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?

Specializes in ICU.
I can look in a chart and find what I need to know faster then hooking up with the other RN for a verbal report.

What "gaps" do you need filled in? Why they are here, vitals, meds given, fluids given, lab and diagnostic results, etc. are in the chart.

You're assuming someone has written a H&P. If the ED nurse calling report doesn't know why the patient arrived because she wasn't the patient's nurse and no one has written a H&P yet, you might not have any idea at all why the patient is in the hospital. Not just verbal report, but verbal report from the nurse taking care of the patient and not just some random nurse down the hall, is essential.

Oh dear God. I know giving and getting report can be an ordeal, but there are some things that are not in the EPIC kardex. Some things are best covered in either bedside or phone report. I don't even use the Kardex portion in EPIC.

Specializes in Postpartum, Med Surg, Home Health.
Oh dear God. I know giving and getting report can be an ordeal but there are some things that are not in the EPIC kardex. Some things are best covered in either bedside or phone report. I don't even use the Kardex portion in EPIC.[/quote']

Epic has a kardex portion? I've never seen or used this at my hospital, I don't think we have it. Also we do not have any SBAR report in epic that people here are talking about that is quick and easy to look at, must be different versions of epic.

You're assuming someone has written a H&P. If the ED nurse calling report doesn't know why the patient arrived because she wasn't the patient's nurse and no one has written a H&P yet, you might not have any idea at all why the patient is in the hospital. Not just verbal report, but verbal report from the nurse taking care of the patient and not just some random nurse down the hall, is essential.

The H&P is not needed. There should be a triage note, or something along those lines. If not, then that is different issue that needs to be addressed.

Evidently, from the many posters here that have shared their experiences, a verbal report from the nurse doing the most care for the patient is not essential. Others have voiced their concerns for patient safety, but yet no one has shared their experience with a adverse event that came from the lack of a verbal report.

Oh dear God. I know giving and getting report can be an ordeal but there are some things that are not in the EPIC kardex. Some things are best covered in either bedside or phone report. I don't even use the Kardex portion in EPIC.[/quote']

What things are not in the chart that are best covered in a verbal report? It's been asked a few times here, but no one has come up with anything.

If you find that on occasion that verbal communication would be best, then by all means do that on a case by case basis. That doesn't mean a full verbal report is needed for every patient.

I find that the Kardex in epic is very useful. I don't know why you wouldn't use it.

Specializes in Med-Tele; ED; ICU.
What things are not in the chart that are best covered in a verbal report? It's been asked a few times here, but no one has come up with anything. If you find that on occasion that verbal communication would be best, then by all means do that on a case by case basis. That doesn't mean a full verbal report is needed for every patient. I find that the Kardex in epic is very useful. I don't know why you wouldn't use it.
My personal belief is that many nurses are not comfortable finding information in Epic. Sure, it may take wrenching in a report or two, and perhaps even working with the EMR team to have a new one generated, but the information is generally there. If it's not, *then* you have a serious complaint against the sending nurse/department.

A 70-bed ED sending patients to a 650-bed hospital and, while I hear lots of complaining, I've yet to see a case of an error attributable to lack of verbal report. In the days of paper charting, sure... but with a modern EMR like Epic, verbal report is superfluous.

And again... if there's an "event" and the defense is, "they said..." or "they didn't tell me..." but the EMR has the pertinent information which is at odds with the claimed information from verbal report... well, I'm sure the 'accepted truth' will be dictated by what is in the chart.

Personally, I don't trust verbal report for anything beyond the most superficial information... and often not even that. I review the chart and assess the patient and then go from there.

Specializes in ICU, CARDIOLOGY.

That is not JACHO policy. Making things "go faster" by compromising patient safety is a BIG NO NO NO NO. No matter how busy you think you are, NEVER compromise patient safety.

Try sitting in front of the State Board of Nursing after an adverse event and explaining, "But I was in such a hurry and the doctor wanted me to rush....". it will fall on deaf ears...and should.

