Bedside report/hand off

colnurse · Jul 25, 2011

we do bedside reporting, and i like it because you meet the patient and the off-going nurse has a chance to say good-bye and if they are going to be back for the next shift. it is nice when you have blood going or they have already starting replacing lytes or not. you can also talk to the patient and see if they want to add anything and the patient knows what is being shared, and for some patients we always wake them up, to see changes of confusion. sometimes we will share info outside the patient room, if it is diagnosis the doc has not shared or mentioning difficult families, etc. i like it and think it helps to improve patient care because you can see what is going on with your patient, pain, alertness, if they need anything right away, etc.

amarilla, RN · Jul 25, 2011

We have bedside report; 40 bed surg unit with 12 monitored step down beds. It's awful and management just continues to push it. :uhoh3:

At first, mgmt insisted that our entire report - history, labs, clinical events, plan of care, etc - be done at the bedside in front of the patient. After patients began to complain that their roommate could hear their private information, we were told to move the 'personal' part of report to our conference room or station and do walking rounds afterward. Our reports - depending who is following you - are usually comprehensive and can take 30+ minutes for 5-9 patients. Walking rounds are a mess - patients wake up, want help to the bathroom or chair, pain medicine (not due yet but now needs to be explained again), etc. Oncoming nurse insists you help as is still 'your patient'. Unfortunately, 30+ minutes for report + additional 30+ minutes for 5 minutes of help here, 5 minutes there means that I have now gone an hour or more over.

I can't wait until we can convince mgmt to dump it.

xtxrn, ASN, RN · Jul 25, 2011

How do you catch the "wrongs/mistakes" with bedside report when you haven't looked over orders and the chart??

Dry IVs, O2 off, wet bed with dry urine rings, someone on the floor, dead people in the bed....things like that :)

tokmom, BSN, RN · Jul 25, 2011

Actually it isn't a HIPAA violation.

As for diagnosis that the pt does not know about. Obvioulsy those are done outside the room in private. Family issues...private. Like another poster said, if a pt has been there for a while, we do the diagnosis before we get to the patient and go over things that are new for the day.

I like it and so do the patients. They are on their call light less, and they feel part of their care. We ask them what their goals are for the day. Sometimes they are completely different than ours. It just really gets everyone on the same page.

Altra, BSN, RN · Jul 25, 2011

I was a patient at a hospital where this was done. It was a non-event for me as a patient because I was an A&O walkie-talkie patient, and a nurse, who understood everything said in report. It did appear tremendously cumbersome ... nurses criss-crossing the hallway multiple times to re-group with different offgoing nurses to get report, mutiple delays as a result of patient/family questions that were really long consultations (not simple requests like "may I have some ginger ale") ... and 45-50 min. had elapsed into the next shift before it was concluded.

However, during my 2-day stay I had 3 different layperson roommates. All 3 were upset to some degree or another because they didn't understand some/all of the terminology used during report. Please understand -- I'm not talking about diagnoses the patient was unaware of or anything like that. But step back and picture yourself as a layperson patient hearing, "A&O x 2, still rhonchorous bilaterally, +2 edema bilateral lower extremities, pulse ox 90-91% on 4L, thinking about upper her Lasix and putting in a Foley. Ativan 1mg q 4 PRN."

Does this enhance your understanding of your health care? Does it lessen your anxiety about your hospital stay? What does it contribute to your experience as a patient?

tokmom, BSN, RN · Jul 25, 2011

I was a patient at a hospital where this was done. It was a non-event for me as a patient because I was an A&O walkie-talkie patient, and a nurse, who understood everything said in report. It did appear tremendously cumbersome ... nurses criss-crossing the hallway multiple times to re-group with different offgoing nurses to get report, mutiple delays as a result of patient/family questions that were really long consultations (not simple requests like "may I have some ginger ale") ... and 45-50 min. had elapsed into the next shift before it was concluded.
However, during my 2-day stay I had 3 different layperson roommates. All 3 were upset to some degree or another because they didn't understand some/all of the terminology used during report. Please understand -- I'm not talking about diagnoses the patient was unaware of or anything like that. But step back and picture yourself as a layperson patient hearing, "A&O x 2, still rhonchorous bilaterally, +2 edema bilateral lower extremities, pulse ox 90-91% on 4L, thinking about upper her Lasix and putting in a Foley. Ativan 1mg q 4 PRN."
Does this enhance your understanding of your health care? Does it lessen your anxiety about your hospital stay? What does it contribute to your experience as a patient?

Ours is set up that we don't criss cross nurses, so no hunting somebody down.

As for the lingo, it's not used. It's 'dumbed down' for the patient. The patient can then understand in lay terms what is wrong with them and education can be given in snippets.

There needs to be something said ahead of time to the patient and family that lets them know that this isn't a grilling time, but a quick report. Youtube has some really good examples. It can work. It just takes discpiline on the nurses part.

Altra, BSN, RN · Jul 25, 2011

As for the lingo, it's not used. It's 'dumbed down' for the patient.

Is this the most effective way for trained professionals to communicate with each other?

tokmom, BSN, RN · Jul 25, 2011

Is this the most effective way for trained professionals to communicate with each other?

I don't need medical jargon to understand what is being said. The other 12.5 hrs of my working life is spent in medical jargon.

If I'm passing on a report, about a cellulitis...do I NEED to say more edematous? Why not say it is looking more swollen in front of the patient? The oncoming nurse understands what the heck I'm talking about.

There are times the medical jargon might be needed and I have used it..sparingly. That is when I tell the pt what it means. Why not take the fear out of medicine?

Been there,done that, ASN, RN · Jul 25, 2011

Actually it isn't a HIPAA violation.
As for diagnosis that the pt does not know about. Obvioulsy those are done outside the room in private. Family issues...private. Like another poster said, if a pt has been there for a while, we do the diagnosis before we get to the patient and go over things that are new for the day.
I like it and so do the patients. They are on their call light less, and they feel part of their care. We ask them what their goals are for the day. Sometimes they are completely different than ours. It just really gets everyone on the same page.

How is this not a violation?

Roommates, visitors, housekeeping, dietary... can hear the private medical information shared in basic report. :idea:

xtxrn, ASN, RN · Jul 25, 2011

My favorite report....

In bed, been fed, got meds, nothin' red, none dead, 'nuf said ...

~Mi Vida Loca~RN, ASN, RN · Jul 25, 2011

Actually it isn't a HIPAA violation.
As for diagnosis that the pt does not know about. Obvioulsy those are done outside the room in private. Family issues...private. Like another poster said, if a pt has been there for a while, we do the diagnosis before we get to the patient and go over things that are new for the day.
I like it and so do the patients. They are on their call light less, and they feel part of their care. We ask them what their goals are for the day. Sometimes they are completely different than ours. It just really gets everyone on the same page.

We do hourly rounding too (I know it sounds like it would be to much) but the results have been the patients on the call lights around 67% less.

Usually the nurse and aide (if you have one) swap off each hour. It doesn't have to be in depth, it's just a matter of popping your head in (while making sure your slacker tracker picks up ) and making sure all is OK. If they are sleeping you leave them alone and if awake you see if they need anything. It's really had good results.

~Mi Vida Loca~RN, ASN, RN · Jul 25, 2011

I will add. We have private rooms here. We go in the room and shut the door. We aren't yelling so it's not violating hipaa, the important stuff is discussed right before entering (we don't have people all over to overhear) the bedside part is more for the patients needs. Involving them in the plan of care and any questions or concerns they might have. If family is present we will ask if it's ok to speak in front of the friends or family.

The whole thing goes very smoothly without any problems.