Jump to content

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

Nurses   (54,241 Views 186 Comments)
by yr.pedsnurse yr.pedsnurse (New Member) New Member

786 Profile Views; 13 Posts

advertisement

You are reading page 14 of Verbal Hand-off Reports - Are they no longer necessary?. If you want to start from the beginning Go to First Page.

Nurse_Ratched has 10 years experience and specializes in ER, SCTU, PACU.

45 Posts; 2,673 Profile Views

I thought nurse-to-nurse report was part of EMTALA law for inter-facility transfers. I also agree, that nurse-to-nurse report, with adequate time to ask and answer questions, is the professional thing to do. That being said, unless the reporting nurse volunteers the information, please stop asking if a consult was called. Unless the consultant physically saw the patient in my ED, I could care less. If the secretary did call in the consult, she left a secretary note in the chart to indicate that. If the note isn't there, I would have to ask the secretary, just like you can ask her. Also, please stop asking about the size and location of the IV: you will find out when the patient gets to you. If it's a 24 in the finger, that's all you're getting, and no, I can't "get you something better than that", I'm happy I have some kind of access. The purpose of report is to obtain information, not to argue back and forth about what was done and what wasn't.

Share this post


Link to post
Share on other sites

13 Posts; 786 Profile Views

I totally agree... and hopefully, all of us agree on your points. I have also heard bedside report take forever as the reporting nurse goes over every minute detail like how many bites of banana the patient ate or how many times steps she walked to the bathroom (exaggerating to make a point, but you all know what I mean) Drives me batty!

But I am talking about verbal handout just to clarify and discuss nuances that might not be in the computer. I today I had a situation where I received a patient from the ED with no report. The Epic summary listed primary concern, "Headache." No other history or any other pertinent information. Turns out the woman was extremely verbally abusive and aggressive to staff. She was placed in a room with a 91-year-old woman with cellulitis who just needed peace and quiet. Had we known the behavioral issues this patient would have been given a private room. In this case the ED could have given us a heads up. The patient transporter told us she was a handful in the ED, so it wasn't like this was new behavior. Come on, we all should work together. This is just one example. I could list many more. There are things not obvious on EPIC and sometimes we don't have 15 minutes beforehand to research this stuff. A quick 3-minute phone call is all it takes to professionally report a patient off to the next nurse. It's the safest and right thing to do.

Share this post


Link to post
Share on other sites

NotReady4PrimeTime has 25 years experience as a RN and specializes in NICU, PICU, PCVICU and peds oncology.

16 Articles; 7,355 Posts; 71,395 Profile Views

I must say, I'm a little envious of those who have EMRs that are accessible to any provider. In my facility only the ICUs and the ORs use EMR. Not only are the floors not connected, they have no idea what's in there, what's not or how to even read the transfer reports. We have such an incoherent documentation system - orders are still hand-written in any willy-nilly arrangement that occurs to the physician writing them (and usually not flagged!), meds are still documented on hand-written MARs in our ICUs, consults are hand-written on carbon-less forms so the consultant(all of them are EMR-illiterate to our computerized ICU charting) can keep a copy and lab results are only partially available to the EMR. The inpatient units outside the ICU, as well as the ED, record EVERYTHING by hand on forms that are different colours from those used in the ICUs. It's all quite challenging.

When we throw patient transfers into the mix, another layer (or 5) is added to the pile. It's hospital policy that no patient moves anywhere within the hospital without a version of the SHOT someone else described. But the ED refuses to fill them out because they don't have time and besides, they're going to personally hand off the patient - except when they don't and someone who was free at that moment brings them up. The inpatient units typically don't fill them out when they're transferring to the ICU because they don't have time and they've got a sick patient they want to get rid of... and besides, the rapid response team or the code team is there and will be helping with the transfer. Meanwhile, the ICU is mandated to fill them out (by hand) with every esoteric tidbit of information that can be crammed into the tiny spaces provided, because the inpatient units will not accept a patient until they've got the form in hand.

The process works like this: The attending physician determines the patient is ready for transfer. The charge nurse relays that information to the bed manager who then either assigns a bed or defers due to no beds available. If a bed is available the charge nurse then tells the ICU nurse, usually no later than 0900 (our ICU does NOT EVER transfer a patient out during the night unless the place si falling apart). The ICU nurse then ensures the invasive monitoring lines are out and all last-minute items are accomplished. Then the ICU nurse follows the attending around for 2 hours to remind them they need to write transfer orders and the transfer note. Once those are done the SHOT can be filled out and faxed. The receiving unit is required to call the ICU to indicate they've received the SHOT and to give a time they'll be ready to accept the patient. It's almost unheard of for a transfer to happen before lunchtime. Most of them happen later in the afternoon... except for the OR and ED transfers INTO the ICU. (They're never delayed. We can be ready for an ED admit in about 6 minutes.) The SHOT may have been faxed hours before the patient leaves the unit, during which meds will have been given, I/O will have changed and several other aspects of the form will have changed. In my experience, the receiving unit often doesn't actually read the form, otherwise the oxygen the patient is on would be set up in the room... So we end up doing both a faxed report and a face-to-face verbal report.

As of the first of the year, our respiratory therapists are now doing bedside handovers side-by-side with the ICU nurses. On many of the inpatient units, the CNAs, LPNs, RN and any other ancillary staff are doing bedside handovers as part of the current flavour-of-the-month model of care. It's all so confusing........

Share this post


Link to post
Share on other sites

airborneinf82 has 8 years experience as a BSN and specializes in Trauma and Cardiovascular ICU.

184 Posts; 3,964 Profile Views

Probably better off reading through the chart then getting report from the ED anyways a lot of the time. I'm not sure who is worse, them or the OR.

