Bedside Report...

[SheriLynnRN]

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.

[guest64485]

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

[Sterling'sAunt]

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.

We are rolling this out presently and we are encountering staff who are very uncomfortable with the process. I want to support them in any way I can but at this point I think it would be positive if I and the manager could talk to someone who has implemented this and had success with employee buy-in. Would you MeanDragonBrett or anyone else be willing to talk to me on a call? And how is that arranged on this site, I am new to this. Thank you very much.

[Mulan]

Hate to be cynical, but is this just another way for the hospitals to save money?

I have heard for instance, statements like it will save one rounding.

Maybe they are looking for a more economical use of the nurse's time and think that this will enable people to clock out on time.

(and maybe increase the patient satisfaction scores?)

[DebRN06]

They are trying to implement this at my hospital. Getting/giving report can already take an hour (sometimes more). Night Rns often have 3-4 day Rns to give report to and days can have 2-3.

There is no problem with the way we give report now. We are not stupid...when there is an issue (or many issues) with a pt most Rns already will go to bedside together after speaking at station.

I want to know how many, already doing this, have problems with pts "taking over" report. I could see that happening all the time. Or, because pct's have just started their rounds, (and haven't gotten to anyone yet) pts will be asking for water, call and order my breakfast, I need to go to the bathroom, pts will need to be cleaned...I can see a never-ending list of things like that, and if it is not done NOW, no-matter how trivial, Rn will be starting off their shift badly with pt.

[Sterling'sAunt]

There are many advantages to bedside hand-off. You can search the internet for "patient bedside report" and find may success stories. Nurses waiting for report to be over so they can go home and the report taking entirely too long is one reason.

How many times have you ever come out of report to find the patient not exactly as the picture you were given in report? How many times did you find the IV infiltrated, the foley not emptied, the patient in distress, some meds not given, pain not controlled etc.

Your eyes provide better understanding of what the patient is really like than your ears do. Staff satisfaction with shift report went from 20% to 88% at one hospital and how well-organized the shift report was went from 30% to 80% both in just 30 days.

During the first week's trial one of our patients said it made him feel secure.

You patients become included in their care. They can now review their medical record at any time during their hospitalization so why not talk to them about how they are doing? Why should it be a secret.

For years I listened to report thinking, I can read the Kardex myself so why do I have to listen to you read it to me. Just tell me what my patient came in for and what we are doing for them and how they are responding.

When a physician is in the room and asks for the labwork, do you tell him over the patient's bed? I would venture that you are saying yes, so if you will tell him over the patient why do we not tell a coworker nurse?

If the patient is going to pull you into something which will take a lot of time, you can say: I am going to take "Lydia" to meet her other 3 patients and then someone will be right back.

I would suggest assigning nurses to rooms beside each other for ease of movement for her and less traveling.

The main reason is to give time back to our nurses so they can be at the patient's bedside more.

[KaroSnowQueen, RN]

We did this at my last job and I absolutely hated it.

HIPAA was a big joke, as most of the rooms were semi-private, and there were always family members at bedside, especially at 7 pm. So then every body in the room knew everything about both patients. No matter how low you spoke, everyone still caught on.

You couldn't give info such as pt is clock watcher, family gripes continually, etc. And the teams were never assigned the same, so I would end up giving/getting report from never ever just one, at least two, sometimes three or four different nurses. It took for-freaking-ever to get through report and get checking my charts and doing my assessments.

I'm sure some suit in an ivory tower thought up this stuff. Maybe in theory its good, but in practice, I despised it.

[Sterling'sAunt]

We ask the visitors to please step out while we check on the patients. No more is said than would be said if the physician were in the room speaking to the patient.

I personally don't think we need to pass on as many "non value added"comments about our patients. If there are necessary items such as, "she will want her pain medication pretty much every 4 hours" then you can say that immediately prior to entering the room or after.

I can't say this is right for everyone. When things are rolled out with the very best intentions in mind for quality of care, giving staff back more time to be with the patient, staff and patient satisfaction etc, and if those things do not fit with some nurses style of nursing then one has to make the decision, do I adjust to these changes or do I find a place where they do not do those things that make me unhappy. And that's ok. We all have to be happy with how we provide care to our patients.

[Sterling'sAunt]

Update on bedside report.

I previously said we were just rolling this out and had encountered some staff who were uncomfortable.

