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?
But its policy- breaking policy wil get you fired. Please don't insinuate that what I'm doing is not safe- like I said, in the years we've done it there has NEVER been compromising to a pt or the care they are receiving. Policies are in place for a reason and this is not one I'm going to fight- these policies would never have to be put into place if the floors did not show consistent delay in transfers. We don't have time for delays- people's lives depend on a bed in the ED at times- there is no reason a STABLE pt that has been worked up needs to continue to monopolize a bed in the ED bc the floor does not wish to take report.
Well, it's policy where you are. Where I am, sending a patient up w/o verbal report would get you fired - since we're throwing that word around.
Well, it's policy where you are. Where I am, sending a patient up w/o verbal report would get you fired - since we're throwing that word around.
What point are you trying to make exactly? I responded to a pp who said that we should be telling pt's and family how dangerous these practices are and yada, yada, yada- I pointed out that 1) it is policy in my hospital 2) not following your hospitals policy is grounds for dismissal, and 3) that spouting off your personal opinion to a pt and family going against a facilities policy could get you terminated. And again, no one has been able to provide examples of how these policies, being instituted in numerous facilities, is "bad" and "dangerous." I've already stated that in my facility, there has been no detriment from this specific policy. If you care to have a rational conversation, at least be concise in making your point and provide examples/rationales for your specific point. A hospital doesn't just institute policies for no reason- in my facility we collect date, run a trial/pilot, while further collecting data- and then institute said pilot as policy if successful with data to support it.
Do you work in a hospital that doesn't do such things? If so, then why work in a hospital that you don't agree with their practice- isn't that being a hypocrite?
I would not suggest doing this unless you want to get fired. Unless you have research, studies, and numbers to back up the "bad things" are occurring due to these policies, then you are simply spouting off opinion.
I never worried about being fired, I'm being honest here. Oh yes, I knew the risks, but I did this on more than a few occasions. And the 'regular' families knew this anyway. I never once 'covered' for the nh. I had more than a few occasions when I couldn't get hold of anyone on the phone (with a family member on the other phone, or even standing at the nurses' station). Oh the DON wasn't happy, but I asked them "what do you really want me to say to the family? What do you reaallly want me to tell them? Because you know I'm gonna chart it".
And of course, ED Nurse, this does not speak to the ED as in the floor nurses vs the ed nurses. Once again, this speaks to inadequate staffing. This is why these stupid policies gain traction. Nurses would rather infight than fight for proper staffing.
But its policy- breaking policy wil get you fired. Please don't insinuate that what I'm doing is not safe- like I said, in the years we've done it there has NEVER been compromising to a pt or the care they are receiving. Policies are in place for a reason and this is not one I'm going to fight- these policies would never have to be put into place if the floors did not show consistent delay in transfers. We don't have time for delays- people's lives depend on a bed in the ED at times- there is no reason a STABLE pt that has been worked up needs to continue to monopolize a bed in the ED bc the floor does not wish to take report.
I *do* agree with a stable pt being sent back up so an ED bed is freed up.
I never worried about being fired, I'm being honest here. Oh yes, I knew the risks, but I did this on more than a few occasions. And the 'regular' families knew this anyway. I never once 'covered' for the nh. I had more than a few occasions when I couldn't get hold of anyone on the phone (with a family member on the other phone, or even standing at the nurses' station). Oh the DON wasn't happy, but I asked them "what do you really want me to say to the family? What do you reaallly want me to tell them? Because you know I'm gonna chart it".
And of course, ED Nurse, this does not speak to the ED as in the floor nurses vs the ed nurses. Once again, this speaks to inadequate staffing. This is why these stupid policies gain traction. Nurses would rather infight than fight for proper staffing.
I honestly have no idea what point you are trying to make, or what you are trying to say in this post. Maybe proofread and give specific examples of the point you are trying to bring to light. "Oh yes, I knew the risks, but I did this on more than a few occasions," and "I never covered for the NH."- I don't understand what any of this means or how it ties into this portion of our discussion about electronic reports.
