Shift-to-shift report in front of patient and family - page 3
by Piglet08 6,207 Views | 28 Comments
New rule at work. I think it was created by someone who has never provided patient care. I'm finding it extremely difficult to implement. I find it hard to organize my thoughts when I don't have the chart in front of me,... Read More
- 2Aug 6, '12 by redhead_NURSE98!Quote from turnforthenurseRNAnd the patient inserts him/herself into the report, adding irrelevant information, asking (mostly) unnecessary questions, questioning their own medical history that THEY provided when admitted, etc. It can take an hour to do 4 patients. That and an agency nurse the other day went to the Pyxis and PULLED HER MEDS ON TWO PATIENTS I was giving her report on, she decided since she'd be in the room anyway she'd go ahead and give the 21:00's, then went in there and medicated the patients while I'm standing in there waiting to give report! Guess she wasn't planning on going back in the room all night?We are supposed to do bedside report at my facility and for awhile management said that they will come around in the mornings (along with the nursing supervisors) to make sure it is being done. No one ever did it and eventually management just stopped trying. I think the only unit where bedside report is done is in the ICU, tbh. On my unit, if we have a more complicated patient or if I want to verify something with the oncoming nurse (such as a drip setting or to look at a dressing) we will go to the bedside but not give a full report.
It can be awkward and yes, there are some things that probably shouldn't be said in front of the patient...as nurse2033 said, you end up having to give two reports. That takes time and then report ends up taking an entire hour or more and then you end up with a bunch of employees in overtime.
- 2Aug 6, '12 by NicuGalWe give report in front of families BUT if there is something we need to say that we don't want them to hear or we feel is too sensitive for other family members to hear, we do it in the hall. Joint Commision says families are to be involved in rounds and have say in their care, welcome to Family Centered Care. We also have it printed in our Welcome letter to the families that while we like to have questions, if they could please hold off until we are done with report it would be great...we don't want to miss something important. It works 97% of the time...if they are obnoxious we move away.
It is also good to go over lines and makes sure they are right and dated right, etc. Can't tell you how many mistakes we pick up this way.
- 0Aug 6, '12 by BluegrassRNI love bedside report. In our facility, it means I'm out of report 15-20 minutes faster. We have 15 minutes to gather info from the computer, then (in theory) 15 minutes to go around and get report on our pts. We usually have 3-5 pts per nurse.
I love eyeballing my pts at the beginning of the shift. The pt is informed/reminded what is going on, I can check lines, assess for pain, and meet the pt. Our bedside report has led to rooms being cleaner (if you know you're going to go into the room with the oncoming shift, you're more likely to tidy up), lower falls, and improved pt scores. Pts feel like they know what is going on, and we've gotten a lot of positive feedback from the pts and their family members.
We have a script of sorts that we followed in the beginning, so that we'd know what we should cover. Frankly, if it's in the computer, I don't really need to hear it. I don't want to know all the labs, unless the hgb is 5 and we're transfusing two units. I want to know the plan of care, a brief outline of what you did on your shift, and what's going to happen in the next 24 hours. That's it. Anything that is inappropriate to say in front of the pt is said at the desk.
I originally was 100% against bedside report, when it was first introduced on our unit. I love it so much, I now insist on it (we still have a few nurses who don't like it). When I do my morning vitals, I always warn pts that we'll be coming in to do report, but that if they're asleep we'll just peek in and not wake them. Lately, I've had several pts ask me to wake them, so that they can hear report. I think it's a good mechanism for keeping the pt informed, for pt safety, and I personally find it saves me a lot of time. Sorry it's not working for everyone; but I think that with a little effort, this is a great report system.
- 0Aug 6, '12 by BringonthenightPersonally I think I would love this type of handover. Handover in a closed off room filled only with nurses turns into a social mixer. Handover infront of a patient and family ensures:
Effective Communication between nurses, patient and family.
Increased patient safety- checking wound sites, IVs etc together.
Improved work ethic ("mindy will be taking over from me tonight, I'd better make sure my patients pain and personal needs are met so that she has a good night")
- 0Aug 7, '12 by applewhiternIf I were the patient, I would be uncomfortable having report on me given in front of visitors. Especially if they were pulling back covers, exposing stuff like a colostomy, drains, etc., that visitors don't need to see or even know about! Seems like it would be awkward regarding HIPAA. Once when I was in the hospital, I was embarrassed just having visitors see my foley bag hanging with my urine in it, but that's just me. Right now, we give report to all oncoming nurses in the report room, and every nurse has to get report on every patient. That includes the ICU's and the floors~ if there are 26 patients on that floor, you get report on all of them, not just the ones you are taking. There isn't much "social" yakking, because if you are the one giving report, you just keep on talking, giving report, and if someone isn't listening, that is their problem. We manage to give report within a 30 min time-frame. I have worked at places where we did bedside reports, and it worked ok in the ICU because there were no visitors allowed during report, due to HIPAA, but it is hard to do that on the "floor" because invariably the patient or family member starts questioning meds, etc., and it ends up taking forever.Last edit by applewhitern on Aug 7, '12 : Reason: mispelled word.
- 0Aug 7, '12 by Esme12 Senior ModeratorQuote from jbuddthis....this...this!:redlight:we are supposed to do bedside as well, but i insist on giving and getting a real report at the desk, with access to labs, orders etc. only have to sign onto the computer once, and it goes quickly. then we "round", do pt handoff and introductions at bedside, check the iv etc. having to sign in on each bedside computer and then try to whisper or talk low enough not be heard is rather rude in my opinion, people really don't like be "talked over".
report this way takes maybe 5 minutes longer than it used to (no bedside), as we have gotten pretty good at it.
the purpose of bedside report is to prevent errors. the "bedside" part is to check iv's for drip rate, patency accuracy of fluids... drug, assessment, pulses etc. care specific item to prevent error and confusion. the bulk of the report is usually given else where.
it isn't all customer satisfaction driven it's a joint commission (amongst others) thing.
errors may occur because communication is faulty.
two joint commission national patient safety goals are to address......
patient safety issues that may be encountered during change-of-shift report. first, patient involvement in care is encouraged as a patient safety strategy and it is also recommended that a family member or trusted friend should be an advocate when the patient is unable to speak for himself or herself.
these national patient safety goals can be applied during the process of change-of-shift report. patients and their families, if desired by the adult patient, should be involved in the communication processes related to their care planning. in addition to the patient and family's need for information, partnering with patients or families at the bedside during report is a patient safety strategy.
roser said it best from the families perspective.....roser13
during my brother's recent hospitalization, both nurses came into the room at shift change. outgoing nurse introduces patient to new nurse, then gives a quick synopsis of reason for admit. then both step to the side and they continue their report in quiet tones. i felt that at any time i could ask a question of one or both. i also (surprisingly) felt comforted that nurse a handed off to nurse b in front of us. i had never understood the rationale behind beside report, and now i kind of do.