Well we have rolled it out to 3 units. We had about 4-5 days of some being uncomfortable, the next unit it was maybe 2-3 days and the 3rd even less. We had some from the 1st unit go to the next unit and help them. The peer to peer conversion helped.

I have heard from several about how much better it is. One nurse said, I get into my patient's room quicker in my shift. Another said, it is so much better to see what the off-going shift is saying rather than just hearing it. One emailed me and said, thanks for bearing with me, change is not easy for me but when I am in charge I see this is going to be a positive change. One nurse got pulled to another floor that has not started it yet and said, please don't pull me to a floor that is not doing bedside report.

There was always overtime that the staff related to report, now they are done and out in 10 minutes.

We are presently looking at the steps to take at 11pm shift change when the patient is asleep. We also have things checked in the room at the same time. O2, foley (to make sure was emptied), NGs, TPN, PCAs, etc. We will work through those issues, but those are not difficult issues to work though. We also looked at how assignments were made. In order to save steps for our nurses, we started assigning the same nurse to the group of patients in rooms next to each other. So nurse 1 would report off to nurse 2 and both had the patient's in rooms 1-4. That could vary due to acuity though. I think at the present time the acuity might make it rooms 1-3.

We have had many questions related to HIPAA. This is no different than the physician talking in the semi-private rooms or the patients who happen to have come from the ED where they might have been in the ward with 7 patients with curtains. HIPAA has even eased up so we can call patients by name to go back to get their radiology exams. I don't really like that practice personally but the outpatient areas did not like calling out numbers. I don't like sign-in sheets either but they are allowed.

You can always get around HIPAA by asking the patient if it is ok, if you continue to question it. Or call your risk manager if you still feel uncomfortable.

At our hospital the ones who voiced this over and over were the ones who bucked everything we rolled out. They were the naysayers. I am not saying that there are not truly concerned employees as well. I am also one who will double check to make sure we are safe by rolling out new practices. I investigate in tremendous detail before I roll anything out and gladly give phone numbers or website addresses of the legitimate authority on the subject to anyone who questions it so they have their fears relieved.

What we have also said for years is that many, many times we do not need to pass on the judgments we have made about patients. I would prefer someone pass on information such as, "this patient will want her pain medication as soon as it is time". Unless it is documented in the record by a physician that the patient is addicted to a medication or comes in frequently with pain medication, who are we to say they are drug seekers? Also if you have a patient who has terrible chronic pain all the time and they usually take 2 medications at home and are then admitted to the hospital and we give them one and refuse to give them 2 because they are just drug seekers, you know what this patient will exhibit??? The need to have that one pain medication on time and would love it even before time but we have been so jaded over the years that we will not do that.

We as an industry do not take care of patients in pain well at all. Yes, I agree that the experiences we have related to "drug-seekers" has contributed to it. Also contributing to it are those who orient us to our hospital jobs and our peers. So leave it up to the next nurse to form her own opinion about patients unless, of course, it is information that will contribute to the patient's care by passing it on. The pith information is not necessary, maybe the patient will love the next nurse.

[november17, ASN, RN]

I'd find a different job if they tried to do that where I work. Waaaaay too many needy people.

That being said, it is a decent idea. I think it would help keep the patient informed of what the plan of care is and help the pt understand what you were doing "behind the scenes" on your shift to help them.

Otherwise, I just think it would take waaaaaaay too long to try and do. It is bad enough that we use the SBAR system.

[MrsMommaRN]

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.

:yeahthat:

It has been rumored at our hospital but nothing has come to play.

[canoehead, BSN, RN]

My favorite type of report was one I really thought wouldn't work. Our boss told us we weren't going to give report at all. Since everything significant is supposed to be in the chart we should read the chart and save face to face info for only the most complex patients. You need a really good Kardex that is well updated, and your charting will improve, but it was a faster and more thorough report because I got to go through labs and docs notes all at the same time. Seriously- I thought that idea would crash and burn but it worked well for our group.

[crabbybut]

These comments are very interesting. Why do some nurses have difficulty speaking about their condition in front of the patient? Should they not be involved in their own care plan? Would we not have better compliance from patients if they were informed about treatments, tests, and procedures? Also what right do we have to label patients as drug seekers, PITH's, and other derogatory terms? As a profession we need to clean up our own act. Perhaps the patients see some of us as PITA's, PITH's or whatever acronym they care to use. They may be correct.