Bedside handoff report on mother/baby unit - page 2
I work on a postpartum unit where we do couplet care from 7 am until 11 pm. At night however, the nursery opens and the nurses there get a patient ration of 6:1 and the nurses on the postpartum unit... Read More
Feb 3, '13Quote from PinkNBlueGood lord I wish our pp nurses would run mag! Our mag moms stay in LD until it's discontinued with 1:1 or 2:1 care depending on unit acuity. Then again, we also do the majority of IVs for our pp nurses and god forbid you don't catheterize your natural delivery if she can't pee (I refuse to do that, it irritates the heck out of me).2 couplets is a downstaff for us and we'll distribute those patients to another nurse. Our usual is 4 couplets; unless mom's on Magnesium, then it's usually 2 couplets, same with infusing blood. But otherwise it's 3-4, usually only 3 if L&D is busy and we anticipate we'll get a lot of admissions. There are days I've had 5. We also keep couplet care 24/7 but we're a baby friendly hospital so we encourage moms to keep their babies in the room with them overnight. Maybe bring up the idea of keeping couplet care overnight so that you're not delaying report. We've found bedside report has made everyone leave on time, if not early.
Feb 3, '13I've heard that a lot of places do not transfer their patients to PP until they're off Mag. We have mag patients all of the time on PP. There are times they're on mag, discontinued after 24 hours and then we have to restart it. Or we'll get a PP readmit with high BP's and they'll have to be started on Mag. It's a pretty common thing.
Sometimes they cath the patients after delivery, depending on their fundal checks and if they're still super numb from the epidural and it'll be a while before they're even able to feel their legs.... but the vag deliveries are always DTV when they come to us in PP. And we'll only call L&D to help us with our IV's if the patient is a known 'hard stick' or we've attempted the max amount. I like to do it as much as possible to keep my skills up... same with catheters.
Feb 4, '13We do what I like to call modified bedside report. We give report at the nurses station that includes things like social issues and then we take the next shift nurse into the room to meet the patient and we usually go over how the baby has been feeding, any special concerns, and what the goals are for the next shift. A exception to the bedside intro would be if mom has stated that she doesn't want to be woken.
We do couplet are with usually 3 couplets per nurse. Our nursery is used mostly for sick babies and procedures, however we will take babies if the parents request it.
Feb 4, '13"Hmmm at our hospital couplet care is 24 hrs meaning babies only go to the nursery if there is something wrong or if mom requests it. The mother-baby nurses are responsible for 3-4 couplets every shift. We do report then go to rooms to introduce on coming shift. 2 couplets is a slow day for us!!"
Same with our hospital. We are Baby Friendly as well and the mag patients stay with us in L&D until it's d/c.
Fyreflie - I would refuse to do that to a naturally delivered mom too!
Feb 6, '13What is the scripting that you guys use for moms who request their babies go to the nursery overnight and be brought back to them for feedings? We get a lot of moms who want to send their babies to he nursery so thy can get some sleep.... Understandable but in a baby friendly hospital, we're trying to not send babies away from their moms. I'm not about to argue or refuse to take their baby but that's the tricky part. I always say it's most beneficial to have baby with them at night and explain why but not everyone gets it.
Feb 14, '13PinkNBlue, I can relate to that! It's kinda funny how new moms expect to get a decent night's sleep in the hospital. They'll be going home with that new baby in 24-48 hours, and last time I checked, we didn't go along for the ride! Although if someone offered me big bucks to be a private duty nurse in that kind of situation, I'd do it in a heartbeat! (I think.....)
Feb 27, '13In my opinion a full bedside report only works if you are giving report to one nurse, and also for units that care for a smaller number of patients (like L&D and ICU). It makes sense in those types of units with more critical patients to go over details face to face, make sure you don't miss anything, and discuss in front of the patient. However, when you care for 8 patients (4 couplets) and each patient is going to a different nurse at shift change, it is way too stressful and time consuming to give bedside report. You have to find the oncoming/leaving nurse, wait for her to finish report with someone else, and it just takes too long. It messes with the oncoming nurses organization and thought process and causes the leaving nurse to stay late. I've experienced both face to face report, and recording report, and I am by far a fan of the recording... at least when it comes to 8 patients and multiple nurses taking over their care.
