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 Med-Surg, OB, ICU, Public Health Nursing.
Someone else posted this earlier. Since when do we always agree with The Joint Commission...lol!

If you bother to click on the links, you will see that they are not the same. In addition, if you look at the bottom of the article, several examples of how communication breaks down, is provided.

Specializes in Med-Tele; ED; ICU.
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.

That's the point... it's *not* compromising patient safety.

Specializes in Med-Tele; ED; ICU.
With a charted handoff note by the primary RN that's probably better than a lot of the verbal reports we are able to give in the ER.
Right?

What the Joint Commission is pushing is a "standardized approach" which, from what I've experienced isn't close to what's happening with verbal report. Having a standardized handoff report in Epic then provides the same standardized information... and the receiving nurse still has the chance to ask questions *after* they review the standardized information so that their questions can be meaningful and informed.

From the perspective of a large, nationally rated academic medical center -- with accreditations out the wazoo... JC included... verbal hand-off is *not* a requirement and does not present patient-safety risk.

I guess we'll see.

BTW, Nicki... I suspect our paths might have crossed IRL.

Specializes in ER.
No report from ER is pure insanity, and utterly dangerous. Half the pts come up before "30 min" because ER wants to push them out. Half the time they have squat for orders, aren't stable at all, can't give a history, etc. I don't care how long you have to wait for a floor nurse to pick up for report. If I'm too busy to take report I'm likely to busy to accept a trainwreck admission right now! /Rant but seriously the come up, no orders but on 02... Diabetic and no orders for anything with a big of 45 or 450. Screaming in pain, no orders, etc. It's a very dangerous practice. We are forced to do time consuming bedside report because laying eyes on the pt and getting good info is so important to safety but now we're getting a surprise admission and no info usually? Unsafe, unsafe, unsafe.

It's also unsafe for the patient to sit in the ED. Patient morbidity and mortality increases for every hour they spend in the ED after they are admitted as an inpatient. Additionally, every minute that admitted patient is being boarded in the ED there is another patient that could be sitting in the lobby. Which is more unsafe, you getting your 5th or 6th patient? or the triage nurse that has to try and keep eyes out for 25 or 30 in the lobby?

Trust me I know the inpatient side I worked it, and even picked up time doing it after I went to ED. But, you realize why the ED is constantly trying to shove patients down your throat after you go to work there.

It is very rarely the fault of the ED RN you don't have floor orders. At my specific facility it is the responsibility of the admitting provider to enter orders for the patient. The ED Docs/PAs/NPs are specifically told to not enter orders except under certain circumstances.

None of this excuses not at least attempting to address known issues for patients. If I know they had a glucose of 450, I'll ask the provider about it. That does not however mean I'll get an order for anything, just like inpatient. Please refrain from speaking about that you do not know.

ok...since you keep asking....here is a good one. An ED nurse gives 4mg of morphine but forgets to chart this off in the EMAR. Patient arrives to our unit in agonizing pain. Floor nurse gives the ordered PRN dose of 4mg of morphine... AGAIN.. not realizing the ED forgot to chart it off. the aptient stops breathing. RR is called. Now do you get the idea?

OR...here is a good one. It happened to me. I was in a room caring for a quadriplegic, stool incontinent patient who was vomiting blood. Our unit clerk, unknown to me, put my usual ED admission on my med cart in the hallway without saying anything... not that it would have mattered because I was caring for another patient in need, not ignoring phone calls. By the time I came out of the room and saw the slip for my new admission, a patient was being wheeled down the hallway, yelling in extreme pain. simultaneously my phone rings. It's the OR asking for report on Mr so and so who is coming down for surgery on his bowel obstruction. I say, "who?? I have no idea who you are talking about."

Just then I look again my new patient slip. Of course, it's my new ED admission whom I know NOTHING about. I can't give report to the OR. I barely know his name let alone his stats. Hopefully, you get the picture. This is just one of many, many bad things that can go wrong without a verbal report and confirmation that the patient is coming. A lastly, this patient should NEVER have come to the floor. He should have gone straight to the OR... but they just had to get that ED bed open.

Here is good article for all of you to read. It explains better than I can.

http://littletonnhhospital.org/images/NursesPages/files/Nursing%20Handoffs-Ensuring%20Safe%20Pasage%20for%20Patients.pdf

It's also unsafe for the patient to sit in the ED. Patient morbidity and mortality increases for every hour they spend in the ED after they are admitted as an inpatient. Additionally, every minute that admitted patient is being boarded in the ED there is another patient that could be sitting in the lobby. Which is more unsafe, you getting your 5th or 6th patient? or the triage nurse that has to try and keep eyes out for 25 or 30 in the lobby?

Trust me I know the inpatient side I worked it, and even picked up time doing it after I went to ED. But, you realize why the ED is constantly trying to shove patients down your throat after you go to work there.

It is very rarely the fault of the ED RN you don't have floor orders. At my specific facility it is the responsibility of the admitting provider to enter orders for the patient. The ED Docs/PAs/NPs are specifically told to not enter orders except under certain circumstances.

None of this excuses not at least attempting to address known issues for patients. If I know they had a glucose of 450, I'll ask the provider about it. That does not however mean I'll get an order for anything, just like inpatient. Please refrain from speaking about that you do not know.

what I know is that I'm getting patientos without orders to care for them and that is unsafe. AND getting my 7th patient who is unstable for the night is dangerous. what I know is that before I send the patient somewhere else that I am responsible to make sure that the patient is safe for transfer and that the person I am giving the patient to has appropriate information. I also know that this kind of bullying to accept unsafe practices and suck it up by other nurses is why nursing is a nightmare so I don't appreciate your rude attitude.

