When is a patient your patient?

MKS8806 · Jul 22, 2011

I don't think a patient should be assigned to a nurse that isn't present to assume care of them.....

Chico David, BSN, RN · Jul 22, 2011

I'm not a legal specialist, but this is an issue I've dealt with as a union rep.

If the patient is already present, then they become your patient when you receive report on them. In a case where the patient is being delivered from another area, then they become your responsibility when you have both received report and been informed of the patient's presence. In California, we have pretty clear lunch and break relief law - not always perfectly enforced - so that when you are on break your patients are the responsibility of the person who relieved you for your break.

A while back, I fought and won an issue where a nurse had been suspended because of something that happened to a patient on whom the nurse had not yet received report.

tmartin83 · Jul 22, 2011

I've been told when you receive report on that patient, you assume responsibility and care...

KayRN910 · Jul 22, 2011

I don't think a patient should be assigned to a nurse that isn't present to assume care of them.....

I understand that in *theory* that is the case, but according to your bio, you have never done ER, and it is quite common to get a new pt in the ER and not know what it is until 20 or 30 minutes after you get it. I have other rooms as well, so when I discharge a patient and finish that charting, I have to check my orders and vital my other patients, so it is usually about 20 minutes before I can peak my head in on my new patient.

That's not *always* the case, but it is a lot of the time. It really, really bothers me from a legal issue, too. Often (in my ER) we do not get "report" from the triage nurse. You have an open room, so you know somebody will be put in there, and when triage, a tech, charge, anybody, gets time, they go get a patient from the waiting room and put them in the room. Somestimes they will get put on the monitor, but not always. There's usually no formal report. You just read the chart, and *sometimes* they will chart,"Pt ambulated from waiting room to treatment room." or whatever to say they were put into a room, but not always.

When we do get report, it's usually like,"I put a chest pain in room 15. Vitals look fine. Already did the EKG" or whatever. Almost never a formal report until you are picking up new rooms.

obenfermera1 · Jul 22, 2011

I'm not 100% sure, but I think this very issue is one of the current Joint Commission identified patient safety thingamajiggys. Their position on the matter is something like there should be an opportunity for the receiving nurse to receive report and have a chance to ask questions at the same time.

We were told this was their way of forcing the "face to face" report issue, as we had implemented a verbal/phone report process for transferring our delivered patients to post partum. At the time, our (L&D) argument was, post partum knows the patient is coming when our secretary calls to request a room, so why do we have to track down the receiving nurse on the gigantic floor to give a face to face report when we've already called ahead and given report to receiving nurse on the phone?

The answer was b/c our phone report process had created a potentially looong lag time between our call to say patient is otw and her receiving RN presenting to the room to assess the patient, and it was unclear who was responsible for patient if report wasn't given face to face and care officially handed over at a precise time.

I know this doesn't really answer your question, but just wanted to say this is an issue across the board. The Joint Commission wants us to have that precise magical *moment* of handoff to make it simpler to identify the responsible party in case of an issue. But then life interrupts the perfect plan........You're not alone! :redpinkhe

crb613, BSN, RN · Jul 22, 2011

I am wondering how this pt was triaged....urgent,non urgent,fast track. If they coded within minutes of being placed into a room (I am thinking they did not go to waiting room) did the triage nurse not pick up on how sick they were? I know a pt can seem fine one minute only to code the next, but usually there are some warnings. I would think that triage would have made someone aware of this pt. In my ER we do not have assigned rooms, we just each take turns taking walk-ins & runs. If one of us is out of the ER we all know it, and take over their pts as well as any new arrivals. We have a huge tracker board that shows every room, with pt name,c/o, and urgency....depending on c/o & urgency someone is in there immediately....triage also lets us know if they have an urgent pt in the chair. I don't know how a nurse can be held responsible when they were not present or aware of the pt....

mmutk, BSN, RN, EMT-I · Jul 22, 2011

I love all these posts from people who don't work ER! It's not like getting report on the floor. Often it is a tech that brings this patient back and you will rarely see the triage nurse to get 'report'. At our ER over the loudspeaker they say "NEW PATIENT ROOM 16" and that is the report. Even if I didn't hear it or was doing a transport.

This is a great topic and I feel like it often falls on the charge nurse to ensure the ER nurse is aware a new patient has been triaged to their room.

merlee · Jul 22, 2011

In most situations, it is 'your' patient only after you have received report. If you are not on the floor when the patient arrives, then the patient is the responsibility of the nurse who received report while you are away.

If someone is transporting a patient to an open bed in the ER then that person bears responsibility until the report or handoff is done.

How can a patient be placed in a bed without someone to receive them??? Poor planning, bad policy.

Hagabel · Jul 22, 2011

The nurse relieving the other nurse for lunch break is responsible for that pt, whether that be a colleague or the CN. The nurse at lunch cannot be held resposible during that 30 min or so period of time, esp if she has never met the pt.

Anna Flaxis, BSN, RN · Jul 22, 2011

I'm curious on how you all feel about it, especially if there are some legal nurse consultants in the mix. When is a patient actually your responsibility? The other day, one of our nurses was on her lunch break when a patient was put into her room from triage. The patient was coded within a few minutes. She arrived, just hearing of her new patient, and was responsible for doing the code sheet (just about finished with the code by then, regained pulse, etc) and for doing the initial assessments on the patient. What if this had happened and no one knew the patient was coding? Sometimes our tech's don't put patients on the monitor. Who is responsible? Or even taking the code out of the situation, many times a patient will be placed in a room and the nurse isn't made aware either because someone forgot to tell them or the nurse was busy in another room and never got the message. Even if you put "initial contact," what is the legality of this situation?

I'm not going to comment on the legality of everything here, but it sounds to me like your triage/flow system could use some work. I don't think it's good practice to have techs rooming patients, except in the low acuity/Fast Track area, where this can speed up patient flow. In the regular ED areas, either a flow nurse (nurse designated to bring patients back from the triage area) should room the patient and hand them off face to face to the nurse assigned to that room (in this case, it would be the nurse covering for the nurse who is on break), or nurses should come get their own patients from the triage area. A patient should never just be roomed with the expectation that someone will get in there eventually. There needs to be a nurse to nurse handoff.

This really sounds like a systems problem that could land your facility in hot water, if it already hasn't.

merlee · Jul 22, 2011

Stargazer - - you said it better than I did!!! Thanks!