So I'm still a new-ish nurse. I've been working in the same unit since Aug 2019 and most of it night shift. I'm fairly recently day shift and in some ways I feel like I am starting over. I have had a total of 2 transfers to other units, one while orienting and one yesterday. I'm worried I "did it wrong". (Also I'm long-winded, so sorry for the length of the post.)
The patient was CIWA and rapidly going up in CIWA scores. The patient had been off unit a good deal of the day for a procedure and came back to us much higher in CIWA scores. In the hour that we were trying to transfer them to ICU for better CIWA management, the patient's scores more than doubled. A family member called right after I called report on the patient and was irrate because the family member wasn't listed as someone who was permitted to receive info on the patient and the patient was not at all in a condition to give permission to talk to that family member. It was a mess. Called a security alert and 4 staff assists due to combative confusion before I could get the patient out of there, all the while we were trying to clean up pee and poop. This took most of the floor's attention for a while, including our case manager and floor manager, neither of which are technically doing patient care.
My floor manager popped by to tell me that a med had come to our unit instead of ICU and that she was going to run it down. I told her about the phone conversation with the family member and she said that she would pass it on, but that ICU nurses deal with this all the time and will know how to handle that family member.
At 2 AM, I popped awake realizing that I had never called the family member that was listed on the patient's chart as the emergency contact. I feel like an idiot. I called the night charge, who I see as my mentor. She said that it really is too late now and not to worry about it, but she'll pass it on in the morning to the floor manager.
So who should call family in these situations? I really think it should have been me. The one and only other transfer I've done to ICU, we really thought we were going to lose the patient, so it was a call to have the family come now. This wasn't really that because it was expected with this patient, but I do feel like I screwed up.
Trying to cut myself a little grace here. We're in the middle of a rapid uptick of Covid in our area and my unit is taking care of patients that are not at all our usual population. We're supposed to be taking all the medicals for the hospital right now, and I haven't seen our usual surgical patients in months. This shift was particularly rough and this patient wasn't my only emergency. Due to low staffing, acuity, and other factors, it qualifies as a "crisis shift". This isn't the first CIWA patient I've had, but the first that I've had to transfer to ICU. I'm also recovering from Covid myself from early Nov. Covid brain is real and not unlike pregnancy brain. Now I'm just spinning my wheels a bit and can't get back to sleep.
Specializes in Community Health, Med/Surg, ICU Stepdown.
Clinical Institute Withdrawal Assessment. Checklist to determine the severity of an alcohol withdrawal pt, usually asks about mental status, hallucinations, nausea and vomiting, tremors, tactile disturbances, etc. I prefer RASS, Richmond Agitation and Sedation Score, where you pretty much just rate how agitated the pt is from 0 to 4, or how drowsy from -1 to -4. much easier and clear, CIWA very subjective and a lot of charting. Just my opinion ? 0 is alert and oriented. +4 pt grabbing the headboard off the bed and swinging it at people while simultaneously ripping out his Foley and screaming at nonexistent elephants... in my experience! LOL horrible
1. If you have the time and can remember, then definitely make the effort. However, your patient comes first not the family. I have seen managers and other nurses confuse this or twist this the wrong way.....the patient comes first.....ALWAYS.....then the family.
2. Sometimes the charge nurse is good to enlist to help and sometimes the physician should call. It really does depend on the circumstance. I have done the same thing....but so focused on my patient or patients that I completely forgot to call the family afterwards. Sometimes it happens....nurses are human and make mistakes too.
Specializes in Oncology (Prior: Ortho-Neuro, Metabolic Surgery).
Thank you for the input everyone. I'm feeling much better about the situation knowing that generally it is the physician that should call for major changes. I keep hearing at work that we should make extra effort to update family right now, especially for Covid patients (this was not Covid).
Last night, however, updating the family bit me in the butt. I was in an isolation room (also not Covid, just contact) and I had just come in with a med I had drawn up into a syringe outside the room. I got a call on my phone. Generally I do not answer my phone in iso rooms, but we just had a policy change that we must answer calls since Covid patients decompensate so fast when off O2. I pulled out my phone and it was a family member of a different patient asking for an update. I stepped back into the hall, phone in one hand, syringe in the other. After a short update, the family asked for lab results. I told them I couldn't recall and wasn't allowed to give specifics and directed them to the physician or the online patient portal, but they were insistent, so I mentioned elevated WBCs (which I vaguely remembered). Family member was alarmed so I reiterated that this is expected for the patient's stage in recovery and ended the conversation on a good note. Got back to a computer later and realized that the elevated WBCs were on the patient in isolation, the one whose room I had just stepped out of, NOT the one I was updating the family member on (the rest of the update was accurate). The patient whose family had called had an absolutely normal WBC count. Ugh!
I feel like every interaction with family, whether in person or on the phone is darned if I do and darned if I don't.
Specializes in Community Health, Med/Surg, ICU Stepdown.
