Bedside Handoff

[ryhudark]

Hello everyone,

The corporation I'm working in is slowly introducing bedside handoff to the unit. In my understanding, this has been an ongoing process on the regular floors but not in the ED. Does anyone work in an ED that has staff do bedside handoff during shift change? What is your experience with it? What were the barries to the change? How has it benefited the unit? Was it well recepted? Is there a specific format to the bedside format(SBAR?)?

[Guest219794]

The biggest barrier to the change is nurse resistance.

It is new, we haven't done it, we don't like it.

I like it, and think it is good patient care.

In my experience, nurses have to be forced into doing it.

[NuGuyNurse2b]

It's both good and bad in my experience. It's good because it brings up accountability - you'll see the IV bag has like 100mL's on it, why didn't the outgoing shift put a new one up, or the IV is leaking, why didn't they change the site - these are things I have addressed with the outgoing shifts.

It's bad because management puts a one size fits all on it. Once we were handing off on someone with newly diagnosed HIV and the outgoing shift said it in front of the patient, who obviously knows it - the patient just started crying. We've brought it up to management saying sometimes "hot button" diagnoses shouldn't be discussed and our managers and directors really said "oh they already know why they're here". And some patients are more involved than others - bedside rounding shouldn't be a mini-assessment - but some nurses and patients turn it into one, and you're doing a 30-min hand off on some patients when you're trying to get out. So even if you tell the patient it's a hand off and that the ongoing shift will return, they report it as you not wanting to assist them (because everything the patients say is true...) and they remark it on the survey, and you are getting called into the office.

[JKL33]

I'm a fan of a basic hand-off and introduction of the oncoming staff member at the bedside. There are circumstances where the details of the hand-off part are better performed prior to getting to the room, and then just doing a recap & intro at the bedside.

Benefits: making better connections with patients and involving them in their care and keeping them better updated on progress; displaying teamwork.

IMHO the downside to changes like this is that they are always laid down like law, as if no discretion may ever be used. That's where things go wrong.

I find nurses embrace sensible change, ask questions about questionable change, and get accused of being "resistant" merely by asking questions.

[canoehead, BSN, RN]

We tried it and it was so disruptive to the patient anxiety, and also the patients wanted to tell their story again to the oncoming nurse. Or we were waking sleeping patients by talking at the door. We downgraded to just eyeballing from the doorway, and introductions if the patient was awake. Then finally gave it up altogether. If a patient is complex the two nurses will go through the drips and lines, and plan of care at the bedside, but otherwise, it didn't stick.

[Racer15, BSN, RN]

We do it in my ED. I have adopted the KISS method. "Keep it Simple Stupid." "I am going home, xyz will be your nurse, this is what we are waiting on." I give the "real" report at the nurse's station.

[DayDreamin ER CRNP]

We do it in my ED. I have adopted the KISS method. "Keep it Simple Stupid." "I am going home, xyz will be your nurse, this is what we are waiting on." I give the "real" report at the nurse's station.

This pretty much what we do. I give the very basics at the BS and give a real report at the desk. I usually give a very brief re-cap of the pt's c/c, what we have done thus far and what we are waiting on. I think this kills two birds with one stone - gives the pt some reassurance that I have listened and a list of things that I have done for him so he can't say, "she didn't do anything for me."

[mmak]

We do it at my level 3 ED mostly for patient satisfaction rating. As with similar postings, I use the KISS at bedside and finish report at the desk. Patients do like it, though.

[TigraRN]

I usually give the report to the oncoming nurse at the computer, go over how pts presented, what was done and what is pending, THEN we both go to the rooms and do very short bedside hand off and line tracing.

[ryhudark]

Thank you for everyone's input. I like the idea of the KISS handoff. Currently, they are trialing bedside handoff at our sister hospital and this as a recommendation for a change may be beneficial.

[nurse2033, MSN, RN]

It works well, although there is significant "groan" factor. We keep it simple for a "meet and greet hello", and one thing that we are waiting for, like labs or a CT. It takes only a few short minutes.