Bedside handoff report on mother/baby unit

[OBnurseSandy]

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 do likewise. At 7am we go back to couplet care. What we have been doing is that the mom's nurses tape report for the oncoming shift then the nursery nurses come in and give the oncoming nurses report on the babies. Because the nurses on postpartum at night will have to give report to several different nurses on daylight because their assignment needs to be broken up, we have found that the taped report does the trick. All oncoming nurses then listen to the tape at one time and are done in a relatively short time.

We just got a new manager. She wants us to begin doing bedside report. The problem with that as we see it is that many patients have social issues which can not be mentioned at the bedside. If we chose to give a cut and dry report minus the social issues at the bedside then we'd still have to come out of the room and finish the rest of the report in the hall. Now imagine this happening where the night shift offgoing nurse has to report off to 2 or 3 separate nurses and then the baby nurse has to repeat these same steps to report on the babies.

Another problem we see in this approach to reporting off is that, depending on the time, some of these patients are trying to sleep after a day of visitors, fussy baby, etc. It seems like this kind of reporting will take a whole lot longer and could potentially cause frustrations in our patients. The part about this taking a lot more time is important because this new manager is adamant about people leaving on time.

Are any of you doing this at your hospital? If so, what makes it work or not work, in your opinion?

[NicuGal, MSN, RN]

As much as you hate it, Joint Commision frowns on taped report. And it is best practice to give face to face report. It will take some getting used to and you will be able to streamline your report by following SBAR. Our nursery is open all day, but the give report to several different people and seem to get out ok. You just have to get a system that works :)

[HeartsOpenWide, RN]

We have a report room and do all reports orally. I agree, bedside report is totally outdated and inappropriate; especially in OB

[Fyreflie]

We have a report room and do all reports orally. I agree, bedside report is totally outdated and inappropriate; especially in OB

Actually bedside report is the recommendation and I have a friend who just did a conference presentation on it--better patient satisfaction and involvement! We do it in my current labour unit.

[PinkNBlue, BSN, RN]

We do bedside report on our PP unit. I actually like it because, if nothing else, it allows the patient to see there is a shift change, they know who their new nurse is for the shift and, for us anyway, we write our name down along with the number they can reach us at. We usually give a report before going into the patient's room, in the report room, so the incoming nurse has a chance to get her own report sheet organized but then we'll go into the room and introduce them to the patient.

I personally like it because then if I don't get into the room right away, they have my number and know how to get ahold of me if needed. There will be issues with some patients, such as social issues, but then let the nurse know before going in and just do the basics in the room. It's also a good idea to let the patient know that you do do bedside report and would they like you to come in with the next nurse...? That way, if they do plan on sleeping, you know and can just let the incoming nurse know they will call when they wake up (or whatever the reason is). It's good for communication, in my opinion.

It's especially important on higher acuity patients, such as mag sulfate, so that both nurses can verify things are what they should be.

[anggelRN]

You can definitely make bedside report work. On my old OB unit, we did bedside report. If I had a social issue I needed to pass along to the next nurse I did so before I entered the room.

I also agree that letting the patients know you're going to do bedside report.

[Fairah01]

We do bedside reporting. We do frown sometimes, especially when they are asking us to do it on our pretermers that are in L&D simply because we they are usually sleeping at shift change and we are not already in their room. On our labor patients most of us are at the bedside due to our hospital being 1:1 for epidurals and/or pit so doing bedside is fine. We usually have social issues/lab results/histor unknown by other family memebers jotted down and point to it on the paper then if we need to go into detail we wil step outside once report is "completed." For rule outs unless we happen to be in the room at shift change we usually don't do bedside report there either. Basically, we suck at following the rule unless we are already in the room! :) But it can be done and it's the recommendations, as a PP stated-it increases patient satisfaction.

[OBnurseSandy]

Thanks everyone for your comments. We started our "bedside" reporting as of Jan 1st. What we do, as some of you have mentioned, is give report in the report room and then take the oncoming nurse and introduce her to the patient. That way the patent knows who her new nurse will be. The one BIG problem we've run into is the time element. No one is getting out on time from the evening shift or the night shift. We are always there 20-30 minutes over our shift end. It's because of going from couplet care all day but then at night we change to mom or nursery nursing and again in the morning revert back to couplet care. So it's not one nurse's assignment to one other nurse but rather one nurse's assignment to several nurses. Once that is all done then the introductions to the patients have to occur. Again, now you have to find the nurse for this patient then the nurse for that patient. There has to be a better was to streamline this.

[SpecialK38, ASN, RN]

Hi Sandy-

I'm curious why you go from couplet care to nursery and back? Our nursery is open 24 hrs and we try to staff a RN and a PCT if we can- if not, just a RN so assessments can get done. Although the nursery RN does much of the care, the couplet RN is still responsible for making sure it gets done- they are also taking babies to moms to nurse so they have contact with both babies and moms at night. Our standard is the bedside report and we also do it like others mentioned- social issues alone with RN and POC/etc in room with pt. I also ask pt if they want to be woke up for bedside report- if not, I document it. Our shifts are 12's and we are scheduled from 0700-1930 with the understanding that report is from 1900-1930. Our ratios are an average of 3 couplets with a max of 4. To streamline my report I have my report sheets printed out and then I fill in all the info I feel like is pertinent before the next shift comes on so it goes faster. Another way we streamline report is that the Charge RN tries to give same assignments if you had pts the day before (unless there are issues). It's much easier to give report on mom's and babies together!

[lovelabor]

can i ask why you switch from couplet care at night? i ask because i am a new working manager at a hospital that always has a "nursery" nurse and a mom nurse. i am a big advocate for couplet care (we are a small hospital, about 135 deliveries a year, so majority of staff do all aspects of care. i also struggle with convincing my staff that an assignment of 2 couplets is totally reasonable (i think, anyway). and another question.....when you start pitocin on a pt, what does everyone have for a time limit for a provider being "readily" available?

[SpecialK38, ASN, RN]

can i ask why you switch from couplet care at night? i ask because i am a new working manager at a hospital that always has a "nursery" nurse and a mom nurse. i am a big advocate for couplet care (we are a small hospital about 135 deliveries a year, so majority of staff do all aspects of care. i also struggle with convincing my staff that an assignment of 2 couplets is totally reasonable (i think, anyway). and another question.....when you start pitocin on a pt, what does everyone have for a time limit for a provider being "readily" available?[/quote']

Hi Labor-

2 couplets is a breeze!!! :) it also depends on the acuity of our moms. Occasionally we get a mom who needs more care (like I had a sickle cell mom or those with PIH issues) . Like I said, we are usually around 2-3 couplets with room to admit one more. Again- it depends on the patients. I've had 8 Pts and my day was a breeze and I've had 4 and it's been terrible! Couplet care makes sense as well because we do so much teaching with the moms and babies- hope this helps!

[kwest210]

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!!