Bedside/Face-to-Face Shift Report

[Northwest_RN_4]

I have been told to develop a method of bedside shift report for our 34 bed medical unit. If any of you work in a unit that does this, I would appreciate any advice you can give. What are some of the problems, time considerations, benefits? This switch will be to meet JCAHO's 2006 goal of improved "hand off" communication. Thanks!!

[steelydanfan]

I have found that a mix works better for me. I get report at the desk, but then ask the offgoing nurse to accompany me into the pt.s rooms for a quick check. It's a great solution, as often things like "distended", "confused", and 'lethargic" can be better defined.

[cardiacRN2006, ADN, RN]

I have found that a mix works better for me. I get report at the desk, but then ask the offgoing nurse to accompany me into the pt.s rooms for a quick check. It's a great solution, as often things like "distended", "confused", and 'lethargic" can be better defined.

You beat me to it. That's what we do. A sit down report in front of the chart, and then a walk in the room for the visual stuff.

[Sunflowerinsc, ADN, RN]

We have been useing a phone system, voice care, for several years now. I have went through many kinds of reporting over the years but this is by far the best. Of course it has cut out overlap between shifts alot ,miss that overtime! The shift before us prints out work sheet from the computer that comes from care plans that has interventions,ect. Includes diet, code,VS, activity, labs and xrays ect but in a very short useable sheet. Then each nurse dials in and hears report on her (his) pt.s. Charge nurse hears everyones. Of course, anyone can dial in and hear whatever ones you want if you have any questions about any pt's. The off going shift nurses go ahead and finish up charting, meds or whatever needs to be finished. The on coming staff is able to still have a face to face if any questions, ect.ER puts in report on a new pt, no waiting for a nurse to come to the phone. That and the accudose med system for controlled drugs has cut down over lap so so much. No more "who's got the keys and who's going to count, and you can't leave until someone counts! We are going to use a "good to go"sheet when pt's leaves floor for tests,ect. Another form but will be good information for when pt going to tests ,its being tested now on a med floor to see if enought (or not enough information)is on it, but we want to keep it short and simple and have it used.

[lvng2banurse]

We do bedside nursing at the hospital that I work at, and it isn't really bedside, its more like at the door nursing. Its pretty private, and we pull the pt. door closed during report and after report we enter into the room and the off going staff says goodbye and the new staff introduces themselves. Works fine. :monkeydance:

Just what I was going to say.

When I trained in the "old" days I can still hear the voice of the senior nurse on handover at the bedside of the patients on our "Nightingale" wards(one long ward with at least 24 beds - UK style - though beginning to be phased out) asking in her very loud Irish accent "And Mrs Smith..... have you had your bowels open today?"

Confidentiality in anything but a single room is just not possible!

Also what about those things you don't want your patient to know yet - or the relatives have said you're not to tell???? Or is that where the "unofficial abbreviaitions" come in??

I truly think a private handover in the nurses office - NOT a tape though (what a horrible idea - do you really have taped handovers??) is the best. Personal opinion only though - of course.

[lsyorke, RN]

I think I've done every kind of reporting there is in my 22 years as a nurse. Bedside was the worst. It would take forever to get in and out of patients rooms with requests, visitors, etc.... Confidentiality went out the window, and overtime went through the roof. We discontinued it after a month.

[BittyBabyGrower, MSN, RN]

In our hospital, all visitors have to go off the unit for 30 minutes when we give report, even the ICU's unless the patient is very, very critical. On the adult floors, they do report just outside the room, so that takes care of the things that the patient doesn't know about yet, but you can still go in and show them a wound, dressing, etc. Since we have gone to this hospital wide, and people have become used to it, it goes quickly and the hand off is much easier.

[Mollytipper]

:monkeydance:

I think that if implemented properly, the bedside reporting would be the best for the safety of the patient and isn't that what we are all trying to acheive? The taped report on all patients seems to be a waste of time. They argument, "I need to know everything about each patient," to me is bogus. If a nurse goes on break or to lunch, a quick report should be given. Any other information about the patient like ambulation, diet, can be viewed on the Kardex or pathway. I know some of us don't like change but change simply is. If we want to go back to the way things used to be, would we want the same paycheck we got 20 years ago? We need to think out of the box.

[RunningWithScissors]

I think I've done every kind of reporting there is in my 22 years as a nurse. Bedside was the worst. It would take forever to get in and out of patients rooms with requests, visitors, etc.... Confidentiality went out the window, and overtime went through the roof. We discontinued it after a month.

I agree. When i clock out I leave out a different hallway than my assignment, otherwise I get stopped in the hall by visitor or patients wanting this or that (me with coat and purse on)...you just can't get away.

You'll be at the bedside soon enough, no need to walk and give report. Heck, that's usually the only time in a shift where you actually get a chance to sit down and get away from it all! If you can't trust your co-workers to give accurate information in report without visually inspecting it for yourself, then THAT person needs to be addressed; you SHOULD be confident that the info you get in report is accurate without having to round with that person.

I like the poster who had the phone-in idea. Sounds like a perfect solution.

[jjjoy, LPN]

FYI re: patient privacy and HIPAA

From the US DHHS website:

Can health care providers engage in confidential conversations with other providers or with patients, even if there is a possibility that they could be overheard?

