PT Reports from Nurses

[MedicPrincess]

If I brought a patient into an ER, looked at the nurse receiving the pt, and told her "I don't know anything about this guy, I just got him....but there's some paperwork you can just read about him yourself. I've got other patients I need to go get.".... I would be willing to be my liscense that nurse would be on the phone with my supervisor and medical director before I got clear of the ER.

Now, why then, do so many nurses feel as though that is an acceptable statement to give me when I am asking for a pt report on someone we are transfering to another facility?

I do not feel as though I am asking to much from the nurse taking care of a pt, to be given AT LEAST the basics.....what they are being treated for, why they are being transferred, what the meds are that are hanging and the rates I need to set my pump for, if VSS or otherwise, anthing special that I might need to know in the sometimes many hours the patient will be with me (depending on where we are going), Code Status.....ect.

I tend to find is total garbage to be told, "Well I just go this patient this morning and haven't even had a chance to see why they are here!" (Especially if its late morning or afternoon when I am trying to trns the pt out)

I could see if I was asking a "hard" question, like the pts allergies or pertinant hx.....but the BASICS PLEASE!!

Help me to understand the mentality that no transfer of care is required from nurse to paramedic....that way, when I go back to work and am handed a patient chart and told to read if for myself if I want to know whats wrong with the patient.....I will have a better understanding of how it is I don't need to know.

 

[JPINFV]

If I brought a patient into an ER, looked at the nurse receiving the pt, and told her "I don't know anything about this guy, I just got him....but there's some paperwork you can just read about him yourself. I've got other patients I need to go get.".... I would be willing to be my liscense that nurse would be on the phone with my supervisor and medical director before I got clear of the ER.

I'd agree, for the most part, but it depends on the situation. Insanely short transport times and critical patients will do that. I've had a 1 transport where that has happened and it was 7 minutes between going on scene (before patient contact), and arriving at the hospital (0.4 miles away). I don't mess when people have blue fingers (cyanosis) and I'm not going to take time to decipher what "yes to transfer, no CPR" means on a DNR I haven't seen before (no CPR= no compressions or no code? It took 2 nurses and a doc to figure it out). As a basic, once a patient is deemed critical, nothing should delay transport or summoning of paramedics that isn't correcting an immediate life threat (yes, a NRB was used). What gets done while transporting/waiting for medics, will get done, if it doesn't then so be it. That patient died ~4 hours later.

Mind you, a paramedic (as is yourself) has significantly better treatment options than a basic which justifies staying on scene to treat vs rapid transport.

-snip rant on nurses-

Completely agree. I find it much more frustrating when transporting a patient to the ER from a nursing facility. Strangely, the BEST reports I seem to get are from non-nurses at assisted living facilities. Unless the patient is the epitome of stable, they get one chance at giving me a report. As with my little story above, I'm not going to sit there and argue and cross examine a nurse about things that should be basic parts of a report. I can see needing to ask about specific things, but the entire report shouldn't be "room 15 bed A, abnormal labs, -hospital name-." I have no problem answering questions about history of the current issue and why I don't have a MAR (instead of a med list) with "The nurses refused to tell/give me (it)."

On the bright side, 2 years of dealing with that has giving me a good ability at finding what I should be told up front (hx, allergies, baseline, etc) from H/Ps.

 

[ffemt8978]

I had the exact same issue at a SNF today. We arrived, and a tech pointed to a pt. in a wheel chair and said, "There she is." The tech then proceeded to walk away, with no other staff around. We then were given a sealed envelope by the receptionist who told us, "Everything for the hospital is in there."

I ask for the nurse to give me a report, and was again told everything was in the envelope. I then stated that I needed a report from the nurse before I would transport the patient (non-emergent call). After about 10 minutes, they finally get the nurse on the phone, and the first words out of her mouth are, "Why do you need a report. Everything is in the envelope." :wacko:

I told her I needed a report, so that I could tell the ED what was wrong with the patient. The basics like C/C, present hx, significant hx, and allergies. I was then told the patient had a cough for 2 days, and has no hx other than that and no allergies. (When I looked in the envelope, the pt. had a significant med list, which is pretty amazing considering she had no hx. <_<)

Transport to ED, give what little information I had received and tell the nurse that was the extent of the report I received from the facility. The nurse asks if the name of the facility and their phone number was on the paperwork, which it was. I go back to the office and talk to my boss about it. My boss was going to call the SNF director and have a little chat about giving report to the ambulance crews. B)

If they want to treat us like taxi drivers, then they should call Dial-A-Ride and not a freaking ambulance.

 

[JPINFV]

Note to staff at a SNF specialized in psychatric patients:

1. Patients refusing to eat are not an emergency. That is not to say that they do not need treatment or transfer to a hospital, but it does make a difference with the on scene dynamics. The full continuum of force will be used starting at asking the patient nicely in this instance and moving to more forceful interactions as needed. The presence of a psychiatric illness does not mean that a patient is still not a person. There is no rush and there is no reason to skip to the end and use restraints. We do not mind using restraints when needed. We do mind using restraints when not needed though.

2. If a patient is "violent" then we need to be told that when we get report. A random CNA telling us after we've approached the patient is not the proper way to go.

2.A. That apprehensive look that the ambulance crew has is because of the other patient that is really large and yelling. Not the docile patient you want us to transport.

