Anything Good About Bedside Report?

[rntg]

I need help- Our CNO and hospital administrators are now making manditory on all units, bedside reporting. We call it Walking Rounds, but it is really bedside report. A little backround on our unit:

We work on a busy orthopedic unit where most patients follow a predicted course of treatment. Their mornings start early with lab draws every morning at 4am, doctors in between 5:30-7am, techs taking vitals and blood sugars at 7am, CPM machines go on at 6, and therapists are in the rooms starting at 7:30am. Now they are asking us to interupt them one more time with bedside report. Our patients chief complaint is interruption of sleep. They are busy from 4am-4pm really. They see a minimum of 2 doctors, PT twice, OT twice, care coordinator, social worker, hourly rounds by nurses and PCA's. They are very informed of their care from every person.

We are having a very difficult time coming up with positives for true bedside reporting. Right now everyone is giving report int he halls, and then if necessary going into rooms to check PCA machines, dressings, etc. What I need from you all is some positives that come from your bedside reporting. Seems everything I have read on here has the same problems we are experiencing.

Our negatives include:

-multiple nurses to get report from

-no one to get pain meds and potty trips during shift report times

-oncoming nurses who want to do their assessments during report

-those who arrive late, or floating from other floors

-waking patients who have finally fallen off to sleep, and interrupting naps in the afternoon

-families, visitors- how do we handle this and HIPPA

-Charge nurse not getting adequate report on patients and not beign aware of problems on unit, and other nurses on the shift not being aware of other assignments, whether it be deterioration in condition of a certain patient, or difficulty of others assignments

-Difficulty writing report down and concentrating on what needs to be said if interrupted during report

Anxious to hear some positives so I can take them to my staff and maybe convince myself that this is really best practice

[JRD2002]

I hope we never go to bedside reporting but I have been hearing that the main advantage for doing it is to involve the patient more in their care.

There was another thread on this recently and they had some good points about some of the challenges of doing bedside reporting.

To me it seems like the idea of a bedside report was come up by people who are too concerned with patient's perception scores and that haven't practiced bedside nursing in a while. It always amazes me that the people who no longer do patient care are implementing changes that affect current practice.

[corky1272RN]

We have just started this as well except we give report at the nurse's station then walk around. I work on a busy telemery floor, it is hard to do this. The only advantage that I see is to "check up" on the previous nurse. So many times I have come in and there is less than an hour worth of IVF left, SCDs/teds not on, etc, so that allows me to check that aspect. We are also supposed to be flushing IVs while we walk around. Ok so the IV doesn;t work I am still going to have to start a new one, but I guess she/he will be more observant of it before shift change next time. Anyway, most of us feel that this is one of those things that will just be a fad.

[fiveofpeep]

we do it in the SICU and the positives are

- if the offgoing nurse missed something you have an opportunity to notice it or address it

- two eyes can assess for pressure ulcers and then document that they did (I guess this is a new JCAHO thing)

- if it's a neuro patient, we do a quick neuro assessment to make sure that the on coming nurse knows exactly what the offgoing nurse saw

so basically, the best thing is that you and the nurse can both agree that this is the way the patient is so that way you will definitely know if there is any change from baseline later on.

[LuckyoneRN]

The biggest advantage from a bedside nurses' standpoint that we have seen since implementing bedside report (about a year ago) is that we are required to trace our lines...the oncoming nurse does the tracing and confirms med and rate, verifies dose/med/drug/wt (if needed) in the pump. You'd be surprised how often there is an error here...or meds that should be run separately *somehow* are running together. I think bedside report is an additional layer of patient safety. Sure, eventually if you are doing your job you should be tracing those lines anyway, but by doing it right at the start of the shift instead of maybe an hour or so later if you get a train wreck admission 15 minutes into your shift, a mistake is caught sooner rather than later.

I work in a very busy MICU, and in addition to the bedside shift to shift report we also do rounds with intensivists, residents, RT, Dietary, Pharm, RN, sometimes Director of unit and Social Work on every patient daily.

Families, especially those of pts who have been critically ill for a long time (vented, sedated, paralyzed, proning, NO...you name it) benefit a lot from being present during these "grand" rounds--they hear the news and the plan directly from the docs lips...it ends up saving us time later relaying all the same information to different family members by encouraging a family spokesperson to be present and participate in rounds--this way they can take all the calls, and answer the questions...which lets me do my job--taking care of the patient!

[CathyLew]

I hated bedside report. You were talking about the pt in front of the pts roomate.... if a pt asks to go to the Br or pain med while you are in the room, it slows you down so much.

I did like seeing the Pt, since many times after report the Dr's show up, you get tied up with a pt or family, and it could be a long time before you set eyes on everyone.

[reef_point]

Hey,

Maybe this is just me on my usual common sense rant, but I would also like to hear some VALID pro's in the idea of bedside report. Over my five years of nursing, I have discovered that nursing reports can be a lot like a game of telephone. Nobody ends up knowing the original chief complaints, the tests that ruled things out, or what the game plan is. Reports become an incredible waste of time that could be spent in front of the chart - viewing the invaluable information contained in the H&Ps, latest prog note, actual labs and test results, AND (most importantly) ORDERS!!!! It cannot be overstated that orders get missed/misinterpreted frequently.

