Question

an ICU nurse and are expecting a transfer from the emergency department. What type of information do you need in the report from the transferring nurse? How do you prepare the room for the patient transfer? What information do you provide to the patient upon his or her arrival?

Answer 1

Preparation for intrahospital transport includes specific necessary procedures that should be completed before, during and after transport. Nurses have an active involvement in every part of this process.

The recieving nurse would expect the following from a transferring nurse:

• All patients transferred out of the unit to another clinical area require handover to be documented in the EMR
• A written and informed consent of patient's relatives along with the reason to transfer is mandatory before the transfer.
• Documentation of transfer time indicating a transfer of professional care needs to be recorded in the patient’s Care Plan.
• A patient transfer checklist accompanies the patient on transfer and this should be given to the registered nurse accepting the patient.
• Structured patient handovers of clinical information are the responsibility of registered nursing or medical staff and the patient information required to do this effectively is contained in the medical notes, which should accompanying the patient during transfer. It is this information that will be used to prior to transfer to complete the patients’ transfer checklist or handed over verbally on the telephone.
• A direct communication between the transferring and receiving facility should be undertaken with sharing of complete information on patient's clinical condition, treatment being given, reasons for transfer, mode of transfer and timeline of transfer, in a written document.

Preparing the Patient's Room
A. Before a patient is admitted, make sure the room is ready for
his/her arrival
1. Check necessary equipment
a. admission checklist
b. pen or pencil
c. gown or pajamas (if the patient is to be put to bed)
d. portable scale
e. thermometer
f. sphygmomanometer
g. stethoscope
h. envelope for the patient's valuables

Ensure modules for SpO2, ETCO2 (ventilated patient), ECG, ABP (NIBP if no arterial line) and a spare pressure module are present prior to the patient’s admission.

Once a patient has been transferred from ICU and the bedspace is vacant, the RN accepting care of a new admission into that bed space must ensure that the area is prepared as per the Guideline.

If equipment is malfunctioning within the bed area (and is essential to the care of the patient), the Team Leader (TL) and Equipment Officer must be notified immediately and the bed space de-commissioned until the equipment is once again available/in working order.

If supplies are unavailable at the time or the nurse is unable to complete preparing the bed area: the nurse must communicate this to the team leader.

2. Make sure there is adequate light and proper ventilation
3. Open the bed for patients by fan-folding the covers back, and
attach the signal cord within easy reach.
4. Ensure patient supplies and equipment are present.
a. Washbasin
b. emesis basin
c. soap
d. towels
e. lotion
f. bedpan and cover
g. urinal for male patients.
h. other equipment may be brought to the unit to meet the
needs of a particular patient. For example, one patient may
need an overbed trapeze, or an intravenous pole.
5. Make a final survey of the room to be sure it is clean, neat and all necessary equipments are available .

When the patient arrives at the new room

• Assesses the patient: visual scan, greet patient (assesses ability to respond), chest rise and fall, observe transport monitor values.
• Where required, obtains appropriate assistance to move patient from transport stretcher using manual handling assist devices.
• A medical to medical handover is to occur whenever a ventilated/medically escorted patient is transfered to the ICU. Nurse involvement is imperative.
• Commence receiving report from nurse escort/anaesthetist: evaluate ventilatory needs, change vent settings as required in conjunction with ICU medical officer and transfer patient to ventilator.
• Auscultate chest for adequate air entry, view tracheal tube for stability and position (if endotracheal tube – note position at teeth/lips), assess rise and fall of chest and observe transport monitor for vital signs’ values.
• Commence transfer of the MMS followed by each monitoring module, one at a time.
• Commence ETCO2 monitoring for all ventilated patients.
• At all times, monitor remaining parameters on transport monitor until each individual module has been transferred to the ICU monitor.
• Zero transducers if required, ensure all alarm limits are appropriate, with ICU registrar/consultant.
• Document plan of care and vital signs and physical assessment findings.
• Review drug chart, anaesthetic/operation chart re major issues of input/output, events

and further actions to be attended with nurse escort/anaesthetist. Ensure all blood
products (excepting thawed FFP) are used as per prescription or returned to Blood
Bank.
Check if relatives were with patient and where they are currently waiting. Check what
information they may have been given verbally by the transferring team.
Prior to the transferring team leaving the ICU, a “Time Out” will be called so as any
final issues can be addressed. The anaesthetist /MO will not leave the ICU until a
medical-to-medical handover has occurred.
Obtain routine blood tests, ABG as required and call for CXR to confirm line
placement and tracheal tube /enteral tube position. Perform 12-lead ECG.