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?
Specializes in palliative care, medicine, rehab/geri.
At our hospital, the sending unit (or ER) faxes a SHOT (Safe Hand Off Tool) to the receiving unit. The SHOT lists reason for admission/transfer, medical hx, background, VS, pain, IV, neurological, cardiovascular respiratory, GI, GU & skin assessments. Most of the areas are check-off assessments (eg Last BM____) with the right hand side of the form open for writen comments or concerns. Before the pt is transferred, the sending and receiving RN's have a brief telephone conversation, at which time the receiving nurse can ask any questions she has, or clarify any issues, and the sending RN can add anything forgotten, or new. This shortens the time of the hand-off report, and provides a written report for the next shift as well. In cases of emergency transfers (eg transfers to ICU post Code Blue or other unstable emergency) a verbal report is still given so that the transfer is not delayed while a written report is prepared.
This has caused issues where I work. Patients have been brought up before the faxed paper has arrived. We've had patients who should be on rule out TB precautions and are found in a regular room exposing the unit.
Management does not care. It's been made very clear it's about money.
Sorry I don't have time to read this whole chain, but saw this on Twitter today and thought it applied. http://www.rd.com/health/conditions/hospital-safety-secrets/ #5 is "Join the Conversation"--and recommends that you ask your nurses to do a bedside shift change. Besides sharing information between professionals, you share with the patient/family. That is the time to correct errors that could cause problems down the line.
Verbal report is important because sometimes things happen on the floor and the nurse is not equipped at that very moment to handle the new patient.
From that vantage, you're arguing for mandatory verbal report as a way to put the brakes on the admission and that's totally inappropriate. The proper manner to delay an arrival is for the charge nurse to inform bed control and/or the house supe and/or the sending department's charge nurse that their floor isn't able to take the patient and let the managers work it out... that's what they're there for.
What meaningful information cannot be gleaned from a properly designed EMR report that would somehow be provided via the telephone?
Which sort of gets me to thinking... I'm sure that there was great resistance to telephone report versus face-to-face...
Nurses generally seem to me to be (1) resistant to change and (2) minimal adopters of technology.
Epic does have a good Kardex portion. Usually it's very accurate and will even have any signed and held orders that need to be released. Report at my hospital unfortunately can be contentious. The floor doesn't want the admit so they look for anything to get the patient to another unit or the last BP was 99 systolic instead of 101 so they aren't "stable" It gets ridiculous.
I would like to know which nurse would be held accountable if anything was to happen to the patient in a situation where the patient is dumped into a bed with nobody aware and something goes wrong. I don't think it should be the unaware nurse since that nurse hasn't even had a chance to accept the patient
Until you accept the patient, you are not accountable from a nursing perspective. Now the hospital might hold you accountable for not accepting the patient but from a nursing vantage, if you haven't accepted the patient then you haven't established the nurse-patient relationship.
When I do patient transports, I do not leave the patient until there is somebody there to physically receive them.
Again, this has nothing to do with verbal reporting, though.
Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.
From that vantage, you're arguing for mandatory verbal report as a way to put the brakes on the admission and that's totally inappropriate. The proper manner to delay an arrival is for the charge nurse to inform bed control and/or the house supe and/or the sending department's charge nurse that their floor isn't able to take the patient and let the managers work it out... that's what they're there for
Yes, for patient safety sometimes the floor is NOT able to accommodate a new patient quickly enough. And our charge nurses are not always available or even on the floor. Sorry but I will not give short-shift to my assigned floor patients to constantly take a transfer quickly enough for TPTB. My patient's on the floor will get their Chemotherapy and CTAD before I can add a new patient to the mix.
Maybe there needs to be a middle area where the patient can be watched over; out of the ER until the floor can take the admit. Shouldn't have to be used too soon. Of course, that would entail spending money to staff the area. Money, money, money!
..."(And of course the administrators- many of whom have never been nurses- that are all about keeping everything moving, moving, moving, $, $, $!)...Pt safety should come first, but our hospitals are way beyond that at this point."...
Bingo! The is precisely how one gets to the bottom of things by following the money. I think the best that one can hope for is to do one's job to the best of his/her ability with the hand that's been dealt with the resources available to them.
What meaningful information cannot be gleaned from a properly designed EMR report that would somehow be provided via the telephone?
People have already touched upon this issue. Report highlights important areas that might otherwise take a longer amount of time to glean from the chart and could be overlooked. In addition, there are a lot of subjective/family dynamic/random issues that can't really be put in the chart. A few things that pop into mind readily are the drunk driving patient I received, and the man who's wife he killed is admitted to the same floor (worked with my charge to get him transferred to another unit). Or how about the guy who was shot and there was a possibility that the shooter would come back to finish the job? (said patient ended up being moved to a locked unit when that threat became credible). Jessy_RN wrote 2 posts before you about issues she's encountered, as well as other people on this thread. In my hospital the ER records are not tied to our floor EMR also.
Yes, for patient safety sometimes the floor is NOT able to accommodate a new patient quickly enough. And our charge nurses are not always available or even on the floor. Sorry but I will not give short-shift to my assigned floor patients to constantly take a transfer quickly enough for TPTB. My patient's on the floor will get their Chemotherapy and CTAD before I can add a new patient to the mix.
Maybe there needs to be a middle area where the patient can be watched over; out of the ER until the floor can take the admit. Shouldn't have to be used too soon. Of course, that would entail spending money to staff the area. Money, money, money!
But that has *nothing* to do with verbal report as opposed to a standardized handoff report in EMR... nothing at all.
I for one can say I have personally called the nursing supervisor and filed an unsafe practice report for a patient coming to the floor without anyone on our unit knowing until the patient arrived. Sometimes I am so vocal I am afraid I might get fired. But this stuff can't keep happening and me not say anything.
LouleeRN
13 Posts
At our hospital, the sending unit (or ER) faxes a SHOT (Safe Hand Off Tool) to the receiving unit. The SHOT lists reason for admission/transfer, medical hx, background, VS, pain, IV, neurological, cardiovascular respiratory, GI, GU & skin assessments. Most of the areas are check-off assessments (eg Last BM____) with the right hand side of the form open for writen comments or concerns. Before the pt is transferred, the sending and receiving RN's have a brief telephone conversation, at which time the receiving nurse can ask any questions she has, or clarify any issues, and the sending RN can add anything forgotten, or new. This shortens the time of the hand-off report, and provides a written report for the next shift as well. In cases of emergency transfers (eg transfers to ICU post Code Blue or other unstable emergency) a verbal report is still given so that the transfer is not delayed while a written report is prepared.