When is a patient your patient?

Anna Flaxis, BSN, RN · 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.

Well, I do work ED and this scares me! :eek:

Anna Flaxis, BSN, RN · Jul 22, 2011

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.

This is not common in the ED in which I work, and I'm glad for that! This is a huge patient safety issue! Unfortunately, I think it's only going to get worse in the years to come, as ED overcrowding worsens and hospitals continue to cut costs. :uhoh3:

crb613, BSN, RN · Jul 22, 2011

This is not common in the ED in which I work, and I'm glad for that! This is a huge patient safety issue! Unfortunately, I think it's only going to get worse in the years to come, as ED overcrowding worsens and hospitals continue to cut costs.

Amen! :up:

KayRN910 · Jul 22, 2011

This is not common in the ED in which I work, and I'm glad for that! This is a huge patient safety issue! Unfortunately, I think it's only going to get worse in the years to come, as ED overcrowding worsens and hospitals continue to cut costs.

If you read some of my threads, that's is one of the exact reasons I am leaving my ER!

Back to the OP, I would refuse to chart code sheets on a patient if I wasn't in the code. I feel like... I'm documenting something legal and official, off of something somebody told me and probably from a paper towel that somebody grabbed to jot down times, and I wasn't even in the room? No thanks.

On the flip side, I would offer to help whatever nurse was doing that paperwork with their patients or whatnot. But I wouldn't sign my name to it. Nah uh.

If they didnt' make it, however, that paperwork is different, and I feel differently about going through the PM checklist because it is still my patient. Just wont chart a code I wasn't in on.

Anna Flaxis, BSN, RN · Jul 22, 2011

If you read some of my threads, that's is one of the exact reasons I am leaving my ER!

....and the day this is common practice in my ED is the day I leave! I feel fortunate to work in a good ED, but I think it's only a matter of time before that changes.

Roy Fokker, BSN, RN · Jul 23, 2011

*If I'm not in the room, I'm not charting anything. Period.

You're essentially asking me to lie - by saying I witnessed things I did not. And I'm not lying, sorry.

Even if I had an event such as an unwitnessed fall on my pt., my documentation usually goes like "at 0900 this nurse heard a loud crash from room 410. Upon entering the room, pt. Smith was found on the floor..."

* In my ED, we "assign ourselves" to patients. While we generally work in set areas (e.g. Nurse Able responsible for rooms 1-4, Nurse Baker for rooms 5-8 etc)., when triage plops a pt. in the room, we click our name on the board beside the pts. name. In areas where two or more nurses share a bunch of rooms, any one of them can pick up patients.

* Sometimes when one section of the ED is getting slammed (say one pod has two crit. pts.) other nurses chip in. Last night when I wasn't too busy back in fast track, I chipped in by getting vitals on new. pts., doing quick assessments, starting IVs, hanging meds, transport to CT etc. In such cases I'm not the primary nurse for the pt.

cheers,

shannonFNP, BSN, MSN, RN · Jul 23, 2011

I completely agree 100% with all of you. I'm going to bring it up to my managers. This particular patient was triaged as a level 2 and came immediately back. Report went to the charge nurse who assisted with the code, but nothing was charted on the patient. Someone always gets report, but even if it's not the primary nurse that gets it, they are considered responsible for the patient if it's their "room." The nurse that took report on her other patients was in another room and was there 5 minutes after the code started. So the initial assessment directly before the code, the initial rhythm... etc, the primary nurse never saw and no one wrote it down. I love this forum because it always helps me learn new things, or reassure myself that I'm not crazy for thinking that this situation was wrong. And it gives me the confidence to speak to my manager about it to fix this situation. I truly feel that you shouldn't document something that someone else told you. If someone said, her first rhythm was v tach, etc... then that person should document it.

Thanks :)

crb613, BSN, RN · Jul 23, 2011

If the charge nurse was given report...then that is her pt, and she should have charted everything until this pt was handed off to someone else.

TrafalgarRN · Jul 24, 2011

From a legal issue and own perspective the patient is your patient when you get report. This does not always happen in the real world and i have have been mad when an urgent patient is placed in the room and the Triage Nurse has to rush outside to take care of other patients. When i triage an emergent or urgent patient i will immediately room them, call the doctor STAT to the room and let the charge nurse know i need a nurse to the room. I always remain in the room till the assigned nurse is in the room. In my department we have a triage nurse in the front and another triage nurse in the back who deals with the ambulances and we have a working relationship where the other nurse will keep a look out on the front when i am in the room with a critical patient. As i mentioned earlier its not always the case and you will end up with a Priority 2 patient been roomed and you discovering it 10 minutes later which is a big NO...NO. As an example, if i get chest pain patient its my duty to connect them to the monitor and get someone else to be doing the EKG while at the same time knowing who will be the primary. And as a Golden Rule, chart...chart...i will make sure i put in my note that report was given to XYZ and MD XYZ was called to room. That way nobody will dispute that they assumed care. Its just scary to hear that some ED's will just announce "New Patient in Room 16".

felineRN · Jul 26, 2011

Ha! Do you work where I work?? I see this all of the time. I had a flash pulmonary edema placed in one of my critical rooms and wasn't informed. I was busy with the hypotensive septic pt next door. The next thing I know I'm screamed at for not being at the bedside with the RSI cart...

I feel like it's the responsibility of the triage nurse or charge nurse (whoever places the pt in the room) to inform the receiving nurse.

MassED, BSN, RN · Jul 26, 2011

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

these types of situations happen in a busy ED ALL OF THE TIME. It is the nature of the beast. You have to know your rooms at all times - you have to be VISUALLY surveying at all times. If you cover someone for a meal, then you are responsible for those 30 minutes. Period.

MassED, BSN, RN · Jul 26, 2011

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.

I know time passes, most quickly when we're busy with our patients and in their rooms, BUT, you really should at least EYEBALL a patient - given the acuity, if it's a CP or ABD pain or any other complaint that COULD progress or actually be something entirely different than say, toe pain, I'd check it out - give it 30 seconds, then tell them you'll be back - at least you can do a quick triage and move back to what you were doing. It's your tail on the line, remember that.

Of course we are in rooms sometimes for 20 minutes or so, but if you have direct knowledge that someone with a high acuity was placed into your room, it's good practice to at least assess ABC's.... and check their EKG to know what might be coming... where I work, anyone that is a serious ESI 2 and moving to a 1 will be placed into our trauma room initially. That doesn't mean that some triage nurses inappropriately triage a person as a 3, but when I assess them they are a solid ESI 2 working on coding - STEMI or Dissecting AAA. The point is - check, take a quick visual and with that eyeball of the patient, you can then reprioritize your patients.

Of course if you work in a place where you are not informed, then run for the hills. RUN! Cause that's gonna bite you in the hiney.