Bedside Report...

psalm, RN · Jan 10, 2008

Our med/onc tried it, using the SBAR reporting. It flopped. Too many of us night nurses had to report of to 2-3 nurses, some of the pts. aren't in the bed, they are already at dialysis, tests, surgery, radiation, etc. Plus most of us revolted at the idea, the HIPAA problems if/when a pt. had a roommate. Or the whole Isolation thing. Handing over report in the hallway is a HIPAA prob. as well.

Plus, how do you tell the next nurse the pt. is a pith (pain-in-the-heinie), drug-seeking, verbally & physically abusive, etc? It's a great idea on paper, but we don't have the staff for it.

What has helped our group: I will tell the pt. the day shift is coming on at 0730 and is there anything specific they want me to relay to his/her day nurse? Then the day nurse has an idea of what this pt. needs/wants regarding care.

meandragonbrett · Jan 10, 2008

We do bedside report, but I work in the unit and there's no other way to do it really.

sleepyndopey · Jan 10, 2008

I am on a commitee to help implement bedside change of shift report on my unit. It is a 28 bed general surgical unit. Another unit in my hospital has done this successfully. We are just in the beginning stages of the process. Any input would be helpful..especially fro those who have experience with this type of report.

I'm interested in this. What are the benefits of bedside shift report? As a previous poster noted, wouldn't it prohibit certain info from being comfortably passed on? Why can't you just give report and then go and do quick rounds? Just curious. I don't think I would like to give/get report like that.

meandragonbrett · Jan 10, 2008

We give report at the bedside, this allows the opportunity to ask any questions that might come up (ones that you might not have unless actually viewing the patient). All critical drips are checked by the off going and on-coming shift. Vent settings, injuries, travel plans. We then step outside of the room to the bedside table and discuss family, pt. history, etc.

TazziRN, RN · Jan 10, 2008

bedside reports are the only way to go in icus but i don't like them in other units. i know that hipaa goes flying out the window in semiprivate rooms, but this is just another way to push it over the sill. plus you can't pass on the nuances of the pts......horse's patootie attitude, big fat liar, etc.

SheriLynnRN · Jan 11, 2008

One of the first steps in implementing this on our unit will be to go to the other unit in our hospital the uses it to observe the process "in action". I'm actually looking forward to that. It sounds like a great idea in theory..ie keeping the pt better informed and increasing accountability between shifts. I do have concerns about how it will play out in "real life" however.

Suninmyheart · Jan 31, 2008

Getting nurses to actually DO IT will be an issue. I am new but I like it. We actually give report just outside the room (quietly) them go in and talk to patient.

This morning I gave report to the back of a nurses head while she scanned the computer - often looking at a screen irrelevant to what I was reporting on - and kept asking about details where the answers were literally in front of her. She then asked me to go get the kardex for her, and then, when I asked her to round with me, said she was too busy.

She is way more experienced then me and I am new so I was trying to be on my best behavior. I should have said "ok then I will go say good-bye to the patient and let them know you are too busy on the computer to go see them right now" and walked out of the charting room.

I did tell her I promised the pt I would introduce her so she was expecting us. That worked but was way too passive for my taste. Shucks.

swee2000 · Feb 1, 2008

My hospital just implemented the "Bedside Report" system last week. So far, I've heard more grumbling, groaning, & complaining from either the nurses coming on for the next shift or those finishing up the current shift. And, like another poster said, sometimes one nurse has to report off to 2 or 3 different people, plus go to each patients' room to do the beside report. That leaves other nurses frustrated & getting mad because they're waiting to hand-off report or get report from one of the nurses in the patient rooms.

Good idea, but I honestly can't see it lasting or being done routinely.

Diary/Dairy, RN · Feb 1, 2008

Bedside report prohibited me from getting out on time EVERY single morning.......

I do think it is a good idea though - just needs some better implementation.

EmmaG, RN · Feb 1, 2008

Bedside report prohibited me from getting out on time EVERY single morning.......

Ditto.

And it prevented the oncoming shift from getting started in a timely manner.

Greenhermit · Feb 10, 2008

We recently switched from group report (4-5 nurses per shift) to face-to-face bedside report, despite many objections. Group report, where the oncoming shift would hear from each nurse in-person (not on tape), allowed us to allocate assignments more appropriately, share suggestions, and plan for situations that may need two or more nurses (e.g., dressing changes). Face-to-face bedside report causes less sharing of ideas and expertise and more staff fragmentation.

Patient privacy was one concern, especially in semi-private rooms, where there were relatives of other patients present. In the hallway, visitors linger within earshot. People quote HIPAA regs, saying that communicating confidential information in front of others while providing care is acceptable. Giving report is not same as talking while providing direct patient care.

The next major concern is patient safety. We know nothing about any of the other patients on the floor other than our own. What happens when the assigned nurse is tied up with another patient? We've already had situations where a patient had seizures but no one knew if these were new onset, febrile, or parameters for intervention. Two pregnant nurses became parvovirus positive after assisting a patient not their own. A family requested that non-family males not enter a patient's room, but that was not known when the nurse responded to the call-light. Just this morning I discovered that the oncoming and leaving aides were not aware that one of our patients has "brittle bone," because they no longer sit in group report with us but have their own face-to-face report..

One option is to tell the patient or family to wait until their nurse is free, even though some of our procedures or dressing changes can last a hour.

At night, bedside report can disrupt hard-won sleep. It also can tie up two nurses attending to an awakened patient's requests.

During the individual face-to-face reports there is no one at the desk to respond to emergencies in the other rooms. Report becomes a frustrating "musical chairs," trying to find 4 or 5 different nurses to get report from.

There are other drawbacks to that system, but these give you an idea.

Most of the articles I've read about transition to bedside reporting were efforts to get away from tape-recorded report methods, which I consider the worst of all shift report techniques. The touchy-feely theory of bedside report is to involve patients in their care. Using a flawed report system to do what should already be done 24 hours a day creates more problems than it accomplishes - it's more symbol than actual doing. It's another fad that sweeps nursing periodically when management nurses with minimal direct care experience read a journal article written by someone with even less real life experience.

An ideal method would be to have group report, then immediately go to the bedside to quietly check the patient, IVs, fluids and other items, before running to the cafeteria for breakfast.