Interacting with patients and their families can be very rewarding. Most are kind, grateful for the care we provide, and responsive to our instructions. Effectively communicating with patients can sometimes be challenging, and patients may say and do things that add to these challenges.
Here are six things I’d like to say to patients, as well as some steps that may help avoid saying them.
We love a good sense of humor, and also love sharing banter with you as we prepare you for surgery. However, please do not tease about the stuff that matters: what we are doing for you today, when you last ate or drank, or other critical questions that require serious answers.
Sometimes, a simple…”these next three questions I require your attention as part of our safety process” may get the message across.
Please tell your caregiver to dress warmly and bring an activity to pass the time. For them, much of the time in our center will be both boring and cold, and we can’t fix that. We hate it when they look cold and miserable, and our bath blankets are in limited supply.
Include caregiver expectations as part of the pre-op teaching process. Something like “It tends to be cold and boring for caregivers here, so instruct them to dress warmly and bring something to do” .
I wish we were not running late. It is something we hate, and do everything to prevent it. Once we are behind, however, we cannot fix it. You would not want us to rush anything for your care, and we won’t do it for others either.
On late running days, I try to keep everyone updated, both in pre-op and in the lobby. Proactive communication prevents some of the frustration. Sometimes, a reminder to the the patient that they wouldn’t want us to rush their care helps.
NPO means NPO. Please follow our fasting guidelines. It is not just an inconvenience for you, it may impact your safety. A little food prior to surgery is not worth a hospital transfer and pneumonia or worse.
When providing NPO instructions prior to surgery, including that the reason is for their safety, which may mprove compliance.
We don’t judge you if you smoke. However, it will slow your healing and impact your post operative course. Also, please don’t smoke as much as possible prior to arrival, as the smell stays with you and impacts others. Same with perfume and cologne. Even our “nurses noses” are impacted when overdone.
Including the no smoking or fragrances as part of the pre-op teaching.
Please don’t give us your driver’s license weight. I know mine lists my goal weight. We won’t tell anyone, and if we were good at guessing, we’d have joined the carnival. We use your weight to make decisions about medication dosages and equipment safety.
Include weight measurement as part of the pre-operative process prior to surgery.
Do you have honest advice you would love to share with patients? I would love to hear them! Please share in comments, or send me an e mail at email@example.com. Thanks!
When we have to facilitate a hospital transfer, we have to shift into high gear. Not only do we have to ensure a safe and smooth patient transition, we have to re-route other facility operations as we shift focus, all while being concerned for our patient requiring transfer, and supportive of our staff. It is even more challenging when a patient is requiring urgent or emergent care and transfer coordination is imminently necessary.
CMS has updated the regs that guide the process as well. Here’s a recommended blueprint to make the process easier.
CMS has changed how it defines a “local hospital”, recognizing that the best facility for transfer may be further than the closest based on the type of care it provides. As an example, a patient with a cardiac emergency may be better served at the hospital five miles away instead of two. If you will be negotiating a transfer agreement, this may impact your hospital selection.
Although not new, as part of your emergency process, your physicians need to have admitting privileges at your receiving hospital or your facility will need a transfer agreement: We need to have one or the other, and the receiving facility needs to be Medicare participating. If you are transferring to a facility where your physician has privileges, check their credentialing file to make sure there is evidence of such and make it part of the credentialing process.
You don’t need a transfer agreement with a transport service, just utilize 911. If the patient requires acute care and is not stable for discharge, best to send them with trained professionals and monitoring. This saves the “how do we transfer” discussion.
One of the new requirements states that we need to communicate to the transferring hospital, and that our policy and documentation supports this. Update your policy to include the communication requirement. If you utilize a transfer form, update the form with a check box indicating the communication took place.
Review your policy to determine if the process supports printing or copying the medical record as part of the transfer. The receiving hospital will want the record. Don’t forget to check out the Advance Directive status of the patient as part of the transfer communication.
Have progress notes with your transfer forms for quick access so the transferring and/or treating physician can document the event. If your anesthesia physician and surgeon are both involved, request they both document.
When the nurse completes and hands off care, have them also document the event as an incident report separate from the medical record.
Utilize a transfer checklist that includes the actions and paperwork involved in the transfer. Include items like belongings disposition, notification of family, to whom report was given, that chart was provided, and that progress notes documenting the event were completed and sent.
I like to maintain an emergency transfer book with the crash cart that includes the policy, forms and checklist so everything is easily accessible when needed.
Practice the process as a scenario for your next code drill, and document the response. You’ll feel more confident if they need to transfer a patient, and the patient will benefit from your preparation.
On a personal note, I want to take a moment to thank all of you for subscribing to my blog. I am grateful for each of you.
This is a picture of Anita Dorr.I recently learned that it turns out that Anita started out as an OR nurse, became a nursing supervisor, then joined the Army Nurse Corps to care for the injured during World War II. When she returned from caring for our troops, she took time off to raise her family. As she returned to nursing, she found a job in the Emergency Department at Meyer Memorial hospital in Buffalo, New York.
She got tired of having to carry all the supplies that were needed and the delayed response any time there was a patient emergency, and, with her husband’s carpentry skills, invented what she called the Emergency Nursing Crisis Cart in 1967, the cart we fondly refer to as the Crash Cart. (more…)