Bedside/Face-to-Face Shift Report

Carla Verbsky · Jun 23, 2008

Something we wondered about at our facility is if you do bedside report, how do you keep confidentiality in a semi-pvt room? I'm interested in suggestions.
Thx!
Becky

You inform the patient upon his/her admission or transfer that in your floor/division nurses have implemented bedside shift report and you ask permission to speak about pt's general issues in case of another patient sharing the same room. When you speak about "general issues" you keep in mind using SBAR tool. Do not discuss delicate issues (i.e. med error, IV access, Iv tubing exp, etc) in front of the patient.

Overall, bedside shift report is better for the patient as he/she is involved in the plan of care, is safe during report time and is definitely satisfied with his/her care.

Thank you.

Carla, RN

Carla Verbsky · Jun 23, 2008

what about the passing of information like 'patient is crazy as a betzy bug today'?

Delicate issues are kept confidential between nurses. A nice way of transferring information without "talking about it" is by writing it down in the report card that is used during shift report at the bedside. The nurse assuming care of the patient has a chance to read the card while walking to the patient's room with the nurse who is transferring care. Remember: by using a standardized method of shift report that improves patient safety, involvement and satisfaction is in accordance with Joint Commission goals for 2008.

JacqueRN · Oct 1, 2010

I have implemented this practice and if you can get all the staff in the mindset to accept the evidence that this is a good practice, you will be amazed at the improvements you will see. I recommend using a change model such as Lewin's to get you through it. Bedside reporting can decrease report time, improve patient satisfaction, increase nurse efficiency, increase safety, AND IT IS NOT A HIPAA VIOLATION. This is such a common reaction for nurses to think that it is a violation. I agree that sharing information such as "this patient has HIV" or " he has a week to live" are not appropriate to say in front of the patient, but are these even important to the handoff anyway. If you feel strongly that they are, then a two second - literally - discreet conversation between nurses outside the patients room prior to going in is fine. The truth is, patients deserve to hear this information. The Joint Commission not only wants us to safely hand off the patient, but they also want us to include the patient in his or her plan of care (NPG # 13). The process of bedside report can meet two NPG's as well as all of the things listed above. As nurses and professionals, we must stop hiding behind HIPAA and move forward with this process in order to see the benefits our patients deserve. The evidence in clear.

Flying ICU RN · Oct 1, 2010

Something we wondered about at our facility is if you do bedside report, how do you keep confidentiality in a semi-pvt room? I'm interested in suggestions.
Becky

Here is a screenshot of the JCAHO guidelines for hand-off report in semi private rooms.

amarilla, RN · Oct 1, 2010

We are in transition from face-to-face report, (in nurses' report room), to bedside reporting. While I concede that it's helpful to see or lay hands on something you're getting in report, I don't care for it and hope we return to the former method.

My issue is mostly one of time; I used to take (and give) report on the hour and stay the half to cover any last minute requests or developments while the oncoming shift got situated. Bedside report puts both of us in the room right at the hour when patient requests reach their crescendo; everyone wants a snack, to go back to bed, to go for a walk, ask for a tv schedule, to get pain meds, or ask about the morning test (for the tenth time). This would be fine if each nurse wasn't reporting to multiple nurses, leaving her unavailable to help and me scrambling to address the many questions our appearance inevitably triggers.

*sigh.

Both of us occupied also means that techs don't get report until well into the hour, which means they are standing in the hallway or stocking linen carts instead of answering call lights.

I don't mind answering patient questions, obviously, but bedside report seems to encourage re-explanation and even argument about things already discussed. Much of the 'nurse talk' needs to happen outside the room, which then means we must go to the med or report room to address additional concerns, (example, 'Dr. so-and-so was on consult but never returned the call, was turned over to risk mgmt'), that are not appropriate to discuss in front of the patient.

Final thought: I originally thought having the off-going take a final peep at the patient would mean I walk in to find fewer empty IV bags, blown IVs, NG tubes pulled out, etc. Naturally, she would help to resolve the outstanding issues before leaving the floor, right? Seems that this was only a temporary effect. :rolleyes: Now, when we get to a patient and find their IV gone bad, for example, all I get is an audible sigh and a harried explanation that she no longer has time to take care of these things with three other nurses to report to in the half hour overlap.

HRMPH

Yep - so, not a fan. Good luck, OP!

jjjoy, LPN · Oct 1, 2010

If the logistics were better, though, do you think you'd feel differently about bedside rounds with shift report?

Given the complexity of many patient conditions and of what all nurses have to coordinate both within a shift and between shifts, it would seem obvious that hand-off between shifts will ideally require more than a two-minute verbal report. In other words, in my ideal world, shift change in acute care environments (with rapidly changing patient conditions and multiple, stat treatments and tests) would be more than just a "passing of the baton" with minimal overlap, but instead there'd be at least an hour of overlap between shifts. Of course, standards for exactly when handover from one nurse to the next was complete would need to be set. Facilities try to run on a bare minimum of staffing, but so many problems could be avoided (in other words, money saved in the long run) if staff weren't stretched so thin, such as trying to rush hand-off between shifts.