Acute Care: A Case Study

Issue: She thoroughly assessed her admission upon arrival to the unit. She noted he had delirium using the Confusion Assessment Method tool, and his wife stated his last bowel movement was five days ago which was not reported during hand-off. Action: She identified hypoactive bowel sounds, dry mucous membranes, and decreased skin turgor in her assessment. She diagnosed him with Altered Bowel Elimination and Geriatric Syndrome. She notified the provider and administered the bowel regimen and fluids that were ordered. The elderly man had a large, hard bowel movement. And a few days later, his skin turgor had increased, and his delirium had ceased. After this incident, she conducted a survey and found that most of the nurses have had discrepancies in the hand-off …show more content…
After identifying the issue, she began to facilitate a project to pilot that would change the culture from a “push” to a “pull.” She created a chart to document the progress of the project and educated the staff members during in-services on how to complete this task using a PowerPoint presentation she created. After the charge nurse would receive notification of patient’s admission, the receiving nurse would have fifteen minutes to call the emergency department for report and discuss an appropriate time for the patient to be transferred. Outcome: The “ED Warm Hand-Off” project was implemented for three months and was found to be successful on evaluation. It has decreased unnecessary delays in transferring patients from the emergency department to the inpatient units which have improved patient outcomes, enhanced hand-off communication, and improved the relationship between the emergency department staff and inpatient unit staff. She has created an atmosphere of teamwork, and reduced the time it takes to transfer a patient from the emergency department to the inpatient