how does your icu perform shift to shift reports??

  1. Hi everyone...
    I have a couple questions regarding how your icu's do rn shift reports. I am looking for a way to improve our communication between the Rn's (the md's are a whole different issue
    Communication between all the members is so important, and in my opionion the value of good communication is very underestimated!! ALL of your suggestions would be GREATLY appreciated

    1. Do you guys use a standardized "kardex"?? How does it work, does this stay with the pt during their stay?? Is this a separte tool for the nursing staff with the up to date pt info, all in one place......gtt's, allergies, etc??
    What does it look like??

    2. If you do use a kardex.....I would love to see some examples, anyone willing to send a copy??

    3. How effective is your current technique?? What would you change or think would improve it??

    4. Do you think Rn to Rn interaction improvment would improve pt safety and care?

    5. Do you think communication between Rn's is a problem??

    Thanks guys..............
    I FIRMLY think that the only way to make changes to improve the ICU is to start with the BEDSIDE RN's........we are the one's who know where the problems are and we are the ones who can MAKE the changes.
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  2. 10 Comments

  3. by   Beary-nice
    I do not work in ICU but have floated to the one in the hospital I work at and this has been my experience:

    Report is given 1:1 face to face, I like that part. It is a small ICU, so maybe this doesn't work well in other places.

    There are Kardexes for each pt in the ICU and they are all kept together. Most of the general information and orders are on them. I do not see them used in report per se. It seems most of the nurses have combed and re-combed through the chart and know the pts inside out.

    Other than that, I think anytime you have excellent communication it would improve safety and care.
  4. by   Creamsoda
    Each patient has a Kardex that stays with the chart. Each nurse has their own table right by the patients room and its our own charting area. The Kardex is what we go by. It has all the orders, meds, history, diagnosis, allergies, tubefeeds, how often labwork is done, infusion rates, everything that pertains to the patient and when to do it. When an order is written it is transcribed to the kardex in pencil and then checked off. The kardex is what we go by. It is also made out of a thicker paper/ cardboard so it holds up to constant use. I go through the enitre kardex at the beginning of shift and write on my timeline what has to be done when, then im organized for the day.

    For shift report we have a report sheet with a carbon copy attached, and we fill in everything from CNS, resp, CVS, GI, GU, misc, med gtts, ect. The bedside nurse keeps the carbon copy to give a face to face report to the oncoming shift, and the original copy goes to the charge nurse, and she gives report of all the patients to the oncoming charge nurse( were a 10 bed ICU).

    I think our system works quite well.

    Cher
  5. by   meandragonbrett
    We have a free floating charge who takes report on the entire unit from the previous float charge. The RN's take report 1:1 and detail things from the day and thigns that need to be mentioned. The orders are reviewed, the MAR is gone over, then walking rounds are performed. Walking rounds include meeting the patient (if they're awake), making sure correct drips are up (dopamine vs. dobutamine), verifying vent settings, etc. It usually takes about 45 minutes to get report on two patients.
  6. by   RYNOBLASTER30
    How about reading the chart. Thanks.
  7. by   meandragonbrett
    What does reading the chart have to do with anything?
  8. by   cardiac.cure03
    When we first come on the shift, we review and write down info from the kardex, which has info such as diet, any labs, procedures needing to be done, drips, vent settings, code status, any cultures or special precautions...gives a brief overview of the current situation. Then we go find the nurse who had the pt the shift before and do a 1:1 report. And sometimes, depending on who you're giving report to, we go into the pt's room and take a "quick peek."

    Considering our unit is a 12 bed unit, this way of reporting seems to work pretty well.
  9. by   sunshineCCRN
    we do not have a patient-free charge nurse and it is an issue (16 beds).

    our charge gives group report and briefly outlines all the patients on the unit. the whole staff listens and makes assignments out together (~15min). this is very good because when trouble happens, your coworkers know how to help you and what you need. also, no one can complain about their assignment.

    report is 1 on 1. we still have paper charts, so we basically go through the entire flowsheet. there is also another sheet that highlights the pt's history, what happened over the hospital stay, code status, etc. we will go over orders and do a "quick peek" if the pt is critical or has a weird drain or dressing change, etc.

    our kardexes are never updated and don't have the info we need on them. they might as well go in the garbage.

    it would be nice to have a column somewhere to write down things that are pending (ie it's PMs, and we want to make a note to ask tomorrow about a wound care consult, or maybe there are blood cultures pending that the next shift should look out for). the nurses are pretty good about these things, but it would be nice to have it written down, since you can't always trust that it will be passed on. report on 2 pts takes 30-45min.
  10. by   christen13
    Thanks everyone...We are looking for a way to develop a Kardex (seperate from the chart) That higlights the specifics for that pt...drip rates, labs, drsg changes....just like the tool described that some of you use.
    I really believe this would cut down on confusion and help the RN's and the patients
    I am wondering if anyone would be willing to share their current kardex. I don't have any examples to go by. This is not an official part of the chart, so it wouldnt be a pt confidentialiy issue, and obviously would NOT have any pt info, just a form that you use.
    would be VERY appreciative!!
    Thanks guys!!
    ps, is a hurry please excuse my terrible typing and spelling
  11. by   RNforLongTime
    I work in a small community hospitals 6 bed ICU/CCU. We do face to face report. Whenever we begin a new shift whether it's at 7am, 3pm, 7pm or 11pm the entire oncoming shift RN's of which at most there are two gets report on all the patients from the previous shift. After report, the new shift divvies up the patients. I usually do NOT wait for them to decide who is taking who, If I have updates since I gave report, I tell them, other wise I leave.

    I work night shift and my day shift colleaugues are frequently late, meaning that at the time that the shift is to begin, they are just walking in the door, then they have to get the coffee pot going, brush their hair, go to the bathroom, all of which puts starting report behind. My shift ends at 7:15am and usually we are still giving report because day shift dilly dallies around. So, after my colleague has finished reporting off, it's almost always after 7:15am and I am out the door. And the same is done when I am starting my shift, of which I am always early! ALWAYS! Me and my fellow night shifters has brought this matter to our boss and she's blown it off. She blows a LOT of things off. But that's another thread.
  12. by   just_peachy83
    I work in a 25-bed MICU at a university hospital system, and I think our RN to RN report system is very effective, and thorough, which is a problem I think on many floors. Basically the report on each patient goes as follows: basic data (age, race, code status, allergies), then past medical history, then a summary of events leading up to the patient's current status (i.e. date of admission to hospital, major procedures/complications this hospitalization, then the current plan), then a head-to-toe summary of the patient's current condition. Usually when I report, I start with the neurological status, then respiratory, cardiac, GI/GU, skin, etc. I finish report by showing lab results/ABG results and discussing family issues. After the verbal report, I check all the new doctor's orders for the past shift with the new nurse, and we do a double-check of all drips together. I know this sounds extremely detailed and tedious, but it is an excellent system and is used consistently by all nurses on our unit. It really helps me get a thorough picture of my patient(s) before starting the shift, and it's great because if something unexpected comes up and I don't get the chance to sit down and read the charts that shift, I already know enough to accurately discuss the patient with the medical team. I hope this helps.

    As far as the Kardex question goes, our charting system is almost 100% computerized. We chart all assessments, labs, vitals, etc. on computer and we actually have a computerized Kardex page that the nurses update throughout the shift as needed. It is really handy and very accessible from any computer on the unit. I love it!

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