Bedside shift report. - page 3

by mamason

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I was just wondering if your facility utilizes bedside shift reporting. Is it working well? What do you feel are the pros and cons with it? Our facility is going to start to use this method of report very soon. I'm willing to... Read More


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    We have sort of being doing bedside report for about a year but our new manager is really starting to crack down on it. Before we would give the majority of the report outside the room, go inside & introduce the oncoming nurse, check IVs, drips, etc and move onto the next patient. Seemed to work fine. Now they want us to do the entire report inside of the room, which includes waking up the patient. Doesn't go over too well when the patient was just admitted a few hours prior and finally just got to sleep. I also am concerned since we have semi-private rooms and I don't understand how it is not a HIPAA violation if the roommate hears their roommates info. I know that it is helpful in catching issues when both nurses are there but I don't like being forced into waking up my patients so they can listen to us give report.
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    We are starting the bedside reporting at my hospital. Honestly, I am not excited about this at all. There are numerous variables that stand in the way of this. First, I believe the oncoming and off going nurse need to be in an area with minimal interruption so we can discuss the history, issues and areas of concern regarding the patient without interruption. It is not a time to look to try to "look good" in front of the patient to set a good image-that is not what it is about and I believe it is being treated more as a "customer service" issue rather than a serious report that needs to have limited interruption as to provide quality patient care. I don't know why the nursing desk as become an area "off limit" to reporting. I have been a nurse for 16 years-so I am old school. I like to write my report out, look at the chart to see the orders in the last 24 hours and have the computer at my disposal to discuss results of tests etc (I am in a unit so I know floor nursing may not get this involved). This is not possible with bedside reporting. Not to mention there are numerous portions of the report that the patient should NOT hear. For example, test results, interpersonal conflict with family members, etc-you get my drift. The SBAR reading at bedside doesn't get it, like I said I like to write my report which helps me organize my thoughts and is an easy reference for me to look at from a personal standpoint. SBAR is great to have, especially when patient is going to a different area but personally it is too all over the place with info-my personal opinion. Anyway, at my facility they say "just tell any portion of the report outside of the patient's room if you don't want them to hear". Really? And you think they can't hear it, especially in an ICU. Then its not really "bedside reporting" then is it? That is ridiculous. This is how pertinent info will forget to be passed along. The report process is a very crucial time to obtain pertinent info that will have an impact on the patient's care for that day. It is not a time to "look good in front of the patient" like they are staying in some 5 star hotel. Patients should not be involved in the REPORT process. The assessment is when you involve the patient. After report then the on going and off going nurse should go and look at the patient to see if the Heparin is infusing at the correct dose, or if the patient is lying in feces that they have been in for 6 hours etc. -get my drift. That is when you can introduce yourself, but only after the nurses have given report in an area were they can focus with limited interruption; which is not in the patient's room. They say this is "evidence based". Well from the evidence I have seen-no. Patient's should certainly be involved in their care, however, we have to be careful. We need to remember there is a line between caregiver and patient and when you start to enact areas with too much patient involvement the line becomes distorted. What next? Think about it.
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    Where I work, we started bedside shift report about 2 years ago. At first I had some of your same concerns ( and some the you don't mention, like getting out on time). Some of your concerns I don't share at all. In either event, bedside shift report turned out to be a great thing, for all of us. The nurses who don't embrace it are having trouble being successful at our network. Of course, they blame their lack of success on anything other than their failure to embrace policy, but I advise you to give it a real honest chance. There is no reason a patient ( who is the consumer, the focus of your work, and your reason for having the policy in the first place) should not be able to participate in report. The second, third, or fourth time I got wrong info ( like allergies, history, or procedures) from the off going nurse proved that this change to process was beneficial - especially when the patient "reported" that they were prescribed meds that they were allergic to, because the records weren't as accurate as we wanted to believe.
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    Quote from dan_dfc
    Wow "Wooh", you sure can jump to some absurd conclusions and hurl needless insults can't you! Feel better after getting that off your chest? Actually, I have no problems with my ego, I assure you it is fantastic. Allow me to paint you a picture. Let's say you arrive for your shift to receive report and the nurse before you has 2 of her 4 patients who have been in the ER for 2-3 hours and not only has she not assessed them, she doesn't know their chief complaint. Is that safe? How about if you receive report on a patient sent from the doctors office for a hemoglobin of 4.0 with active rectal bleeding, and that patient has not been type and crossed, or had an IV started, or had O2 or vital signs taken in the last 4 hours. Safe? Or maybe, you receive a patient who is being held in the ER for an ICU bed and has had no vital signs documented in the past 8 hours? Sound good? Oh yes, all of these things happened, and yes I cleaned them all up with minimal drama in front of the patient. I even turned off the nitro drip on the patient with a pressure of 70/30 without making them "super-needy" I tried to offer some constructive criticism to this nurse in a polite, proffesional manner. didn't work. Then I spoke to the charge nurse and nurse manager. . .no effect. Now, let me ask you this, would you want to give report in front of the patient if you had no idea what was going on with them? I'm simply hoping that bedside report will introduce this individual to some aspect of accountability. I'd rather spend my entire shift caring for a "super-needy" patient than spend 1 hour doing post-mortem care on a patient I found dead after a report that consisted of "There's a patient in room 2, they're here for a nosebleed or something, I think" But maybe that's just my ego talking, I dunno?:icon_roll
    I really try hard to be mature and not take sides, but in this case... come on, dan! Go back and read your first post. Without the above detailed explanation, your earlier post totally sounded juvenile and vindictive.