Answer

Yes. The HIPAA Privacy Rule is not intended to prohibit providers from talking to each other and to their patients. Provisions of this Rule requiring covered entities to implement reasonable safeguards that reflect their particular circumstances and exempting treatment disclosures from certain requirements are intended to ensure that providers’ primary consideration is the appropriate treatment of their patients. The Privacy Rule recognizes that oral communications often must occur freely and quickly in treatment settings. Thus, covered entities are free to engage in communications as required for quick, effective, and high quality health care. The Privacy Rule also recognizes that overheard communications in these settings may be unavoidable and allows for these incidental disclosures.

http://www.hhs.gov/hipaafaq/limited/196.html

[CHATSDALE]

what about the passing of information like 'patient is crazy as a betzy bug today'?

[Greenhermit]

We recently switched from group report (4-5 nurses per shift) to face-to-face bedside report, despite many objections. Group report, where the oncoming shift would hear from each nurse, allowed us to allocate assignments better, share suggestions, and plan for situations that may need two or more nurses (e.g., dressing changes).

Patient privacy was one of the concerns, especially in semi-private rooms, where there were relatives of other patients present. In the hallway, visitors linger within earshot.

The next major concern was that we knew nothing about any of the other patients on the floor other than our own. We've already had situations where a patient had seizures but no one knew if these were new onset, febrile, or parameters for intervention. Two pregnant nurses became parvovirus positive after assisting a patient not their own. A family requested that non-family males not enter a patient's room, but that was not known when the nurse responded to the call-light.

One option is to tell the patient or family to wait until their nurse is free, even though some of our procedures or dressing changes can last a hour.

At night, bedside report can disrupt hard-won sleep. It also can tie up two nurses attending to an awakened patient's requests.

During the individual face-to-face reports there is no one at the desk to respond to emergencies in the other rooms. Report becomes a frustrating "musical chairs," trying to find 4 or 5 different nurses to get report from.

There are other drawbacks to that system, but these give you an idea.

Most of the articles I've read about transition to bedside reporting were from tape-recorded report methods, which I consider the worst of all shift report techniques. There is less sharing of ideas and expertise and more staff fragmentation with the face-to-face bedside report.

[Ayvah, RN]

I love bedside reporting at my last hospital. Here is what we did:

Before entering the patient's room, we report on any psych issues or other issues/concerns that can't be fully expressed at the patient's bedside. Then we enter the room, introduce the upcoming nurse, and explain to the patient that we are giving report.

Pros

-The patient can jump in and fill in the gaps, which can be especially helpful for timeline and help correct confusion if the prior nurse was misinformed somehow.

-You and the new nurse can conveniently get a patient turn in, or get a back/buttocks check in. Sometimes, I've gone in with the next nurse to see the patient very far down in bed, so we can get the pull-up done too very conveniently. This alone has been very nice, since it can be difficult to find a second person to help at shift-change time otherwise.

-The patient can emphasize what is important to them.

-The new nurse may have questions about something she sees that would not have otherwise gotten asked if it was a report done at the nurse's station.

-Another visual on your patient helps to see if there are problems. For example, if the IV fluid bag has almost run out, the off-going nurse can get that done at some point before she leaves, making the transition for the oncoming shift easier. And, two eyes are better than one, so the other nurse may see something that could be a potential problem, and collaborate with you on a solution. As well, visualizing the patient is a good way for the upcoming nurse to ask things like "does he always look this pale?" "did the incision always look like this?" "Does the patient always act this groggy?" So, you will have the prior nurse there when you are doing the visual check so you can compare it to their baseline. This way both nurses know of any significant change and initiate a faster response. Also, the patient can give input on if they feel there are any changes or deteriorations. This is comforting to have.

-If there is a serious problem, you have both nurses there, instead of just one, to help deliver better, faster, patient care. The prior shift nurse helps make things go much smoother.

-gives the patient a sense of closure on the last shift, instead of suddenly seeing a new face "out of the blue".

Cons

-Some of the patient's don't like "not understanding half of what was said", but from the feedback we got, the vast majority are ok with it, or at least tolerate it. Sometimes I've had a patient ask what one thing meant. So we have to try using more laymans terms when available.

-Rarely, the patient will try to dominate report, by talking extensively about one issue. or over what the nurse is saying.

-Some of the patients feel like they are an object on display (look at this line, look at this wound, etc), and some have complained that nurses sometimes move the bedcovers to show a wound without asking the patient first.

All in all, bedside reporting is much more thorough and is beneficial for patient safety. It is also a good teaching tool between nurses, where the more experienced nurse can add tidbits, or confirm findings of another nurse. It aids in nurse-nurse collaboration. I would highly recommend it.

edit: If a patient is sleeping, the nurses will decide how important it is to wake them up. Most of the time we whisper report, and show what we can without disturbing the patient, or we'll show what we can, and then give report at the nurses station. I guess the viability of bedside reporting varies with what floor you work on. I can see less need for bedside reporting with less sick patients. We also varied whether we gave most of the report at the bedside or at the nurses station (and then popped in for a quick hello to the patient) depending on factors such as if they were about to go home, or, if the oncoming nurse knew them well already, etc.