Shift-to-shift report in front of patient and family

[Piglet08]

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, and to say everything in a way that doesn't overload and possibly scare the patient, but still adequately informs the incoming nurse. I also have trouble feeling I am adequately informed when I take report that way. Not at all sure it's a good idea. Doesn't matter what I think, though, I have to learn to do it.

Thoughts? Tips?

[JBudd, MSN]

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.

[roser13, ASN, RN]

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.

[Been there,done that, ASN, RN]

Bedside report is a charade that administration is requiring at the current time. It is part of the customer service model that is being shoved down our throats.

Administration thinks that patients want to see a hand - off of their care.

"Good Morning Mr. A .. here is your new nurse. Oh, sorry you are...

-Vomiting

-in pain

- on the commode

- sleeping

The exchange of information depends on the situation. Anything that cannot and should not be shared at the bedside .. then leads to a separate , private report.

One more task for the nurse.

[Been there,done that, ASN, RN]

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.

Voila! The answer to "bedside report" Well done.

[anotherone, BSN, RN]

Yes report is almost always inadequate this way. We have to do this and pretty much everyone hates it. Most people will give history and some report out in hall than go to pt's room to say things like," this is shleby she will be your nurse today. i am leaving. ---this is mr smith, he has not had anything to eat or drink since midnight, he is going for an ID of his knee today. He has had good pain relief with percocets and 1 time dose of morphine. He has 125ml/hr of NS in a 20 in his left hand."

[anotherone, BSN, RN]

Bedside report is a charade that administration is requiring at the current time. It is part of the customer service model that is being shoved down our throats.

Administration thinks that patients want to see a hand - off of their care.

"Good Morning Mr. A .. here is your new nurse. Oh, sorry you are...

-Vomiting

-in pain

- on the commode

- sleeping

The exchange of information depends on the situation. Anything that cannot and should not be shared at the bedside .. then leads to a separate , private report.

One more task for the nurse.

I view the whole thing as one last performence of the shift.

[SwansonRN]

There's no way I would be okay with doing the full report in front of the pt/familly! I think in theory it sounds like a good idea, but I just don't think you can give a 100% thorough report with an audience. Report is not the time for patient/family to be asking questions, in my opinion, nor is it time to be censoring information. I work in a MICU and it is highly discouraged to interrupt nurses while they're giving report. It's a safety concern. It doesn't mean we are gossiping about the patients or saying things we shouldn't, but some patients have important psychosocial considerations that are important to disclose between nurses. We're professionals, give us the benefit of the doubt sometimes!

We always go into the rooms after report and the outgoing nurse says goodbye/the new nurse introduces themselves. The new nurse then checks to make sure all the bags and lines are properly labelled/not expired and that any loose ends have been tied up.

Oh I would be so cranky if they tried to make that change to my unit!

[picurn10]

yes, bedside report is part of the "customer service model" that is proving to have dangerous pt outcomes, but because they government and insurance companies are starting to reimbure on "pt satisfaction scores" (the biggest load of bs ever) we're going to see more and more of this junk.

We are supposed to be doing this, very rarely do we comply. For me personally, I am a very visual learner and am almost handicapped with auditory information. I HAVE to write down report, see the charts, see the labs, read the kardex and then I have a good handle on the situation and can give the best care to my pts. I don't want to be inturrupted while I'm gathering the information I need. What happens when we go bedside is the family asks for a million little things: cup of coffee, when can we order breakfast, can you get me another pillow... constantly inturrupting report, breaking the train of thought of the offgoing nurse, and I feel that really puts us at risk to leave out vital info. Research shows that poor communication is very often a factor in sentinel events, and this is creating poor communication IMO.

We do a system by system report outside the room. Working with peds, more often than not there are relavent social issues that can't be discussed bedside. Then we go in and do our required introduction, then we check drips, trace lines, look at wounds/drsg, and give the family a quick update about the plan for the day and ask if they have quetions. A lot of families are scared and confused by what we're discussing in report. Its pointless to do it in from of them IMO. I do like the aspects of discussing their care plan and ask the family if they have questions, but actual report in front of kids and families is stupid. Of course no one ever asks nurses

[redhead_NURSE98!, ADN, BSN]

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.

And 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?

[NicuGal, MSN, RN]

We 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.

[BluegrassRN]

I 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.

[Bringonthenight]

Personally 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")