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?

[PinkNBlue, BSN, RN]

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.

[Fyreflie]

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.[/quote']

Good 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).

[PinkNBlue, BSN, RN]

I'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.

[Roshy]

We 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.

[Alikatz]

"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!

[PinkNBlue, BSN, RN]

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.

[RN520]

PinkNBlue, 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.....)

[RN_BSN09, RN]

In 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.

[PinkNBlue, BSN, RN]

I 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.

[RN_BSN09, RN]

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.

That'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.

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.

[PinkNBlue, BSN, RN]

I'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.

[DalekRN]

We 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!