We usually get a faxed written report from the ED and our ICU transfer patients are brought to the ward by an ICU nurse so a verbal report is given. If there are concerns/things that need to be addressed, the ED nurse sometimes phones up to the ward. Or vice versa. This usually works out ok. Even if we get sent a pt at shift change (which is 0700 or 1900) the ED nurses are there until 0730/1930 so we can usually call them if we really need to. Sometimes these faxed reports don't come through for whatever reason. This also usually works out ok. Essentially, once we are told by our charge nurse that the bed is booked, we know that pt is coming up fairly shortly. We can access their basic diagnosis, labs, etc. before they are even on the ward so we can anticipate at least some of their needs. This system works out pretty well most of the time.
No verbal reports from our ED to the floor. We just passed our TJC inspection with flying colors.
The JC is not a regulatory body so you can fail on a number of points and still pass the overall survey. Under the communication safety section relating to handoffs, the person receiving the patient must have the opportunity to ask questions and on the interpretation of this standard simply providing a phone number to call isn't sufficient.
Something like a patient coding and you know nothing about them, not even if they are a DNR/DNI because you barely knew they were coming, let alone have time to look them up on the system. Electronic reports give only a small picture about what is going on. A verbal report can fill in the necessary gaps. I worked at a place where they faxed an SBAR report. These had similar drawbacks.
Excellent question. We sign the sbar & put our extension. Before the pt is transported, we call the floor to confirm the sbar was received. If confirmed, the receiving rn can call with any questions.
This is only for stable, no tele for transport pts. Unit and/or constant monitoring still require verbal report.
As noted by several posters above, the change to faxed report was a result of throughput delays directly attributable to the ed's inability to get a floor nurse on the phone to give report.
And that's great and all but I'm not sure where in there you as the nurse handing off the patient is confirming that the nurse you're handing off to received and understood the report. I get frustrated too trying to get a hold of a floor nurse sometimes, but if time is the only concern why even spend the time to write the SBAR, just send them up. I put in some work on patients in the ED, if that information isn't properly communicated to the next person caring for the patient then it sort of makes my role in the ED somewhat pointless.
Something like a patient coding and you know nothing about them, not even if they are a DNR/DNI because you barely knew they were coming, let alone have time to look them up on the system. Electronic reports give only a small picture about what is going on. A verbal report can fill in the necessary gaps. I worked at a place where they faxed an SBAR report. These had similar drawbacks.
The ED gets none of this typically when a pt is brought in by EMS. This situation, of a pt coding, had this actually happened to you, or are you just speculating? We can speculate all day. Bottom line, this process has been implemented in numerous facilities due to the breakdown and issues with the previous system. If you have an empty bed, you need to get into the mentality that you will be getting a new patient. Pushing back continuously, as like in the previous process, is still going to get you the admit. If you don't like the process, then you need to have data document to back up why this process is "dangerous" and "bad." PI is here to stay in nursing, how else do we improve the system? If you don't like PI then nursing is not for you.
I posted a similar topic almost 2 years ago, I work at a large magnet/ trauma center that newly implemented SBAR paper reports instead of a verbal handoff… it lasted a few months and we went back to calling report. There has to be give and take on both ends, the floor can't stall report and the ED can be understanding and willing to compromise for a timely report. There are a lot of factors that need to be taken in for this system, largely patient acuity and staffing. I don't doubt that a paper report system can work when appropriate, but for a large, high acuity medical center- we were unable to make the change. Same issues tend to occur when PACU is trying to call report for their patients to the floor, when there is compromise and understanding on both sides- it works!
The JC is not a regulatory body so you can fail on a number of points and still pass the overall survey. Under the communication safety section relating to handoffs, the person receiving the patient must have the opportunity to ask questions and on the interpretation of this standard simply providing a phone number to call isn't sufficient.
Whose interpretation of the standard? Our handoff process wasn't on their "list" of concerns that was communicated to staff. I would think that would have been a big one. Also, CMS visited us recently as well.
VANurse2010
1,526 Posts
Well, it's policy where you are. Where I am, sending a patient up w/o verbal report would get you fired - since we're throwing that word around.