3. If you are a CNA that just advised a crew that their patient is "violent," the proper action is not to immediately walk away. Little details like that need to have more communicated.

4. If you are the CNA in 3 and return to see the patient still not on the gurney, the proper response is NOT to man handle the patient onto the gurney without even saying another word to the ambulance crew. Patient take downs should be coordinated.

5. Actions such as 4 that are unnecessary and uncoordinated will be deemed as assault by the ambulance crew and, following state law, mandates a report to the local ombudsman. Sorry, but we have no choice.

Dear ambulance company:
When your crew witnesses the above event, their hands are tied. It is not speculation, and it is not the same as another crew being complete idiots and reporting a bad bed sore. There is no reason to consult with the crew chief because state law is rather specific. An incident report will be made and submitted at the end of the shift, though. If you manage to lose said incident report before contacting the crew, then that's your fault.

Love,
Your EMT-Bs.

 

[firecoins]

I hear alot of compalints like this from transport guys doing emergency transport from a nursing/health facility to the ED.

 

[enjoynz]

If they want to treat us like taxi drivers, then they should call Dial-A-Ride and not a freaking ambulance.

Nice rebutle!
But isn't that the way we are seen, as far as transfers are concerned,
just an 'Ambulance Driver'!
ER is a different kettle of fish. I'm talking about the wards!

I don't know about there, but here other than paper work, lifting the patients from bed onto the stretcher is something hospital staff are not too welling to help with either. Most transfers have one crew member. Bit hard to lift the pt on your own. I have heard of the Ambo's saying they come back and get the patient when they have someone to help lift, because all of a sudden there isn't a nurse in site, or they bring up the 'no lifting policy 'that seems to be in hospitals here now.
Taxi drivers and weight lifters!
It doesn't happen much, but it does happen.

Cheers Enjoynz

 

[Ridryder911]

Okay, I agree for the most part. As one being on both ends. First, you only have one patient to deal with, remember that we have four more that is wanting something as well as the two other physicians, pharmacy on the phone, the RT tech, five other patient family members complaining that ...."the ambulance drivers stolen something".. , meanwhile I have to hang three antibiotics to other patients within a certain amount of time or I will get reprimanded. Then now, you decide you want a detailed history, although you have discussed this with your buddies outside in the ER bay or might have even brought the patient in.

I can give you a brief synopsis alike I do to the transfer facility, but pay attention alike I should when you arrive with a patient. Most of the information such as previous med.'s, home med,'s and such are in the transferring paperwork, read it. When I give you a diagnosis or treatment regime; be honest that you either know about it or not. Don't lie. I will explain to a point, but maybe not in detail at the current time.

Also, be sure the IV's are infusing after you have taken them off the IV pump. Be sure you have all the paperwork, x-rays, CT scans, before you leave. Transferring patients should not be that difficult of a procedure, as well notify the receiving hospital before arriving. A heads up, ensures they maybe prepared.

As I said, I do understand. I have been on both sides, and yes I know it is difficult to believe; I can be an a-hole to both sides I expect to receive and give what should be done.

R/r 911

 

[Outbac1]

I've met a few of "those nurses". Mostly at nursing homes and our local rehab center. They don't seem to understand that we, (medics), are responsible for the pt when they are in our care. If they only have an envelope to give me I'll ask questions while scanning the documents. If they have nothing I'll then ask for the info I need eg: name, address, health card #, hx, meds, allergies etc. I tell them I have to have that info or I can't transport, the I'm responsible speech. Then I talk to my partner while I wait and they scramble to get it. Sometimes it works and the lesson is learned. The next time I come in the paperwork and a short story is ready.

I have very little trouble at ERs and on the floors. The nurses know we need certain information. I can appreciate when they are busy, shortstaffed etc. and can be appropriately patient. I'm fortunate that we frequent the same ERs and floors and have over time built up mutual respect which works to everyone advantage.

 

[fma08]

if the nurse is nice enough to give a report then awesome, usually only get decent ones from ER or CCU nurses, but i still have a little grudge that'll stick for a while. see my post in the bad calls section and you'll know why.

 

[firetender]

"Gee, I'd really like to take this patient without a verbal report from the Nurse, but you know, if I just read what you gave me...

...I may be in the middle of reading, the patient may code, and I still won't know why...

...I might miss something. The Nurse can direct me to what is most important so that if the patient becomes compromised enroute, everybody would be prepared.

...I'd not be doing my duty which is either do a complete head-to-toe examination until I know what I'm transporting or to have the patient released to me by a licensed individual who will take responsibility for the accurate assessment of the current condition of the patient."

Bottom line, you have the right to press the issue if you have any concerns. When all else fails:

"I can't do the job I'm supposed to do for the patient without your cooperation. Would I be better off speaking to your supervisor or would you prefer that the Head of EMS speak to your Director tomorrow??"

From the other end of the gurney, Rid, what's your impression of that final approach?

 

[gcfd_rez31]

I had the exact same issue at a SNF today. We arrived, and a tech pointed to a pt. in a wheel chair and said, "There she is." The tech then proceeded to walk away, with no other staff around. We then were given a sealed envelope by the receptionist who told us, "Everything for the hospital is in there."

LOURDES --> KADLEC???? LOL