I agree though. I like a verbal report. It doesn't need to be long at all, but it ALWAYS involves a little back and forth. I think this is best for patient safety. But what do I know.

Share this post


Link to post
Share on other sites

Beverage specializes in Cardiac/Telemetry.

95 Posts; 5,173 Profile Views

There was a short unsuccessful trial of faxed SBAR report from ED where I work. We are back to verbal report and I am thankful. Once bed control hands me an admit slip, I have 10 minutes to look up info in EPIC and I make the call to ED for report. If I take too long to call ED, they will call me at minute 11 LOL. If for some reason I can't take report, ED gives it to the charge nurse for me and this avoids delays.

I have had a faxed SBAR missing key data like SBP in the 80's that was not filed in EPIC. Had an SBAR fail to mention BG of >500 that hadn't been covered. I had a SBAR pt on a nitro gtt which needed a higher level of care. So for those who have asked, here are 3 instances where faxed SBAR wasn't appropriate and to just send the patient up to the floor wasn't the right thing to do.

Share this post


Link to post
Share on other sites

34 Posts; 1,082 Profile Views

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.

I've called the Licensing and Regulating Body in my State before. I'm not sure if that's an option where you are or perhaps if its something the Union at your place of employment can look into.

Share this post


Link to post
Share on other sites

SC_RNDude has 7 years experience.

533 Posts; 16,489 Profile Views

There was a short unsuccessful trial of faxed SBAR report from ED where I work. We are back to verbal report and I am thankful. Once bed control hands me an admit slip, I have 10 minutes to look up info in EPIC and I make the call to ED for report. If I take too long to call ED, they will call me at minute 11 LOL. If for some reason I can't take report, ED gives it to the charge nurse for me and this avoids delays.

I have had a faxed SBAR missing key data like SBP in the 80's that was not filed in EPIC. Had an SBAR fail to mention BG of >500 that hadn't been covered. I had a SBAR pt on a nitro gtt which needed a higher level of care. So for those who have asked, here are 3 instances where faxed SBAR wasn't appropriate and to just send the patient up to the floor wasn't the right thing to do.

BG, vitals, and meds given should all be documented in EPIC for you to see. If not, then that is the bigger issue.

You don't think a verbal report might have missed covering important things? Are the verbal reports you receive 100% accurate?

Share this post


Link to post
Share on other sites

typical has 5 years experience and specializes in stroke unit, trauma, ENT, MS, ED.

8 Posts; 417 Profile Views

I used to work at a large teaching hospital in the northeast who did not give report for patients being admitted from the ER. You only got report if the patient was being admitted to a step down or ICU. Otherwise, the RN was simply told the patient's name. He/She then could look the patient up, read the ER nurses and doctors notes, history, read radiology reports etc etc. It really wasn't that bad. On occasion the patient would need to be transferred on the monitor, in which case the ER nurse did the transport and would often give a quick bedside report...or I would go down to the ER and touch base with the nurse before doing the transport myself. I'd like to add that I worked on a ridiculously busy neuro trauma unit and never had a problem with finding the extra 10 minutes it took me to go downstairs and get the patient myself. The ER not only appreciated it (because regardless of how busy I was, they were managing a volume of 120,000 annually, and were ALWAYS busier than me). The practice gave me an opportunity to get a quick blurb from the ER nurse, and assured I knew my patient was appropriate for my unit before formally accepting them.

Share this post


Link to post
Share on other sites

typical has 5 years experience and specializes in stroke unit, trauma, ENT, MS, ED.

8 Posts; 417 Profile Views

My current hospital is beginning to implement standardized report format. We're definitely getting push back from ER because our standardized format is essentially a head to toe. I have trouble commiserating with them though. I've worked both high volume ER and floor. When I worked ER I performed a summarized head to toe on every single patient (mini neuro, heart, lungs, pulses), a focused related to the complaint and then additional assessments depending on the patients age, general health and co-morbidities. i.e. if I had a 91 year old who fell and broke her hip...darn right i rolled her over and assessed her skin. How long was she down for? How long does she sit at home? I feel like nurses are getting lax with reports and assessments in general....it's not just a single department or single specialty issue. I don't think that a nurse should be reciting the chart to the nurse taking over....but he/she should be able to recite their own assessment so that the oncoming nurse knows if there are changes.

Share this post


Link to post
Share on other sites

10 Posts; 1,634 Profile Views

I find this outrageous with more stress added to the caregivers not to mention the patients. Oh, yes, don't worry about the patients as long as an extra buck is made.

Share this post


Link to post
Share on other sites

rnccf2007 is a BSN, RN and specializes in Critical Care.

214 Posts; 5,227 Profile Views

You took so many words out of my mouth!!! Thank you.

Share this post


Link to post
Share on other sites

typical has 5 years experience and specializes in stroke unit, trauma, ENT, MS, ED.

8 Posts; 417 Profile Views

I've been to certain hospitals where the nurses leave a tape recorded report, other places where they leave a note on the kardex....all in lieu of verbal nurse to nurse report. I wasn't a fan of either method. However, my old hospital did not give us report from the ER and it really was not that bad. It forced the floor nurses to look the patient up and read the ER docs note, the ER nurses note, labs, radiology reports, vitals trends etc. If the nurse was prudent enough to do this, she was perfectly prepared to accept that patient when he/she arrived to the floor. Expecting the ER nurse to call repeatedly, holding the patient until the floor nurse can take a verbal report is not what's best for the patient in some of the bigger, higher volume hospitals. It really is not about the money. It's about getting the patient out of the ER where they are getting bare minimal medical attention, into a bed, into a room where there is privacy, and among a team of nurses who specialize in their diagnosis.

Share this post


Link to post
Share on other sites
  • Recently Browsing 0 members

    No registered users viewing this page.

×