Holding in the ER again…. You got this!

For many ER nurses like myself, we actually invite the constant turn over of patients. Literally there are no two nights of work that are the same…ever. I love my job and I can’t see myself doing anything else. When patients come to the emergency room they are either admitted or discharged. At least that is the case a majority of the time until there are no open rooms in the hospital. Then we are holding our patients in the ER and then we instantly become both ER and floor nurses. This sucks for patients, nurses, and doctors. The ER isn’t designed for holding since we have to be ready to take whatever comes in the door and we cant turn anyone away.

According to the Center for Disease Control, based on 2015 results emergency rooms across the country are seeing approx 136.9 million patients a year. Among those patients, 12.3 million are admitted to the hospital. There isn’t an Emergency Room in the world that is exempt from holding patients at some point. There is good news though. It doesn’t have to be miserable and it’s up to us to make it better! We can’t control holding patients but we can take responsibility for what we can control.

Every time I have a patient that is admitted and know they will not be getting a bed anytime soon I make a quick reference sheet. I get a sheet of printer paper and place a patient label at the top and fill the paper out accordingly. I just make note of  the patients allergies, brief history, diagnosis, systems review, things to do, IV, medications, and family. If the patient is progressive it’s not as detailed as if the patient is ICU status. If the patient is ICU then I also jot down things I need to make sure I chart. For example, hourly assessments, I&O’s , and restraints. Pictured are the differences between the two (excuse the man handwriting). A quick reference sheet makes it is easy to keep track of what I need to do and makes giving report very easy. You have it all at one glance what you’ve done and what needs to be done.

When I orient a nurse to the ER, I always tell them there are three things you focus on when you have an admitted patient. Those three things are: bathroom, medication, and comfort in that order!  If you address these things right off the bat then I promise you it will save you ALOT of running around.

Bathroom:

  • Clean your incontinent patient. Even if they do not appear soiled. Provide peri-care and a new brief. (Make sure you document it.) That way you know for sure that the patient was dry and all the linens are not bunched up underneath them.
  • If they can ambulate  without assistance, then make sure they go to the bathroom so they know where it is.
  • If they need assistance to and from, encourage them to go to get it out of the way. Then make sure you communicate with them to let you know as soon as possible because it is the ER and it can chaotic at any given time.
  • Provide urinals if the setting is appropriate.

Medication:

  • Make sure home medications are reconciled if possible.
  • Whatever medications are scheduled then work with pharmacy to get the medication so you can give it. Yes even the stool softner….
  • If pain medications are due then give them.
  • When you look through orders if the patient needs pain meds, muscle relaxants, tylenol/motrin, anti-coagulants, anti-reflux, or anti-nausea meds then be proactive in asking for them from admitting physician.

Comfort:

  • Make sure they’re in a gown and socks.
  • Provide warm blankets and pillows. (If your facility does not provide pillows in the ER or notoriously runs out, then you keep asking management for them. This is a cheap and easy way to make the beds comfortable and aid against skin break down like floating heels.)
  • Check their diet status and if they can eat and drink then make sure they have something available.

It is VERY easy for nurses to do the bare minimum for admitted patients but you don’t want to be that nurse. You want to be better than that. You want the patient to go to the floor and ask to go back to the ER because the nurses took such good care of them. Communicating with them about what is going on will help decrease their anxiety of wondering what is going on. Make sure you are updating them and the family. Holding patients isn’t ideal but it is doable. It’s what you make it!

 

 

 

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