Mar 4, '13I do agree with the fact that it does mess with the incoming nurse's organization and thought process. Sometimes the patients, when we're giving report in their rooms, ask for things they need right away which can take some time. We used to do report one at a time where the nurse leaving would give report to all of the nurses in the report room. If it was your patient they were reporting on, you'd obviously pay the most attention, while the other nurses would organize their report sheets etc. Now, we do bedside or individual... it does take up time finding the nurse to give/receive report but ironically enough, it's been quicker, at least for our unit. Most of the time, unless it's a higher acuity patient and a report that takes longer, they're out of there before they need to swipe out.
Mar 4, '13Quote from PinkNBlueThat's pretty much the most you can do... once the mom is exhausted and wants the baby to go to the nursery, she's made up her mind. Just like mom's who want to bottle feed... you can try to tell them all the pros and reasons why to BF or room-in, but they are going to decide what they want to do anyway.What is the scripting that you guys use for moms who request their babies go to the nursery overnight and be brought back to them for feedings? We get a lot of moms who want to send their babies to he nursery so thy can get some sleep.... Understandable but in a baby friendly hospital, we're trying to not send babies away from their moms. I'm not about to argue or refuse to take their baby but that's the tricky part. I always say it's most beneficial to have baby with them at night and explain why but not everyone gets it.
I recently had a BF only mom who wanted her baby in the nursery between every single feeding. It was frustrating, because the baby wanted to start cluster feeding, which meant going back and forth between nursery and room. I told the mom that it's probably easier to keep baby next to you, so that you can pick-up on early hunger cues; if the baby starts acting hungry in the nursery we are going to bring him back anyway, so he might as well be next to you sleeping. She still wanted the baby to go to the nursery anyway.
Mar 6, '13I've had patients like that as well and you're right, it's frustrating. I just end up charting that I've educated mom and she understands but is requesting infant to nursery. It's all we can do, you're right.
Jul 3, '13We do bedside report, 24 hour couplet care, and average 4-5 couplets on night shift. It gets crazi but it is doable. I could not imagine getting a taped report. I always have questions!
Jul 11, '13Quote from kwest210This is totally us as well.Hmmm at our hospital couplet care is 24 hrs meaning babies only go to the nursery if there is something wrong or if mom requests it. The mother-baby nurses are responsible for 3-4 couplets every shift. We do report then go to rooms to introduce on coming shift. 2 couplets is a slow day for us!!
I think the switching back and forth between couplet and nursery is a bit odd. Do you force your moms to send the baby to the nursery? If mom IS keeping her baby in the room overnight, I'm assuming then both the PP RN as well as the Nursery RN would have to check in with her for cares which would increase the amount of interruptions at a time when they should be minimized.
I would MUCH rather have 3 couplets than have 6 moms to care for.
We're working toward baby-friendly status now so we are supposed to encourage not sending the baby to the nursery also. However, as someone who's had 3 babies and DID send them to the nursery between feeds (and still successfully breastfed for roughly 18months each), I might be a little ticked off if I got a lecture (even a polite lecture) against this. Yes, moms DO need to sleep and this is the only opportunity to do so. They're not going to be able to send their baby off when they get home so why not take advantage of it for the 2 nights they can. Many moms have been awake for well over 24hrs and even the normal little whimpers of a newborn can be hard to sleep through. Just trying to give you a mom's take on this.
Jul 14, '13A few thoughts from a pp unit who is quite nearly certified baby friendly-
We regularly do bedside report, handing off a 4-5 couplet assignment to multiple nurses. It is nearly always done in half an hour. We only don't go bedside for the report if the pt refuses or if they are asleep. It is completely doable!
The portion of baby friendly which includes making rooming-in the routine recommendation rather than routinely bringing babies to the nursery has changed our unit for the better.
We never, ever tell a mom that the nursery is not available. It is just not routinely recommended. It had led to a more judicious use of the nursery- we watch the moms, try to intercept before there are tears, panic, etc, and offer the nursery in these sorts of cases. I would never suggest it if a mom has good support and is feeling fine. Then moms go home knowing so much more about how their baby is, 24 hours a day. We often have nights with an empty nursery. But all our moms are aware that they may request the nursery, however, I will try to help them settle their baby down first. Without a lecture on rooming in, of course. No lectures around here.
When I had my first, we were feeling fine but our baby was brought to the nursery overnight and out for feeds. I didn't know any different and didnt question it. And I did get some sleep. But I brought that kid home the first night and had NO IDEA what to do with him. I just thought he would go to sleep or.... something... In my opinion, it is better to have the nurses teach the parents how to care for their infants 24 hours a day. The time for solid sleep has passed when the baby is born.