Bedside report - page 3

by jrwest 7,631 Views | 41 Comments

I know there are many posts on this subject. We were just told we WILL be doing this under no uncertain terms. We have semi private rooms. We have dementia pts,confused people , psych pts, drug seekers, etc now. How is bedside... Read More


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    We also have done it on our peds floors where we would have 4 or 5 patients. Our med surf floors do it and they have become pretty efficient at it. If you use SBAR it usually goes pretty quickly.
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    The Adult Med/Surg. facility I work at has done SBAR at the bedside for quite some time and for the most part it isn't that big of a deal to be honest. I give my report to the oncoming nurse in front of the patient (including Psych. patients) and if I need to say something that is really sensitive or a side note that I don't wish to say in front of the patient I will do so after we leave the room. I include Psych. patients in my previous comment because I believe that by giving the SBAR in front of the patient (instead of in the hallway outside of the room) it decreases the patient's anxiety and lets them know exactly what your saying about them in the presence of another staff member. Some Psych. patient's tend to get more agitated if they think you are talking about them to another nurse in the hallway. I also like bedside reporting because I can see IV sites, ostomies, wounds and give the patient a quick look with the nurse I am getting report from/giving report to. It has its Pros/Cons but I do think that some patients (especially if they are AAO X 3 and really paying attention to what is going on) really like to hear what is being passed on in report.

    !Chris
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    I can see both sides of this argument. The big upside I can see to bedside reporting is that both nurses are laying eyes on the patients at the same time. I know that many times over the years, there was a huge disconnect between the picture painted in report and how that patient looked when I went into the room. In the PACU, we phone a report and then have to wait for an RN to come into the room to take over care on the floor. Coordinating this can be a nightmare; however, both nurses are laying eyes on the patient at the same time, which helps ensure a reliable exchange of information.

    That being said, I do not think it is always appropriate that the entire report be given in front of a patient. I think it could be embarrassing and perhaps frightening for a patient to hear that twice a day. "This is Mr. Smith, he is a 68 year old DM2, with a history of ETOH abuse, schizophrenia, hypertension, MI, etc, etc, etc. He had a left TKA yesterday and because he is on daily pain medications, he has needed x, y, z, for pain management and rates his pain at 15/10. His latest labs show a whole lot of crazy scary stuff that his doctor hasn't reviewed with him yet, and it is really freaking him out to hear me tell you. I put in a call to Dr. Important regarding his total lack of urine output, but they have not bothered to call me back. We are waiting for a social worker consult before discharge because his (insert family member) is believed to be stealing his pain meds and unable to care for him at home. Let me just keep saying a whole lot of stuff that you really need to know, but is scaring and angering Mr. Smith at the same time, blah, blah, blah." Awesome customer satisfaction scores or incomplete reporting? I guess that's our choice.
    weemsp, RNsRWe, anotherone, and 2 others like this.
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    Quote from wooh

    By the way, I have to know what special snowflake terms you were given to sugarcoat the truth enough to say it in front of the patient. Please share!!!
    I was so "not happy " about the paper I left it in my locker, and thank God I've had two days to cool off (lol) . I will bring it home and put it on here. It was ridiculous !
    anotherone and wooh like this.
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    Quote from wooh

    THAT is the one weapon you have. Make it take longer. Once the incidental overtime starts adding up, and this idiocy costs money, only
    One of the more "senior" nurses did bring this up. I guess we will just have to make sure we are "thorough" in our reports.
    anotherone likes this.
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    Ok found it online- per studor :

    #9)If the patient is non-compliant, then the off-going nurse should not say “uncooperative” to the oncoming nurse. You could say “He/she was
    informed of …but the patient chose to disregard and …..” “I have
    explained that if he refuses to use the walker for assistance, the likelihood
    of a fall and injury increases.”

    Oh and I guess this "addresses" the hipaa thing lol:
    # 8) If visitors are in the room, explain that you are doing the Bedside Report
    and ask the patient if he/she wants them to step out. You should say “We
    will be talking about your condition and your progress this past shift. Since
    we want to maintain your privacy would you like your visitors to step out
    for this report?” If there are concerns about the patient being able to
    answer this honestly with visitors in the room, ask the patient during the
    shift when patient is alone.

    I mean, this all looks so good and proper on paper, but the reality is going to stink.If every nurse was cut from the same mold, maybe this would work. Well since report will take longer, I guess I will enjoy the extra money LOL
    anotherone and wooh like this.
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    Nurse A: The patient has chosen to disregard using his walker...
    Patient: What do you mean "disregard"???? I'll give you something to disregard!!!!!!!

    Imagine all the healthcare that could be paid for with the money hospitals give to Studer, Press-Gainey, etc. to make nurses' lives miserable...
    brandy1017, WoosahRN, anotherone, and 1 other like this.
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    My facility tried that crap. Going room to room and talking in front of the patient. How would you feel if two people were talking about you in front of you. This also puts us in a pickle when they stop and say what is this that etc. We cannot interpret and this has put staff in situations with patients and their families for many of the reasons listed by others on this post. We get report at the desk then do a walk through to check on the patient. This is more than efficient. I have no clue why we would be discussing their labs tests etc. in front of them. The doctor is the person to discuss this.
    brandy1017, WoosahRN, anotherone, and 1 other like this.
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    I'm currently on a handoff taskforce (the precursor to bedside report, it seems) and we're discussing using Epic (our EMR) to indicate the sensitive things so we can get the "talking" piece of report done quickly... the labs are evident in the computer, the braden score, fall risk, code status, precautions, problem list shows history, last vital signs are there, etc. We need to take advantage of our technology, but this shift in thinking away from the kardex - write every last thing down on paper so you can report it off to the next nurse - will be very difficult for many of our nurses (new and seasoned...) it should be interesting!

    on the other hand - as a nurse, a mother ,a daughter, and if I was a patient - I would wonder why are the nurses saying things that I cannot hear / should not hear? I think it can be done, but we need to put aside the defensiveness and begin to see it as a patient safety issue. We may not like the world we're in (patient satisfaction driven) but I am proud to be at a Magnet hospital and be part of the planning process for changes like this - I'd rather have my input be an integral part of the change, and help my colleagues with that, than to be told what needs to be done, knowing that there wasn't input from the floor staff.
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    Nurse A: Mr Smith has chosen not to acknowledge that his doctor will not write him anymore orders for IV dilaudid'
    Mr Smith:you better get me my pain meds!!!!!!!!!




    LOL

    Oh we could have so much fun with this part.

    Nurse B: Ms Jones has chosen not to eat the prescribed diet here, and has had her family bring in 2 big macs and a large order of fries, with a coke, so her Bg"s have all been off the charts......

    LOL
    sandyfeet, Altra, pamelalayn, and 2 others like this.


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