Your Gettin a Patient - The Doors Open and In Rolls Your Pt.

allnurses Guide · Oct 15, 2007

How does this happen???
Pt. arrives is seen in ED @ 2100 as a trauma alert. Primary/secondary survey, orders entered in CAPOE, plain films, CT scans done, etc.
I get a call from my AP (unit clerk) @ 0230, "you're getting a pt., report's in the computer." I knew there was no bed in the room, as I walk out into hall to get the bed to bring it to 17A, the doors open up and in rolls the pt. Fortunately, the pt. was A&O and could tell me his injuries. I stood there and read report in front of patient.
We won't even begin to talk about the crazy orders the first year put in... But in his defense, he was just hired a few days before.
I don't mind short notice but how about 5 minutes... Hmmmm.... How 'bout 2 minutes.... 10 seconds just don't cut it.

I'm in a new, bigger city ER.

We have to fax an SBAR to the floor first. Then call to give report to the actual nurse caring for the patient. Then we call transport, who takes the patient alone OR if monitored I go too.

In my small town ER, I walked the 30 steps to the nurse's station in our 10 bed acute floor and gave them a copy of the admit orders, gave them a report and then they called me when the room was ready.

steph

Tweety, BSN, RN · Oct 15, 2007

I hate when that happens. It happens to us too. Usually, I assign the patient and two seconds later the ER or admitting is one the phone...."um, can't I tell the nurse first?".

CarVsTree · Oct 15, 2007

I hate when that happens. It happens to us too. Usually, I assign the patient and two seconds later the ER or admitting is one the phone...."um, can't I tell the nurse first?".

It's been going so well. The summer and we were really busy this summer, it rarely happened. But lately, things are going downhill. They just got a new director downstairs and I'm wondering if that's the problem.

Lately, mip's aren't getting done. We had a pt. with no RUDS done and the ED RN didn't even tell the floor RN that it needed to be done. Turns out pt. was pooring his urinal. I took it from him and got 4ml's out of it and we got our RUDS! :lol2: I'm sure you can guess whether or not it was positive.

Hey Tweety, did you ever do Trauma critical care? I'm going through the CC course beginning in Nov. They're orienting me in Trauma Neuro ICU and I'll float between MICU/SICU, Burn & TNICU... I'm both excited and scared!

CarVsTree · Oct 15, 2007

I'm in a new, bigger city ER.
We have to fax an SBAR to the floor first. Then call to give report to the actual nurse caring for the patient. Then we call transport, who takes the patient alone OR if monitored I go too.
In my small town ER, I walked the 30 steps to the nurse's station in our 10 bed acute floor and gave them a copy of the admit orders, gave them a report and then they called me when the room was ready.
steph

Yeah, that's how its supposed to work... Trauma alert supposed to be phone report, 'cause they use paper in the trauma bay. Traum consult or other service ED admission is T-system report, that we print ourselves by accessing the T-system report screen. But we're supposed to be told we're getting a pt. as soon as they are assigned a bed. Then we're supposed to get a courtesy call or report when they are sending pt. up. I love when the courtesy call comes long after they've called transport to send pt.

I think I've seen an ED RN bring a pt. once. And that is 'cause it was so nuts downstairs and the ED and transport were totally backed up.

I did see an ED RN come up to see if the rooms that we claimed were dirty, really were dirty though. That was interesting.

EmmaG, RN · Oct 15, 2007

On my last assignment, that happened ALL the time. Seriously. And I never got report (except on those patients coming from the admissions unit). When I asked about this, I was told the ER didn't give report, and they weren't required to either.

What the heck????

This was a neuro/neuro step-down trauma unit. Very disconcerting to have a patient just appear and to have NO idea why they were admitted, what transpired in transport to the hospital or in the ER. To make matters worse, we were unable to access any of the computer charting and records from the ER either.

I aggravated alot of folks calling back demanding a report, what meds, tx's and diagnostics had been done, etc. Though often, the nurse had already left her shift and of course no one else knew anything about the patient.

CarVsTree · Oct 15, 2007

:eek:

I'm speechless and that never happens! Ask my co-workers! :lol2:

So, what does the ED do at that place exactly? Oh wait, you don't know 'cause you can't access their records. :selfbonk:

SCARY!!!

UM Review RN, ASN, RN · Oct 15, 2007

I agree. The nurse taking the patient needs to confirm Report before the patient is sent.

I used to have a Charge nurse who took Report for me, which irritated me to no end too. I want to hear Report in all its gory detail, and I will decide what's important enough to write down.

Even now, when I know I'm getting a patient, I look up the labs and other test results before the patient gets to the floor. I've headed off a few inappropriate admits that way and been able to prepare the techs for special needs patients as well.

EmmaG, RN · Oct 15, 2007

I'm speechless and that never happens! Ask my co-workers!
So, what does the ED do at that place exactly? Oh wait, you don't know 'cause you can't access their records. :selfbonk:
SCARY!!!

I think it kinda broke JCAHO rules, eh?

It was interesting, to say the least. And challenging. I felt like a CSI, piecing together my patients' histories :monkeydance:

(sorry, that just came on here--- gotta love Gil! :lol2: )

UM Review RN, ASN, RN · Oct 15, 2007

I think it kinda broke JCAHO rules, eh?
It was interesting, to say the least. And challenging. I felt like a CSI, piecing together my patients' histories :monkeydance:
(sorry, that just came on here--- gotta love Gil! )

Not to mention trying to piece together what meds were given and when. Good heavens! What a nightmare.

(And a virtual goldmine for a professional complainer like me )

CarVsTree · Oct 15, 2007

(And a virtual goldmine for a professional complainer like me )

I think we're cut from the same cloth. :rotfl:

EmmaG, RN · Oct 15, 2007

I agree. The nurse taking the patient needs to confirm Report before the patient is sent.
I used to have a Charge nurse who took Report for me, which irritated me to no end too. I want to hear Report in all its gory detail, and I will decide what's important enough to write down.
Even now, when I know I'm getting a patient, I look up the labs and other test results before the patient gets to the floor. I've headed off a few inappropriate admits that way and been able to prepare the techs for special needs patients as well.

My ex-ER was famous for forgetting a few fine details. Like the 30 something woman admitted with pneumonia--- they just happened to neglect to inform the supervisor she was also a vent-dependent quad. Or the man with the "rash", whose skin was literally sloughing off all over... or the little ol' lady who "only" had a fractured pelvis--- but oops, that was due to passing out from an MI. Or how 'bout the admission for 'pain control' for a patient with a fractured wrist. What the heck? Turns out she'd had the snot beat out of her and had a face that looked like raw hamburger.

I could go on, but I think you get the idea...