1 hour ago, Ioreth said:
Thank you for the input everyone. I'm feeling much better about the situation knowing that generally it is the physician that should call for major changes. I keep hearing at work that we should make extra effort to update family right now, especially for Covid patients (this was not Covid).
Last night, however, updating the family bit me in the butt. I was in an isolation room (also not Covid, just contact) and I had just come in with a med I had drawn up into a syringe outside the room. I got a call on my phone. Generally I do not answer my phone in iso rooms, but we just had a policy change that we must answer calls since Covid patients decompensate so fast when off O2. I pulled out my phone and it was a family member of a different patient asking for an update. I stepped back into the hall, phone in one hand, syringe in the other. After a short update, the family asked for lab results. I told them I couldn't recall and wasn't allowed to give specifics and directed them to the physician or the online patient portal, but they were insistent, so I mentioned elevated WBCs (which I vaguely remembered). Family member was alarmed so I reiterated that this is expected for the patient's stage in recovery and ended the conversation on a good note. Got back to a computer later and realized that the elevated WBCs were on the patient in isolation, the one whose room I had just stepped out of, NOT the one I was updating the family member on (the rest of the update was accurate). The patient whose family had called had an absolutely normal WBC count. Ugh!
I feel like every interaction with family, whether in person or on the phone is darned if I do and darned if I don't.
Sounds very distracting to have to answer any call that comes through while you're in a patient room. Do you have a clerk? I don't think calls from another pt's family member should be sent to you while you're in a different pt's room. HIPAA violation and/or med error waiting to happen. Family members need to understand that the first priority is not updating them, the first priority is taking care of their loved ones. In my experience they are usually happy to know that the nurse is in their family member's room and someone will call them back, if we tell them in the right tone.
Is there a way you and your coworkers can suggest changes to this phone call system? Who transferred you this call? I'm sorry this happened to you. And that the family member didn't listen when you said you couldn't disclose or remember specific lab results. When you're new it's easy to feel pressured by insistent family members. I've learned to be polite but firm and explain that we can't always answer their calls because the first priority is patient care and that frequent calls take us away from providing care to their loved one. If multiple people are constantly calling about the same pt we ask them to designate one person to call and disseminate the info to everyone else.
With this situation a lot of factors contributed to you giving them misinformation, but at least it wasn't a big detail like saying the wrong diagnosis! I'm sure the family member has spoken to someone else by now and has accurate update. If they are confused by the conflicting info and want an explanation I would find out the policy on which providers share what information, and/or ask the manager what to do (and explain how unsafe it is to answer random calls while trying to give meds!)
Specializes in Oncology (Prior: Ortho-Neuro, Metabolic Surgery).
We don't have a clerk, so it was most likely the charge nurse that transfered the call. This keeps happening all the time, and I'm almost always having to take these calls when I'm at the Pyxis or in a patient room. I always keep HIPAA in mind, but I agree that it is a major safety issue with meds. I'll talk to my manager about it.
Specializes in Community Health, Med/Surg, ICU Stepdown.
Yes, and talk to your charge nurse. They can always take a message and phone # and you can call the family back if appropriate and at a safe time to do so, or ask the MD to call if that is more appropriate. good luck!
Specializes in med-surg, IMC, school nursing, NICU.
On 12/10/2020 at 7:03 PM, canoehead said:
With a transfer to the ICU, the physician makes contact with the family, in all the hospitals I’ve worked in.
Yup. Same here. If the physician is ordering an upgrade they should be at the bedside to assess the patient and calling the family is their responsibility. I have found that families usually would rather talk to the provider in a situation like that, anyway.
Thank you for the input everyone. I'm feeling much better about the situation knowing that generally it is the physician that should call for major changes. I keep hearing at work that we should make extra effort to update family right now, especially for Covid patients (this was not Covid).
Last night, however, updating the family bit me in the butt. I was in an isolation room (also not Covid, just contact) and I had just come in with a med I had drawn up into a syringe outside the room. I got a call on my phone. Generally I do not answer my phone in iso rooms, but we just had a policy change that we must answer calls since Covid patients decompensate so fast when off O2. I pulled out my phone and it was a family member of a different patient asking for an update. I stepped back into the hall, phone in one hand, syringe in the other. After a short update, the family asked for lab results. I told them I couldn't recall and wasn't allowed to give specifics and directed them to the physician or the online patient portal, but they were insistent, so I mentioned elevated WBCs (which I vaguely remembered). Family member was alarmed so I reiterated that this is expected for the patient's stage in recovery and ended the conversation on a good note. Got back to a computer later and realized that the elevated WBCs were on the patient in isolation, the one whose room I had just stepped out of, NOT the one I was updating the family member on (the rest of the update was accurate). The patient whose family had called had an absolutely normal WBC count. Ugh!
I feel like every interaction with family, whether in person or on the phone is darned if I do and darned if I don't.
Don't let yourself get distracted with a syringe in your hand. A simple Im with a patient now would suffice. Distraction =errors.
amoLucia
7,736 Posts
Please, am foll along, but what is CIWA? TYIA