Worst information given in shift report!!!

mstigerlily · Oct 8, 2005

I don't consider last BM to be crucial, you can just ask the pt, that is something they will know (unless they aren't talking). I hate when I get a rushed report and they forget to tell me something really crucial which I uncover after reading through their charting or during assessment.

I have been known to forget to give a piece of info during report (usually not crucial, just a need-to-know) and call the nurse from my cellphone on the way home in the morning just to give her the info.

Melissa

What has been some of the worst information you've ever been given during shift report on your patients? Don't you just hate hearing "i don't know" or "i'm not really sure" when it comes to essential information like last BM, last BS on a diabetic patient or I & O's (especially on surgical patients)?

rn/writer, RN · Oct 8, 2005

We have a system that works pretty well for giving report. I came from the old school of verbal report. That took forever because we invariably would start yakking about non-essentials. At other times, I have listened to taped reports. You don't have the element of conversational distraction to contend with but the sound quality sometimes leaves a lot to be desired. Using the same tapes over and over, background noise, soft- or quick-spoken nurses can make getting the information a challenge.

When I started my new job earlier this year, I wondered which inadequate system I'd be using and, wonder of wonders, found an entirely new system awaiting me.

We use folders called pathways (because they contain shift-by-shift guidelines for what should be happening with our patients). We have computer documentation and the regular old hardcopy charts for looking up labs and other info, but everything that's relevant to the oncoming nurse is available in a succinct and easy-to-read format. The pathways do not become part of the legal chart so they allow us some latitude in communicating with other staff members.

I'm on a postpartum floor so a typical entry for the mom might state her IV status, whether or not she still has a Foley, PCA usage, last oral meds, critical labs, new orders, other complaints or requests, consults that have been requested, etc. We can also transmit other important items like "Mom needs cueing re: three-hour feeds." or "Mom speaks little English--Dad will stay tonight and translate." For the babies, we list new orders, feed times and amounts, critical labs and vitals, circs scheduled or done, breastfeeding progress, and any other concerns.

Of course, when we have two seconds to breathe, we look up the computer charting and check the rack charts for orders that may have been missed, but this is a great way to hit the ground running, knowing you have the most pertinent information at your fingertips. I was skeptical of using the pathways at first, but I love them now. One additional benefit is that when I am writing my section of the pathway for the next shift, I can catch things I forgot to chart on the computer and take care of them. It's a good system all the way around.

MarySunshine · Oct 8, 2005

While I appreciate a good, thorough report (minus the gossip/fluff) if someone tells me "I don't know" to something that I can easily look up myself, I am very forgiving. I've definitely been in their shoes -- sometimes you are just trying to keep everyone stable -- last bm, as important as it may be, just doesn't cross your mind and before you know it, your shift is over.

mugwump · Oct 8, 2005

I can't stand stories and non-pertinent info. I wrk at an antepartum unit and one day it took someone 10 minutes to describe the red colored smear someone had when wiping. (not important) are they bleeding now? No I don't care than it was light red, not like your shirt a little darker than that. etc...

maggie1979 · Oct 9, 2005

Yup, in a perfect world, but alot of times, this stuff isn't even charted.

Isn't this so true! I worked on a renal/urology unit and only asked/needed to be told if things were out of whack with whatever is going on - esp pertinent labs, falls, bleeding, etc - I gave and expected highlights, how the pt ambulates, etc.. Most of the time, the nurse coming on shift has already or is going to gather all the other info needed - and most patients stayed long enough to get to know them! And sometimes the nurse was too busy to chart prior to report or forgets in general and the asking prompts the answer - NEVER BE AFRAID TO ASK ANYTHING!!!! Just remember to do it polietly!

lady_jezebel · Oct 9, 2005

All of that information can be found on the chart. It just drives me nuts when report drones on and on because we are giving I&O, IV credits, BMs, etc. If there is something abnormal about that information, fine, tell us in report...otherwise, if we need to know, we can look it up.

Ditto

KaroSnowQueen, RN · Oct 9, 2005

I HATE HATE HATE HATE HATE sloppy out of order report.

