assistance w/ report, anyone?

[David's Harp]

Okay, if anyone I work with reads this thread, they'll know it's me in a heartbeat, because I've been complaining about this to anyone that'll listen, picking their brains, & generally trying to get others' input on this.

I'm five weeks into orientation, and I really need some advice on giving report. Not unclear on SBAR, and I've *heard* report given many times before. I think I have a pretty good grasp of exactly what goes into the thing, and the reasons why all the different components are in place. Ideally, a continuity should come of it, that would to the patient's perspective be as though no handoff had happened, right? So, the oncoming nurse needs to have as good a perspective on the pt's history, history of present stay, demographic data including allergies, code status, any abnormal labs & vitals, any pending ones, any "to-do" items, and the overall plan for the immediate future if not the remainder of his stay. Is this a fair, albeit cumbersome, summary of what's needed?

What I feel I'm falling down on is in gathering some of these items (especially the 'plan', though I'm getting familiar w/ the residents and being able to grab them and ask) throughout the course of a busy day, and keeping some previously-reported items stored for reporting (his history of present stay, for instance). I feel a lot like a pinball being shot from task to task, to phone call, to this, to that, etc. I can't see where I'm wasting any time at any point, though I'm sure my ability to cluster activity could stand improvement. I've tried various strategies I've found on this site involving organizing data throughout the day, and some of them involve a little more graphic design-time than my day will allow me! :behindpc:

My preceptor tells me I'm doing well, and tells me not to get too preoccupied with this. Reviews from peers, clinical specialist, manager, patients, all have been positive, but this aspect of nursing is really bothering me. Some of it is that I blank when put on the spot about a patient, and come across as knowing considerably less than I actually do! :angryfire:

Has anyone dealt with this and worked through it, or is anyone currently going through it? Questions, comments, suggestions, curses? Are there days where you just physically *can't* pull it all together by change of shift, and if so, how does that play out?

If you've read this far, thank you. Have a cookie, it's on me!

-Kevin

[CarVsTree]

hi kevin,

first of all... relax... listen to your preceptors. sounds like you're doing great.

now report comes in many styles/qualities. my own report varies depending on the type of night i had and why the patient is in the hospital.

i work trauma med/surg so many of my patients have no hx, many have substance abuse hx, many have hx of violence, many stay in the hospital for weeks/months, while others are on a 23h obs.

this is how i do report on a perfect day with an average pt (not super sick, but sicker than a 23h obs)...

john smith 32m, dr. smith (trauma) admitted 9/25

s/p mva car vs. tree, restr. passenger, +airbag

conc w/ +loc

r rib fxs 6-10, r hemothorax, ct to 20cm pleurovac suction

r acetab fx (orif'd 9/25)

r open tib/fib fx (x-fix & woundvac 9/25)

no hx, no allergies (i don't always remember to say this)

vs q4h

neuro checks q4h

neurovasc checks q4h

telemetry 24h (d/c'd 9/26) don't always remember to mention routine tele that's been d/c'd.

tolerating regular diet

bedrest hob 30 degrees

neuro pupils 3=brisk

good strength all extremeties with exc rle.

lungs clear decreased b/l bases, r more decreased.

uses incentive but needs encouragement.

good pedal pulse on left. right difficult to palpate. strong doppler pulse.

assessment otherwise benign.

lbm 9/26/07, small hard. gave mom/warm prune juice last night.

morphine pca & percocets for pain. pca 2mg q6mins/ lockout 10 attempts. put new bag up at 2000. pain well controlled.

plan (if i know it).

go over new orders.

abnormal labs & what we're doing about it.

if have labs in a.m.

so that's an example. now after a hairy night or when i'm really tired... this isn't automatic. sometimes oncoming nurse has to ask me labs or ask me re: pain control. i've given report and not told my assessment until asked. i don't always give lab values, just the highlights.

i like face to face report, because if i forget to mention something, the oncoming nurse usually remembers to ask.

it i give an take. no one is perfect at giving report. and some ppl love tons of details, i just want the hightlights. i also adjust my report for who i am giving it to. if they like a lot of details, i give a lot of details. if they like just the highlights i give just the highlights.

really, you'll get comfortable in time. only time. all the advice in the world won't replace the time it takes to just feel comfortable in your own nursing skin. some ppl like to use report sheets. if you see someone with one, ask for a copy.

hth!

[David's Harp]

Okay, I tried a couple of times to reply, and my attempts were apparently eaten by internet gremlins.

Thanks so much for your response! It was very informative, and especially what you said about getting comfortable in my own "nursing skin" put a good perspective on things. I do realize that not everyone gives "perfect report", in part because there are as many ideas as to what that would entail as there are RNs, and styles vary as much as techniques do. Thanks for the reminder!

-Kevin

[awbrn]

When I worked in the hospital on a med/surg floor sometimes I could have anywhere from 5-6 patients on my shift. I learned very early that there is no way that I could remember 5-6 people in and out with a 30 minute report, without having some type of cheat sheet to refer back to when I needed. So I bought a clip board and went home and got on the computer and made me a cheat sheet, it included data like

Room #

Patient Name:

Allergies:

Diagnosis:

Diet:

Activity:

Medication Times:

Special Procedures:

Times of Special Procedures:

Etc.