    Back to the topic...

    I am starting as a new grad and we have to do bedside reporting AND we are discouraged from writing things down -- no more cheat sheets or the portable "brain" on a sheet. Instead, we're to utilize the computer workstation fully. Honestly, it doesn't sound too bad since computers are available both at the bedside and nurses station. Any changes are painful, but I think it's a necessary transition in order to adapt to the changing culture (patients wanting to be more informed and empowered) and technology (availability of computers and quite sophisticated software).
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    Quote from tokebi
    I am starting as a new grad and we have to do bedside reporting AND we are discouraged from writing things down -- no more cheat sheets or the portable "brain" on a sheet. Instead, we're to utilize the computer workstation fully. Honestly, it doesn't sound too bad since computers are available both at the bedside and nurses station. Any changes are painful, but I think it's a necessary transition in order to adapt to the changing culture (patients wanting to be more informed and empowered) and technology (availability of computers and quite sophisticated software).
    What about when you have downtime? I couldn't possibly remember everything about a patient off the top of my head. I'm getting much better at it but I would still be lost without my brain sheet!

    When I first started working, bedside report was utilized. Our director would write up employees for not utilizing it. After awhile, though, bedside report kind of went on the back burner. We were then under new management who said we had to go back to doing report at the bedside but once again, it wasn't being done. Everyone was doing report at the nurses' station. Our manager would come by and wouldn't say anything. I gave report to my manager once because the RN who was supposed to relieve me was running late (it was close to 0730) so she took report for me so I could leave and again, we did it at the nurses' station. The last time I was at work our educator stated that we MUST do report at the bedside...our CNO is going to be making rounds to ensure that this will happen. If not, there will be "consequences." I have a feeling this is because we're expecting a JCAHO visit soon.

    I have done report at the bedside and I like it, but at the same time I don't. It's good to clarify things (such as IV pump settings or to look at a dressing) and not be left with surprises from the off-coming shift but I feel like bedside report also takes a lot longer. No one gets out in time.
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    Yes, we were all wondering about what happens when the system goes down or needs maintenance. I guess we'll see how feasible that is once majority of nurses start practicing it.

    As for the common problem of bedside reporting taking longer with interruptions, couldn't we minimize it by educating the patients and families what the report is for and how it's supposed to be? We can answer simple questions but whatever requests that need longer time, we can gently remind them we need to complete report first, and the on-coming nurse will come back and explain things in more details or help the patient with whatever...
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    This is a quick update to my above post. After spending some time on the floor, I came to conclusion that it is IMPOSSIBLE to work without a cheat sheet! I wonder if educators have been away from the bedside for too long.

    I still believe that bedside report can work without taking too long. But I can't try this for real because no one really does it. I can't just drag an unwilling nurse away from her comfy seat.
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    Actually, although I initially hated bedside report when our unit first started doing it, I've come to (generally) like it and see its value. For me, like others have said, the benefit really is that you *see* the patient, can quickly assess for safety issues, and notice things that remind you to ask questions to the previous nurse. I also feel that it makes me at least see every patient quickly at the start of the shift so that if things get crazy quickly in the morning, there is not that one patient that I'm like, "Oh shoot, I haven't even seen yet."

    I have to say also that I think bedside report usually takes too long when 1) the next shift is late and thus you "lose" 5-10 mins immediately or 2) the person giving report is not following any sort of SBAR-ish pattern in what they say and going down rabbit trails/saying "ummm" constantly/asking the patient to "refresh their memory" etc.
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    Research suggests bedside report has positives, and definitely it's negatives. It would be wrong to wake up a patient who is suffering delirium from sleep deprivation, or any patient who is confused. It would be wrong to talk about family conflict, pathology that the doctor has not shared with the patient yet, etc, in front of the patient. It is also in conflict with management demands that nurses clock out by 7.30 as many patients are understandable nervous in hospital and want to tell you their entire health/ sleep/ pain history hoping it will improve their care. Another example (happened last night) is that one patient just wanted to talk about every member of staff who had ever been good to her (a long list!). HOW ARE WE SUPPOSED TO CLOCK OUT ON TIME?!?!? Positives include an increase in patient safety on one hand, as they can correct misinformation etc, but I have also heard nurses say that patients interrupt so much that they have been unable to stick to an SBAR format or forgotten to pass on key information. In my experience, it works extremely well with patients who like to participate in their own health care, particularly educated patients - but not so much with those who refuse to participate, which is unfortunately a large proportion of patients as that is why they are in hospital in the first place. It would be wrong to say that checking drips and dressings etc is a benefit of bedside reporting, because all nurses at our hospital practice this at the bedside no matter where they give report. Overall, I believe nurses are very educated individuals who should have a little more autonomy in their decision making. It is a shame that large institutions inflict blanket policies that do not allow for this. There will always be lazy nurses, resistant to change despite heaps of robust research that proves they are wrong, and no blanket policy enforcement will change their attitudes. But most of us want to give the best care we can and are intelligent enough to familiarize ourselves with research then make good judgment calls.
    Wise Woman RN likes this.
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    On my unit we go into every patient room to check dressings/ drips etc - the question is, where do we go through the SBAR report? If you do that outside, then go in to check drips etc, it is not bedside report. I agree that going into every room is essential - but should you go through SBAR at EVERY bedside too? It's a good question, research says 'YES", I have posted some more LONG WINDED thoughts below :-)


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