 years since we have been not been getting verbal report from the ED. I believe that we are one of the only floors in the hospital to not receive verbal report since we have a lot of beds. Before it was a PITA to get report from the ED: either they were busy or we were busy. There is definately a perception from non-ED nurses that the ED thinks we are not as busy as them, or somehow their situations are always more taxing than what we deal with on the floor, but whatever. Our floor takes it in stride. But it is annoying that the same little things happen over and over.

Our system is supposed to be set up such that we have 20 minutes between being notified of an admit to read the notes and ask questions before they are on their way. Things I've noticed not all necessarily due to not receiving verbal report but maybe could have been avoided:

-When reading the notes we find a patient has care not appropriate to our floor. Hopefully it's caught before they are on their way up.

-Sometimes we will receive a patient that hasn't been checked on in a long time- i.e. empty bolus bag still connected, in severe pain.

-Med errors? You can seen in Epic that meds have been withdrawn from the Omnicell, but they have not been charted as given. Who knows what really happened?

-I find it interesting that very often somehow the patient will linger in the ED just until right before shift change...

-Missed charting discovered when doing assessment.

-There are no notes. There may be a note stating a patient has been BIBA, but sometimes not even that.

-Every once in a while the room wont be clean and the patient arrives.

I do think there is a safety component to not receiving verbal report, large or small. Sometimes you remember things that are important when giving verbal report. I think the hospital will only start to get involved when "patient satisfaction" comes into play.

Specializes in Critical Care.

As long as the report is detailed, I don't feel like there is a need for verbal report. Like you stated, however, most of the time that is not the case. On top of which, in my experience, the nurse gets upset when you call them to ask questions that could have easily been placed in report. It's as if other clicking off boxes, no one wants to type in any necessary information.

Specializes in Critical Care.
Here is another good one...morphine is given in the ER, and is appropriately charted. Verbal report is given, but the ER nurse forgets to report on the morphine. The floor nurse, who doesn't review the chart, gives more morphine when the patient arrives. Is the floor nurse going to be off the hook because it wasn't reported over the phone that the patient already recieved morphine?

Where I work, meds are accurately scanned and thus charted 97% of the time. Can you say verbal reports you receive are that accurate?

We could play if's and but's all day. The examples you are giving are when someone doesn't do their job, or the process is messed up. It's not a verbal or no verbal report issue.

I don't think anyone is arguing that there are errors that occur regardless of whether or not a verbal report is used. Errors kill about 100,000 hospital patients a year, the largest single root cause is communication errors, so if we consider it a problem that we kill that many patients a year, focusing on optimizing our communication is the most effective way to deal with that problem, even though it won't prevent every error.

Specializes in ICU.

This thread has become about things it should not have become. I have seen some very indignant ED nurses making this about them vs. the rest of the hospital and it should not at all be about that. It should be about patient safety.

My clinical in ICU Friday was a perfect illustration of why verbal report is needed. I'm not going into specifics but we received a gentlemen from med/surg who was going downhill fast on our unit. We did not have any time to look at a computer. By the way, who still faxes?? Lol. We had no time to leave the patient.

The nurses from his floor had the appropriate info we needed and verbally gave the pertinent info to us. Info we needed for this gentleman's care.

This is should not be about well, I don't have time to do this, or I need to open up a bed. This is about patient safety and care. This is about the patient only. Some of these comments have confounded me. Every nurse in your hospital is busy. Every nurse has charting, meds to give, new admits, discharges. Every, single, one. No floor is better than any other, no dept is exponentially busier than another.

Stop making this about you. It's about the patient. What I liked about where I was at Friday, it was stressful, but every person worked together. Every one. I feel like anymore the best interest of the patient has gone by the wayside for paperwork and an "assembly line" which I think was quoted earlier.

Seems to me the whole purpose of this change is the result of a disciplinary issue. Nurses refusing to take report is a disciplinary issue, and compromising patient care for a disciplinary issue is appalling to me! Maybe some nurses argue for no reason but it is our job to advocate for our patients and what if an assignment is unsafe? You call to the floor and a nurse is say changing several dressings and can't come to the phone and you send a patient when the assignment is unsafe? Sure this rarely happens, but it could.

I probably feel more appalled to this because I work at a smaller hospital and our system is horrid, there is no chance looking in the computer or chart would get you the same information as report. We don't delay receiving report at my hospital. You get a call you answer it, finish up what you are immediately doing to take report, ask your questions and go back to what you were doing until your patient arrives. If you don't take report within a few minutes management/charge is going to be tracking you down. We have more problems with people holding on to patients so that they won't get a new admit. That too is a disciplinary problem, but I wouldn't say we need to skip discharge instructions to solve it...

Specializes in Emergency.

In the hospital where I work, whenever a patient is being transferred internally, any sending floor is required to pneumatically tube a written Transfer Report form (organized in SBAR format) to the receiving floor at least 30 minutes prior to transfer. The nurse is responsible for reviewing the form in that time and if there are any concerns or pertinent questions, the sending floor is called for clarification. With a Transfer Form from the ED is also a carbon copy of the orders, so we know what is going on with the patient being admitted.

ED admissions to CCU receive verbal reports though. An elevator was strategically placed from the ED to the CCU (on top of one another), and the CCU nurse will actually come down and receive that verbal report in person. If CCU is not able to come down, the ED nurse is required to accompany the patient upstairs to CCU themselves. A policy was created due to crashing during transfer.

And the Transfer Report form is still sent 30 minutes prior!

Specializes in as above.

I enjoy good marketing buzz words..EPIC...aka BS. How are you supposed to do you job with knowing NOTHING about a patient, that shows up at your door, with nothing but a gown and ambulance guys. This is a cost cutting measure. Decision making people: aka executives who dream up new ways to save money. Ask the boys to come to your floor, and advise. Take them to task.

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