I found this very helpful to me when it was time to give report to the next nurse about the patient and I would ad lid depending on what happened during the day. On the floor also, we had patient cards that were produced when the patient was admitted that was to stay in a designated place and data could be changed to it throughout the day, so that it was up-to-date. I hope this helps alittle.

I also agree with the other person who put a post up...it also depends on the nurse that you are giving report to...some love details and some just want to basics...it gets easier with time...don't stress.

Good luck with everything.

[David's Harp]

Thanks, awbrn.

Actually what you wrote is very similar to what one of my preceptors just wrote out for me a couple nights ago, basically an outline of what the "flow" of report will involve. I've been on nights this past week and next week, and thus have had a few spare minutes (literally) to compile a solid report on _most_ of my patients, barring of course the late admissions, which are nobody's favorite. Most nurses report from their printout of the kardex, but for this nervous newbie that's a jumble of print and my handwriting to try and sort through while giving report, so having the list has helped move things along.

I just need to organize the data I collect through the day a little better, and I should be alright. I can't help but wonder how I'll end up getting _more_ done in a shift. I can't see where I really waste any time, and I don't want to skimp on time talking with the patient - I try to make it a point to have an actual conversation w/ each patient, if they're able, in addition to the "strictly medical", to build rapport/trust/their comfort/etc. Not a long conversation, just a check-in.

I guess I'll get better at making my work more efficient through the day, in order to squeeze everything in, but at this point it looks like a steep climb!

-Kevin

[AliRae]

but at this point it looks like a steep climb!

I remember being on the phone with a good friend of mine shortly after starting my job as a new grad in the PICU. I was close to tears, and said something along the lines of "They told me there would be a leaning curve, but no one said it would be mount EVEREST!"

He let me rant for a bit and replied calmly, "Relax. It's just Kilimanjaro."

Those words have gotten me through some of my toughest shifts. I always remember that, at the end of the day, this isn't the hardest thing in the world. It may come close, but it's doable. =)

[november17, ASN, RN]

You'll get the hang of it. It took me a while to get used to it too. Most of the time in report we go over the exceptions...like variances to the norm and skip the stuff that is okay. You're still in orientation, once you're on your own you'll learn what is important to share and what isn't. Sometimes going over every system in detail, especially when everything is fine, can be a little too much for the oncoming nurse.

Patient name, diagnosis, relevant history, doctors taking care of them, active lines (IVs, O2, foley, drains, etc)/meds given/last bm/etc, abnormals and normals if they are relevant to the case, what the plan is for the upcoming shift. Then a little Q+A if there are questions about anything

That's about how my report goes. We do verbal report - and get roughly two minutes to talk about each patient. We used to do a scripted taped report but we switched about a month ago.

[jb2u, ASN, RN]

Everyone has their own way of giving/receiving report. Just relax and find your way. I am a new grad and this is what I do.....

Every shift I take my kardex and fold it in half so that I can see the pt's name, room #, allergies, attending MD. I then write...

Hx_______________Skin_____

N________________Lines_____

C________________IVF______

R________________Other____

GI_______________

GU_______________

Just like that every time.

This would be...

Hx = what brought them here, major events leading up to today, and medical history.

N = neuro, A&O, confused, PERRLA, etc.

C = cardiac, what has the pt's HR, BP averaged. Afib/flutter, SR, ST, PVCs, etc

R = respiratory, any O2, NC, mask, or vent. If vent, what are the settings. what is his/her O2 sats been. ABG values, are lungs CTA or crackles, diminished, whatever, etc.

GI = any bowel sounds, hypo/hyper/absent, any tube feeding, what kind of diet, last BM, etc

GU = does the pt have a foley, are they anuric, dialysis, etc

Skin = any skin issues, breakdown, ulcer, skin tears, wound care, etc

Lines = what access? 20G peripheral in the right hand, 18G in the left AC, or right groin quad lumen central line, etc.

IVF = what do I have running? NS @ 20, insulin gtt right now going at 2.6, has levo off now but there is a bag hanging with orders to titrate to keep SBP >90. Pt's SBP has been in the 100s all day.

Other = what else do I need to know/tell? Pt is on the electrolyte protocol, I hung a bag of K at 1800. It should be done at 2000, so you need to draw a K level at 2200. Pt is going to specials today for a picc line placement, consent needs to be signed when his daughter gets here, etc. What labs are elevated/decreased? Anything that you think is important not covered in the above sections.

I do this every time without fail. First, it helps me get a good report because if the nurse is done with report and I see my "lines" part is blank, then I can say, "Hey, what kind of access do I have" etc, etc. Second, it ensures that I give a good report. I just read each section starting with Hx, then N, C, R, GI, GU, Skin, Lines, IVF, and finally other. That way I have covered everything and left nothing to chance. The only thing that gets me is when I am trying to give report and the on coming nurse keeps interrupting me (ie: I'm talking cardiac and they are breaking in with "what kind of access do I have" well, if you let me give report then I would answer that for you!!) Other than that, report for me normally goes pretty smoothly. I hope this helps. If not, just find what works for you. Good luck!!!

Sincerely,

Jay