....and then came the bedside report! I've done travel nursing for 2 years, and I will say all of the hospitals I worked at are trying to implement this. Hospitals with single rooms or with double rooms, research and university hospitals, HMO and small community hospitals, etc. Makes me wonder if it's an upcoming gov regulation based on correlations and not causes, like nosicomial infections being used as a factor for medicare reimbursement (the infections happen, but it doesn't necessarily mean the direct cause is poor care. There are other factors, including compromised immune function and increased exposure to those bugs that play an important role in the outcomes.). So, we're still taking "misinterpreted telephone" notes in report time without laying eyes on the facts, but now, we're extending report time to 45-60 min. I'm sorry, but this screams inefficient.

Recently, I heard an argument by an administrator in terms of this being a process-improvement deal, in which we are minimizing the involvement of the person-the nurse, and replacing it with a systematic task - a forced checking IVF, name bands and account numbers, etc (yes, doing the assessment for the next shift). Furthermore, the argument continued that it guarantees that patients will be at least visualized once during the beginning of the shift. I believe the bedside report is an intended move towards safety, but I wonder if it's a misguided move. I also wonder if this is a method of sacrificing our common sense and critical thinking skills on the alter of rote tasks. We will likely continue to see errors with this method of report-wrong IVF hanging and orders misread and passed on in report that way.

Why am I always shot down when I suggest an alternate method of report? Here's my idea: I would like 20 minutes with the chart for my 4-5 patients, and 10 minutes with the nurses. I've been doing it for years, and it works great. I've found and corrected many errors. I also know more about where things are going case by case, and am more prepared to answer pt's questions, which comes off as an air of competence to them.

Wonder if this helps you?

[zofran]

We have recently started bedside reporting at my hospital. We are just giving it a trial run to see how it goes.

We have been mainily doing it between day and evening shift because most pts are awake at 3pm.....So I'm a day shifter....

While I think bedside reporting is a good idea in theory, it hasn't been working too well for me.

Often, the pt will interupt, "whats NPO mean?" or get into a long involved story about what brought them to the hospital, ( "Well on Thursday, I started having diarrhea, then on Friday I started throwing up. Then my husband told me to try saltine crackers, those didn't work and I was still having the diarrhea, then my mom came over and blah blah blah." ) So with some pt's it's taking twice as long!

Then, some tricky evening shift nurses will use the report time to question the pt about their pain/nausea and basically force the day shift into staying over to medicate people. (now, I normally round on everyone at 2pm to make sure everyone has had pain/nausea meds but sometimes they decline, or are at a procedure, or it isn't due at 2.) I think this is unfair. Or they will start a "mini" assessment- taking off dressings or looking at swolen feet. And again, report is taking longer.

One poster stated an advantage to bed side reporting is to "check up" on the previous nurses work. I don't agree. When I go round on my pts when I first get there, and an IVF bag only has an hour left, its MY job to change it. Or if the SCS's aren't on, I can easily put them on. It would be rude to correct another nurse over small issues like this in front of the patient anyway. Making the offgoing nurse look bad is not going to benifit anybody. Nursing is a 24 hour job after all. Thankfully, this has not been an issue for me.

The only advantage I have noticed is that the evening shift at least gets to lay eyes on all her patients at the begining of the shift to make sure they are breathing.

[zofran]

Sorry, meant SCD's!

[mappers]

We do bedside reporting and here are the advantages I see:

We can show where a dressing is, look at drains, ivs, etc. Everyone is looked at before you get started. If I'm having a bad day and feel like I'm leaving a bunch of stuff, I can work with the other nurse and say "I'll make sure such-n-such is done if you'll do this...." Most patients are OK with it and it doesn't take too long. Some patients though, it's better to do it in the hallway then walk in to explain a few things...up coming tests/procedures, etc.

Biggest issues I have is it can be very time consuming depending on the nurse and the patient, waking patients up in the morning, and HIPAA.

For the ICU nurses who commented...In you situation, with two complicated patients, absolutely it has positives. On a med surg floor with 6 - 8 patients.....different situation.

"They" tell us the biggest plus is patients feel more involved in their care..know more about what their plan for the day is, etc. Well, I try really hard to inform my patients of this stuff anyway. I almost always tell them what the doctor ordered and why, etc.

[fiveofpeep]

For the ICU nurses who commented...In you situation, with two complicated patients, absolutely it has positives. On a med surg floor with 6 - 8 patients.....different situation.

this is very very true :) I just added why I love it in my unit, but I definitely agree how it could be cumbersome in lower acuity areas

[mailners]

We have been using it in the ED for while. I was resistant at first. I have found it better for pt's. They are introduced to the new nurse and told "good bye" by the off going RN. Many things come up in report that the pt was not aware of and yes errors are found. Bedside report does not replace reviewing the chart. It is really just a common courtesy I think we ignored in the past. As a pt I would expect it now. Also, best time to reposition patients with 2 staff present. Just my thoughts.