A person who is stable one minute can quickly go south the next. That is very short-sighted perspective. And yes, I totally believe it's about the money, not patient safety. Fill all the beds as quickly as they can. Omitting verbal report for any reason is a BAD action. Period. If nurses are truly avoiding report because they are slammed and can't take another patient at that moment, that IS valid and needs to be addressed. Why bring a patient to the floor when they will most likely sit waiting to be assessed or given their meds? Certainly not considering patient satisfaction or safety. Let's address the real issues, not ignore them by simply avoiding report to save minimal time. That is not the best solution.

Specializes in PACU, pre/postoperative, ortho.
ok...since you keep asking....here is a good one. An ED nurse gives 4mg of morphine but forgets to chart this off in the EMAR. Patient arrives to our unit in agonizing pain. Floor nurse gives the ordered PRN dose of 4mg of morphine... AGAIN.. not realizing the ED forgot to chart it off.

--Eh, I can see that happening with a verbal report also. A nurse who neglects to chart a med is just as likely to skip details in a verbal report.

"It's the OR asking for report on Mr so and so who is coming down for surgery on his bowel obstruction. I say, "who?? I have no idea who you are talking about."

Just then I look again my new patient slip. Of course, it's my new ED admission whom I know NOTHING about. I can't give report to the OR. I barely know his name let alone his stats. Hopefully, you get the picture. This is just one of many, many bad things that can go wrong without a verbal report and confirmation that the patient is coming.

-Again, this is where facility policies make a world of difference. There is no verbal report at my hospital for pts going to OR either. A short sbar is faxed (minimal info like DNR status, allergies, reason for OR & meds on call to OR). In pre-op, we have access to the EMR & are perfectly capable of looking up hx, meds, orders, etc., in preparation before the pt ever gets to us.

Specializes in LTC Rehab Med/Surg.

Reading through the previous posts I definitely come down on the side of verbal reports.

Then I wondered why, as concise well written reports are almost better than rambling scattered verbal reports.

Then I decided I just like it when I talk to the nurse who last set eyes on the patient I'm receiving.

There's a connection and continuity between two living, breathing human beings, delivering another living, breathing human being.

I believe that patients are more than just words on a paper. Or lab numbers and XRay reports. They aren't just packages delivered from one area to another. As kooky as it sounds, I think it's a respect issue, and I'm not sure how to explain that.

Or I'm just old fashioned and need to retire.

Specializes in PACU, pre/postoperative, ortho.

Then I decided I just like it when I talk to the nurse who last set eyes on the patient I'm receiving.

And I've pretty much always known that I will do whatever I can to avoid talking to people, especially on the phone! 《shrug》 I prefer seeing it all in black & white but cringe when I'm forced to give or receive a phone report for a transfer or for ICU, lol. I almost always feel something is left out and it's all a bit rambling and less cohesive for me.

Specializes in Critical Care.
Right?

What the Joint Commission is pushing is a "standardized approach" which, from what I've experienced isn't close to what's happening with verbal report. Having a standardized handoff report in Epic then provides the same standardized information... and the receiving nurse still has the chance to ask questions *after* they review the standardized information so that their questions can be meaningful and informed.

From the perspective of a large, nationally rated academic medical center -- with accreditations out the wazoo... JC included... verbal hand-off is *not* a requirement and does not present patient-safety risk.

I guess we'll see.

BTW, Nicki... I suspect our paths might have crossed IRL.

The Joint Commission's safety goal for communication includes both a standardized approach as well as interactive communication. https://psnet.ahrq.gov/primers/primer/9/handoffs-and-signouts

The JC is an accreditation group, not a regulatory group, so a facility just has to get enough right to pass. A C- student will still pass the class, that doesn't mean they couldn't do better.

I certainly don't think the Joint Commission is the end-all-be-all of good practice, but the role of communication in patient safety is pretty clear. In root cause analysis of safety failures it's the most frequently cited cause, a problem not limited to healthcare which is why we've adopted ways to mitigate these safety failures that have also succeeded in other high risk fields, a basic component of this is interactive communication of information being transferred to someone else.

I get annoyed trying to give report to the floor as well, but there are other ways that are not only more likely to speed the process, but don't sacrifice safety to the same degree. According to studies, a bedside report is the most consistent way to reduce delays, a hard 15 minute limit also works well. I also don't think that a verbal report is the best way to transfer all the information, transferring the data about the patient for the nurse to review followed by a quick discussion of the patient is ideal.

Specializes in ICU.

I don't think JC standards mean anything when it comes to report. All they ask is that the person receiving the patient have an opportunity to ask questions. In theory, a faxed report 15 minutes or whatever before the patient arrives means the nurse has 15 minutes to ask questions. On paper, JC standards are passed.

In reality, there is a disconnect when the nurse never gets the faxed report because she's doing wound care, toileting someone, etc., and comes out to see the ED staff leaving after they're put her new patient that she knew nothing about in the bed. That's why I like verbal report - you have an actual dialogue between the receiving nurse and the sending nurse, not a pretend exchange of information that may or may not have ever happened. There is at least some information exchanged if two people have to talk to each other.

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