Bedside report in the ICU setting

[squirtle]

I was curious to know if other hospitals have tried or are currently doing bedside report in the ICU setting? We have recently been told that we are to be doing what they are calling a "meet and greet" in our SICU. We are to introduce the next shift to the family, check gtts, and perform a neuro assessment together(if applicable- so we can determine what the prior nurse describes as "weak" etc). These few items I see no problem with, but I feel very reluctant to give the full report in front of the family- which we are also supposed to be doing. I truly don't see how this is different than giving a pt a full copy of their chart during their stay and we don't allow that. If I were to say "and their platelets are critical at 35 and I am waiting for the docs to decide if they want to transfuse or not" the pt's family is going to become more anxious. Also, won't they interrupt to ask? I feel like the potential interruptions or the need to censor some information (things like, I think its time for the doc to discuss changing status to DNR) will cause vital information to be left out. Just curious how it has worked for others?

[APRN., DNP, RN, APRN, NP]

At my facility, bedside report is expected, but it is not expected that the entire report be given exclusively at the bedside. Everything is recorded in the computer at this time, and report is either begun, or ended in front of the computer to go over new orders, labs, etc.

[Schuur451]

I save the sensitive things for after we leave the room. The bedside report is just to clarify neuros assessment (such as neuros), check drips, talk to the patient/family, etc. There is no rule as to how much you say at bedside, just that the patient/family feel involved.

[BacktoBasics]

We tried it in a PICU I worked with. A lot of effort was put in by management to get the nursing staff on board. Well, 2 weeks after we started bedside reporting, it pretty much stopped. Our instance was a bit different because they wanted EVERYTHING to be said at the bedside and we were to follow the "SBAR" format (but the one we were giving, was too confusing and didn't make sense. We were supposed to go over lab results before staying why the patient even came in. It was ridiclious).

If information was something that was confidential or you didn't want parents to know, you were supposed to write it down and point to it on a sheet during the report, which seemed pretty suspicious. Parents kept interupting to ask questions or to add information. We were told to ask the parents to leave questions or comments til the end, and we did, but it still happened. We only had 2 patients in the PICU, but we wouldn't leave until 30mins after our shift.

I think it needs to be a mix. My current hospital hasn't started bedside reporting yet, but we're supposed to in the near future. Having worked in the PICU prior, I have changed my current report style. I give report outside of the room, go over lab values, test results, show progression of CXR's, and then go over my past shift orders (that also always me to see if I missed anything). Then we go into the room and go over our lines and stuff and show abnormal findings on assessment. I like it because I can tell the on coming nurses what I determined as abnormal or normal.

[Ruby Vee, BSN]

we do bedside report -- there's no place else to give report in our tiny unit -- but the families are all asked to leave unless the patient is on death watch. if we step far enough from the bed, keep our voices low enough and huddle to prevent lip reading, the patients rarely interrupt. enough acronyms confuses them anyway. the problem i'm having is that now management wants to do away with our brain sheets because "everything is on the computer." i don't remember anything i haven't written down, so that's not working for me.

[fiveofpeep]

oh ruby, thank you for the term "death watch" which when used so candidly as you did made me laugh out loud :)

[bellehill, RN]

In our neuro ICU we do a neuro assessment together at the end of the shift. We are supposed to be going to full bedside reporting and I really don't see the harm. Of course there are some items that simply cannot be discussed in front of the patient or family but what a great way to include the patient in their care. We have family step out for report anyhow so that won't be an issue. I think it will be a great way to answer questions and make sure the patient understands what is going on with their care. Of course, we haven't tried it yet so my opinion might change. As a patient, I would like to know both of my nurses are on the same page.

[Mrs.Rollins, ASN, RN]

I think the term "bedside report" is inherently confusing. I've always taken it to mean that at some point we go into the room together to look at the patient, clarify/discuss some of the physical assessment data, verify gtts/vent settings/CT's/etc, introduce ourselves to family, and just generally give the room a once-over together. I've never interpreted it to mean that the entirety of our report must be given standing next to the patient; rather, we look at the chart and orders together, along with going over any pertinent history or sensitive information, before we enter the room.

Having said that, there are some facilities and nurses who interpret bedside report to mean just that: the entire thing, right there in the room. Eh. I think it's a potential landmine of privacy/dignity issues, not to mention the fact that I would certainly forget a lot of things that way. And I'm certainly NOT going to march into a room with an oriented patient and tell the oncoming nurse, "Yeah, he's pooped 2 liters of foul liquid stool today. Been drinking like a fish since he was 15 and now his liver's shot. He's terminal with 2-3 months left, and look at those ascites! No family involved with his care and apparently he's got a history of extreme psych issues. Okay, Mr. Smith, Nancy Nurse here will take great care of you tonight!" :icon_roll