Specializes in Emergency & Trauma/Adult ICU.
I review the chart and assess the patient and then go from there.

Thank you!

Specializes in Critical Care.
Time isn't the ONLY concern, but it is a big concern. Not just to the hospital, but also to the patient waiting to go up (a big pt satisfaction concern) and the patients in the ED waiting room.

The results of your work is documented in the chart. The floor RN can see what they need to know. What else do you have to offer?

The chart contains the various bits of data that fit into the more complex understanding of a patient that an RN is expected to formulate. If a (short) interactive conversation about the patient doesn't convey any more understanding of the patient than the bits of data then that nurse isn't practicing to the expectation of an RN, a tech is fully capable of gathering bits of data and observations and putting it into the EMR.

Specializes in Critical Care.
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.

From AHRQ: "The Joint Commission National Patient Safety Goal also contains specific guidelines for the handoff process, many drawn from other high-risk industries:

  • interactive communications "

https://psnet.ahrq.gov/primers/primer/9/handoffs-and-signouts

Specializes in Critical Care.
What kind of "accident waiting to happen" are you envisioning?

There's a variety of evidence to choose from as to why communication is the hot topic these days when it comes to patient safety, take your pick from IHI, AHRQ, or other industries. "Why hospitals should fly" by John Nance is worthwhile read.

I can tell you first hand why interactive communication is important. I worked at a facility where we trialed a faxed report. A patient came into the ED with CP, was on revatio for PH so was not given nitro in the ED. Of course there was no checkbox on the form for "didn't give nitro because patient was on revatio." The fact that the patient was on revatio was available to the receiving nurse in the EMR, although she was unfamiliar with the med and didn't make the connection to nitro. The patient coded after the nitro and couldn't be revived. When the nurse who had the patient in the ED, who was unaware at the time that the patient had died, was asked what they remembered of the patient the nurses first description of the patient was "the one who had CP but couldn't have nitro because they were on revatio". While this could have been avoided if the nurse had written this somewhere on the form, that's not the only way this information gets passed on, it often gets passed on because the receiving nurse is able to ask "why didn't they get nitro?"

Specializes in Emergency Medicine.
There's a variety of evidence to choose from as to why communication is the hot topic these days when it comes to patient safety, take your pick from IHI, AHRQ, or other industries. "Why hospitals should fly" by John Nance is worthwhile read.

I can tell you first hand why interactive communication is important. I worked at a facility where we trialed a faxed report. A patient came into the ED with CP, was on revatio for PH so was not given nitro in the ED. Of course there was no checkbox on the form for "didn't give nitro because patient was on revatio." The fact that the patient was on revatio was available to the receiving nurse in the EMR, although she was unfamiliar with the med and didn't make the connection to nitro. The patient coded after the nitro and couldn't be revived. When the nurse who had the patient in the ED, who was unaware at the time that the patient had died, was asked what they remembered of the patient the nurses first description of the patient was "the one who had CP but couldn't have nitro because they were on revatio". While this could have been avoided if the nurse had written this somewhere on the form, that's not the only way this information gets passed on, it often gets passed on because the receiving nurse is able to ask "why didn't they get nitro?"

So it's the ED nurses fault that the floor nurse didn't know what a medication was and further investigate the medication? Why don't we hold the floor nurse accountable for not critically thinking like a nurse should? It's not the ED nurses responsibility to be held accountable for what the floor nurse does not know- that floor nurse was negligent in giving a medication and not understanding the ramifications of other medications the pt was taking, which is readily available in the EMR! People need to take personal accountability for their actions- the ED nurse in this situation is in NO WAY responsible for what happened to that pt when he was on to the floor due to the negligence of the receiving nurse. It serious boggles my mind that this situation is blamed on the ED nurse- even if report had not been called, how was the ED nurse to know the floor nurses deficit in knowledge? Obviously the receiving nurse didn't know what questions to ask or to seek further guidance.

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