Bedside Report...

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

I love bedside reporting at my last hospital. Here is what we did:

Before entering the patient's room, we report on any psych issues or other issues/concerns that can't be fully expressed at the patient's bedside. Then we enter the room, introduce the upcoming nurse, and explain to the patient that we are giving report.

Pros

-The patient can jump in and fill in the gaps, which can be especially helpful for timeline and help correct confusion if the prior nurse was misinformed somehow.

-You and the new nurse can conveniently get a patient turn in, or get a back/buttocks check in. Sometimes, I've gone in with the next nurse to see the patient very far down in bed, so we can get the pull-up done too very conveniently. This alone has been very nice, since it can be difficult to find a second person to help at shift-change time otherwise.

-The patient can emphasize what is important to them.

-The new nurse may have questions about something she sees that would not have otherwise gotten asked if it was a report done at the nurse's station.

-Another visual on your patient helps to see if there are problems. For example, if the IV fluid bag has almost run out, the off-going nurse can get that done at some point before she leaves, making the transition for the oncoming shift easier. And, two eyes are better than one, so the other nurse may see something that could be a potential problem, and collaborate with you on a solution. As well, visualizing the patient is a good way for the upcoming nurse to ask things like "does he always look this pale?" "did the incision always look like this?" "Does the patient always act this groggy?" So, you will have the prior nurse there when you are doing the visual check so you can compare it to their baseline. This way both nurses know of any significant change and initiate a faster response. Also, the patient can give input on if they feel there are any changes or deteriorations. This is comforting to have.

-If there is a serious problem, you have both nurses there, instead of just one, to help deliver better, faster, patient care. The prior shift nurse helps make things go much smoother.

-gives the patient a sense of closure on the last shift, instead of suddenly seeing a new face "out of the blue".

Cons

-Some of the patient's don't like "not understanding half of what was said", but from the feedback we got, the vast majority are ok with it, or at least tolerate it. Sometimes I've had a patient ask what one thing meant. So we have to try using more laymans terms when available.

-Rarely, the patient will try to dominate report, by talking extensively about one issue. or over what the nurse is saying.

-Some of the patients feel like they are an object on display (look at this line, look at this wound, etc), and some have complained that nurses sometimes move the bedcovers to show a wound without asking the patient first.

All in all, bedside reporting is much more thorough and is beneficial for patient safety. It is also a good teaching tool between nurses, where the more experienced nurse can add tidbits, or confirm findings of another nurse. It aids in nurse-nurse collaboration. I would highly recommend it for ICU/IMCU's.

If a patient is sleeping, the nurses will decide how important it is to wake them up. Most of the time we whisper report, and show what we can without disturbing the patient, or we'll show what we can, and then give report at the nurses station. I guess the viability of bedside reporting varies with what floor you work on. I can see less need for bedside reporting with less sick patients. We also varied whether we gave most of the report at the bedside or at the nurses station (and then popped in for a quick hello to the patient) depending on factors such as if they were about to go home, or, if the oncoming nurse knew them well already, etc. For some patients we did it fully at the nurses station only if we were absolutely sure the patient was doing fantastic.

Also, there's another active thread that's very similar, maybe it can be merged with this?

https://allnurses.com/forums/f8/bedside-face-face-shift-report-175915.html