- Cross cover is a significant part of clinical education. It is how inexperienced clinicians start to develop their own gestalt and clinical judgement.
- There is no amount of hand-off or predetermined guidance that can prepare anyone completely for this, and there is no substitute for this experience.
- Believe in yourself, but when in doubt, call the upper-level or attending.
- Rely on nurses and support staff, but do not allow them to dictate orders or dictate plan of care.
- Do not allow nursing/staff to get away with sloppy or lazy work. If they are calling, it is reasonable to expect them to have investigated what the patient normally takes at home for a problem or to have checked vitals if there is concern about stability.
- Early on in training, visit the patient at bedside. As more experience is accumulated, concerns may be addressed more frequently over the phone.
- Always think twice before prescribing potentially altering medications such as opioids, pain medication, benzos, sleep aides, benadryl, etc. Know the basics of the Beers Criteria.
- When in doubt, lay eyes on the patient. There is no substitute for this.
- It is ok to say, "NO".
- Most events should be recorded in the EPIC Hand-Off tool, and reported to the primary team.
- Significant events or order changes, not just rapids and codes, need to be documented in a "progress" or "significant event" note in the chart.
On-Call Cross Cover
- The on-call team should record any events in the "Event" box and any new tasks in the "To-Do" Box using the EPIC Hand-Off tool for items that changed after assuming care.
- The on-call team should verbally report any cross-cover events that occurred after assuming care to the night float team.
- If significant, it is also important for the on-call team to notify the primary team in the morning.
- EPIC Hand-Off is expected to be updated before night float takes over.
Night Float Cross Cover
- The night float resident should record events in the "Event" box and Tasks in the "To-Do" Box in the EPIC Hand-Off tool during the night.
- The night float resident verbally reports cross-cover events that occurred overnight.
- If an order was changed, then it is important enough to mention.
- Defer on providing too much information.