"Mrs. X has a foley. She is on a regular diet. Her lungs are coorifice. Her skin is ok, no wait, she has a Stage 4 on her butt. I didn't change the dressing, I don't know what it looks like. I guess that's all."

ARRRRGGHHH!!!

How about this instead:

"Mrs. X is in for XYZ diagnosis. She is a DNR. She is alert and oriented. She is SR on the monitor. Her lungs are coorifice, she's on O2 2 liters satting 93%. She has a double lumen picc in her left a/c with RL at 50. Her bowel sounds are positive, last BM today. She has a foley with clear yellow. Pulses are palpable but weak. No edema. She is accucheck q4. Last accucheck was 212. She got coverage per sliding scale. She is OOB with one assist only. Skin is good, no breakdown, using Criticaide as a preventive measure. Family at bedside. 'Insert pertinent information as to condition, procedures scheduled or reports in , etc. here' ".

I get the first kind of report MUCH more often than the second. I try very hard to give the second kind, but then I get interrupted by the oncoming nurse asking, "What did the boyfriend bring her for supper?" If she's not on a special diet, I don't know and really, I don't care. Or "What did you say she had done today?" If you were listening and not asking me what she had from McDonald's you would know!!!!!!!! I want to go home, not give you all the gossip about the patients for pity's sake!!!!

AMARTIN1 · Oct 9, 2005

Thanks for all the feedback. As a new nurse I am trying to tweak my report giving skills a bit and it's good to know what everyone is doing outside my hospital system. We all pretty much are asking for an organized report but I am also guilty of forgetting information so I really like verbal reports for this. God Bless, AMARTIN1

MamaTheNurse, BSN, RN · Oct 9, 2005

Report from ER for an admit with diagnosis of L arm weakness R/O CVA. We generally received a head to toe report and when it came to the cardiac report, it was reported to me the patient's rhythm was "irregular", he was on the monitor in ER and was being admitted to a telemetry floor. As soon as we hooked the patient up, his irregular rhythm was clearly A-fib. Hummm, anyone ever heard of an association between A-fib and CVA? Doc was thrilled to hear this finding had been missed and promptly heparinized the patient. Granted some doc was responsible to assess the patient in ER and I don't know how that could have been missed (yes his ER strips all showed a-fib so he didn't convert on the elevator).

hope this guy did well - I took care of a CVA transferred to us from a little hospital in the middle of nowhere - his facial droop was gone, spoke clear as a bell, had almost full strength in his arm and leg was gradually improving when I got him the next day - why was he doing so well? hopefully because, the ER doc at the little hospital made the connection between his a-fib and CVA and they got some tPA in him pronto......(I know that's not always appropriate but at least someone realized it within the window of opportunity and it worked - isn't it 3 hrs?)

Blackcat99 · Oct 9, 2005

I hate to give report when the on coming shift doesn't listen and they want to do all of the talking themselves. In the past, I have had to just keep talking right over the on coming nurse who was busy blabbing during my report. I am sure she missed some important information by not listening.That was her choice. It is so rude when the next shift doesn't have sense enough to sit down, shut up and listen to report. :madface: :nono:

Aneroo, LPN · Oct 10, 2005

My biggest pet peeve is when ER calls to give report and they just read the pt. name and diagnosis and the new orders and never tell me what made them go to the ER in the first place.

I WORK in the ER and that peeves me off! I'll be reading through a note and see "c/o SOB", and that's it.

Since when? What makes it better, worse? All that good stuff.... Makes me try so much harder to be thorough in my assessment and documentation. At least if I forget to tell someone vital info, I have it charted, KWIM?

Gompers, BSN, RN · Oct 10, 2005

I once got report from a nurse who forgot to tell me that the baby had an extra digit on her hand that had been "tied off" a few days before. I had no clue, and nothing was written on the patient care summary either. So there I am, unwrapping the baby, and caught a glimpse of something black in her hand. I jumped so fast that I banged my arms on the isolette portholes and scared the heck out of anyone within ten feet of me! The shape of the digit, the black-purple color of it, and the black sutures that were tied and then snipped to look like two little antennae...I thought the kid was holding a cockroach!