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?

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.

Muno's point is that a verbal report can help clarify important patient information. Why are you making this into an ED versus floor nurse issue? This is much more important than the nurses' egos. This is about giving and receiving important patient information that can mean the difference between life and death for a patient.

Specializes in Emergency Medicine.
Muno's point is that a verbal report can help clarify important patient information. Why are you making this into an ED versus floor nurse issue? This is much more important than the nurses' egos. This is about giving and receiving important patient information that can mean the difference between life and death for a patient.

It is not ED vs floor- but that's the situation that was given. Even if a verbal report had been given, the receiving nurse obviously did not know the appropriate questions to ask- she gave nitro, when the ED did not, and didn't even stop to think/ask why nitro was not previously given. Nurses need to learn to think things thoroughly through before just acting- this is critical thinking and is a skill required to be a nurse. If you can't think situations through, you are putting pts in harms way- a verbal report isn't going to change that. The majority of new EMR's have all the pertinent information you need right there, if you can read. Not being able to think for yourself or plan is not going to change with a verbal report.

It is not ED vs floor- but that's the situation that was given. Even if a verbal report had been given, the receiving nurse obviously did not know the appropriate questions to ask- she gave nitro, when the ED did not, and didn't even stop to think/ask why nitro was not previously given. Nurses need to learn to think things thoroughly through before just acting- this is critical thinking and is a skill required to be a nurse. If you can't think situations through, you are putting pts in harms way- a verbal report isn't going to change that. The majority of new EMR's have all the pertinent information you need right there, if you can read. Not being able to think for yourself or plan is not going to change with a verbal report.

In Muno's example above, a verbal report would have made it possible for the nurse giving the report to clarify why Nitro wasn't given, and for the nurse receiving the report to hopefully take note of that important piece of information, which was not conveyed during the faxed report. So yes, a verbal report may help someone to think critically. Again, we are talking about patient safety.

Specializes in Critical Care.
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.

I'm not sure why you're jumping to who can be labelled as being at fault, that actually never came up in reviewing the incident, it was the process that was at fault.

It's not a question of determining a winner and loser between the ED nurse and floor nurse, the patient was the loser, it's a matter of figuring out what could have been done differently in terms of processes, safeguards, etc to have avoided what happened. Having the receiving nurse perform a detailed review of all of the patient's home medications prior to receiving the patient would have added excessive delay to the process. The information the receiving nurse needed already existed with the previous nurse, it just didn't make it to them which wasn't helped by intentionally removing the method by which communication is most effective which is interactive. Ironically, we tracked ED throughput times during the trial and they actually got a little longer. It's now a moot point since the state no longer allows a nurse to transfer a patient to another nurse without speaking directly with the receiving nurse.

Specializes in Telemetry.
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?"

I can see something like this occurring in some facilities where medications given in ED may not show on the floors charting system or if the ED often doesn't have med administration charted at all. If a CP patient came up from ED with current CP I would probably have begun to follow our protocol and administered nitro without taking time to find med lists which may or may not be up to date.

I also liked to know if I needed to order a specialty bed or mattress (wounds or bariatric) and it's nice to know of any important family dynamics.

Let us also not forget some facilities have ED charting systems that do not communicate with floor systems.

Again solving most issues will require admin to increase staffing throughout facility and that means instead of fighting each other we need to come together and demand appropriate staffing and charting systems that make sense.

Specializes in Emergency Medicine.
In Muno's example above, a verbal report would have made it possible for the nurse giving the report to clarify why Nitro wasn't given, and for the nurse receiving the report to hopefully take note of that important piece of information, which apparently she/he did not pick up on from the written report. So yes, a verbal report may help someone to think critically. Again, we are talking about patient safety.

The nurse should have not given nitro, but did bc she could not critically think through why it wasn't previously given- most nurses, who have a pt with CP who did not receive nitro, is going to stop and think, hmmm why wasn't nitro given?? Even with a verbal report, that nurse obviously did not know the correct questions to ask- the nurse or herself. Like I previously said, it's not the reporting nurses job to know the knowledge deficit of the receiving nurse- that nurse has to be able to think for themselves and ask the appropriate questions. Just bc an electronic report is given, does not mean the receiving nurse cannot ask questions- at our hospital we put our direct ascom number on the electronic report in case there are questions.

Yes, it's about pt safety- most hospitals don't implement changes that hinder pt safety. What's not safe is for stable floor pts to take up a bed in the ED that critically ill pts coming in via EMS or sitting in the waiting room need. Electronic reports have become a necessity bc of the ridiculous amount of time it takes to get the pt transferred so a more ill pt can be taken care of. I find the more pressing issue of pt safety to fall more on a sick person waiting for a bed to be seen vs getting an electronic report.

The nurse should have not given nitro, but did bc she could not critically think through why it wasn't previously given- most nurses, who have a pt with CP who did not receive nitro, is going to stop and think, hmmm why wasn't nitro given?? Even with a verbal report, that nurse obviously did not know the correct questions to ask- the nurse or herself. Like I previously said, it's not the reporting nurses job to know the knowledge deficit of the receiving nurse- that nurse has to be able to think for themselves and ask the appropriate questions. Just bc an electronic report is given, does not mean the receiving nurse cannot ask questions- at our hospital we put our direct ascom number on the electronic report in case there are questions.

The point is that a verbal report from the off going nurse explaining why Nitro wasn't given would very likely have assisted the oncoming nurse to pay attention to this piece of information. We're not debating that the nurse should have used his/her critical thinking skills.

Specializes in Emergency Medicine.
The point is that a verbal report from the off going nurse explaining why Nitro wasn't given would very likely have assisted the oncoming nurse to pay attention to this piece of information. We're not debating that the nurse should have used his/her critical thinking skills.

You are obviously missing my point, so I'm just going to leave it at that.

You are obviously missing my point, so I'm just going to leave it at that.

Your point obviously isn't a good one.

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.

Various bits of data? I thought it was the permanent record that patient's care from their arrival through discharge.

Why do I have a feeling your "interactive conversations" that convey a more meaningful understanding of the patient are anything but short.

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?"

Would a verbal report prevented this mistake? Possibly, but far from a sure thing.

Following a written protocol for nitro administration would have. Or including nitro in the allergy/adverse reaction section of the chart. How about a note on the kardex?

I also liked to know if I needed to order a specialty bed or mattress (wounds or bariatric) and it's nice to know of any important family dynamics.

You might like to know, but it isn't a priority.

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