Bedside shift report.

Nurses Safety

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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 try it..But, don't see how it's really going to work high acuity pts and admissions late in the shift etc...Any thoughts?

Specializes in ER, progressive care.
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.

Specializes in Hem/Onc/BMT.

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...

Specializes in Hem/Onc/BMT.

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.

Specializes in Med-Surg, Transplant.

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.

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.

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 :-)

Specializes in PCCN.

I think it stinks. The concept is a great idea, but 80 percent of the time , yep " i have to go to the bathroom, or since you're here, get me some fresh water. Now you have to explain yourself as to why you want to have the tech help them; they don't understand why, since you are right there, that you cant help them. They don't care that you have to get report on another person- they've all been led to believe they are the only pt that you have.

I also find that stuff gets missed, as , of course, we want to have the ptt hear the "good report", not the " she's a manipulative, borderline personality who has already told previous nurse that she doesnt care if she has other pt's, I want NOW!. Or, hmm pt has a 20 year etoh hx, and now his ef is 5. Pt asks, what's that mean? Now we have to tell him,despite that the dr is the one who should have told him in the first place.

For simple cases, sure, the BS report (lol) is great- ms. m had a lap chole, her pain meds are due at such and such, her incisions look like this, vss. any questions? the the bs report works well.

Bedside report is administration's response to HCAHPS.

Customer service equals ... Medicare payment... equals maximum reimbursement.

Administration has deemed bedside report improves customer satisfaction.

Get used to, get around it .. whatever.. it's not going away.

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 :-)

Please provide references for this research.

Specializes in Med/Surg, Academics.

We now do a hallway report and take a look at the patient together to see what we're getting. Sometimes it's half and half...talk and look at the same time. We're supposed to do a full bedside report to meet the customer satisfaction stuff, but we look at the patient together for nursing continuity more than anything. I've gone back and forth about whether I like the idea of bedside report or not, and now I'm firmly in the camp that it should be nursing related, not customer service related, if you know what I mean. I want to be able to talk the lingo without having to explain myself when the patient/family is listening in.

Specializes in Critical Care.

"Safety checks" are a great idea, full report at the bedside is ineffective at best, dangerous at worst. A universal complaint about doing a full report at the bedside is lack of access to the chart and other patient data, which means Nursing feels less informed by report, which isn't acceptable (then there's also the issue of interruptions, self censoring, etc. As Nurses we work under our own license, others are free to make suggestions, but if you feel a bedside report impairs communication about the patient's plan of care, then stand up for your patients (and your license) and don't do it.

Specializes in Critical Care.
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 :-)

For the sake of the basic premises of Nursing, please stop using SBAR for report, that's what the Nursing process is for. SBAR is for communicating a single change in status, not for communicating an overall Nursing care plan, we have enough trouble with remembering the "evaluation" portion of the Nursing process without adopting an inappropriate format that does away with it all together.

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