STEPS IN ENDORSEMENT

PERSON RESPONSIBLE: STAFF/STUDENT HEAD NURSE Steps:

1. Incoming and outgoing staff must observe sit-down and walking Endorsement 2. Shift report or endorsement involves 2 phases: a. Sit-down report, followed by b. Walking rounds 3. The sit-down report is done in the unit with the outgoing charge nurse giving her report, referring to the nursing kardex, while the incoming charge nurse listens and notes down pertinent information on the 24-hr shift report.

4. The sit-down report must include the following:

a. Total number of patients in the unit b. Breakdown of patients as:
1. 2. 3. 4. 5. 6. 7. 8.

Patients for surgery Patients for special procedure/treatment (i.e. endoscopy, UTZ, UGIS, etc.) Number of critical patients. Patient with special nurse or special watcher. Number of new admissions. Number of patients for discharge. Patients with escape precaution. Patients for referral.

c. Shift report on each patient must include:

1.

2. 3. 4. 5. 6.

7. 8.

9.

10.

Room number, patients full name, age, sex, civil status, religion, attending physician, co-management and consultation. Case (diagnosis and chief complaint) Present status (i.e. vital signs, level of consciousness, etc.) Any diagnostic test and procedures done. Laboratory results with significant findings. Supportive devices (i.e. IVF, foley catheter, NGT, oxygen, CVP, respirator, under water sealed bottles, suction machine, cardiac monitor, etc.) Any new pertinent orders. Any referrals to maintenance department (repairs) and housekeeping (cleaning and disinfection) Any treatment and diagnostic procedure to be done outside of the hospital (schedule, financial arrangement, transportation and companion.) Any refusal of treatment, its reason, and documentation.

5. Observe the following during the walking rounds: 1. The outgoing charge nurse and the incoming charge nurse must observe the walking rounds. The outgoing bedside nurse must stay in the unit to answer telephone and patient call. No outgoing staff can leave the unit without the permission of the charge nurse. Permission can only be granted in extreme emergency. 2. The incoming nurse must carry the 24-hr shift report. 3. Missed procedures should be accomplished by the outgoing staff. 4. Check and inspect patients and turn the bedridden if necessary as you go from one patient to another. Look at IV fluids and check for patency. Check all body connections and take note if they are working well. Talk to patients. Include patients environment particularly the bed, bedside table, presence of bed pan, urinal, emesis basin on the floor, empty bottles, and over all cleanliness. Note anything that needs to be repaired and report immediately to the supervisor.

6. Endorse all the equipment especially the suction machine, standby oxygen tank with gauge, cardiac board, the E-cart, emergency medications, BP apparatus, and the stethoscopes after the walking rounds.

Note: The outgoing charge nurse must check all charts and see to it that everything done to the patient had been documented.

CALLING A PHYSICIAN DURING REFERRAL 1. When calling remember to identify:

a. Self, unit, patient, room # b. The admitting diagnosis and date of admission.
c.Briefly state the problem, what it is, when it happened or started and how severe it is,Pertinent labs, current orders, meds. Include info related to your assessment, actions taken, patients response, and other info that may facilitate decision making (labs, current orders, PRN meds etc.)