Bedside Report

SassyTachyRN · Feb 27, 2015

Well, I looked through the material last night, and it addressed all my big concerns. We are not to wake sleeping patients unless they have specifically asked to be awakened for report. It's not a HIPAA violation as it is necessary communication in the course of our duties( we are to ask the patient if visitors can stay during report.) It specifically said not to put the other nurse on the spot in front of the patient( I doubt that will prevent it but since it is addressed in the material, I can point at it later when my coworker starts being obnoxious.) and I guess the goal is to sanitize report, to "keep it clean" instead of gossipy.
The scripts are atrocious though! They want us to say, "this is your RN so and so and I've worked with her 6 years. You'll be in great care!" What if a nurse is brand new? "I've worked with Nurse So and So for 2 days."

Something we did was ask everyone in the room to leave so we could do bedside report. If the patient wanted people to stay they would usually request that they stay or ask if they could stay. This takes the pressure off the patient, instead of saying do you want your visitors to step out? Then the patient feels on the spot and guilty for making people leave so they let people stay even though they really don't want everyone knowing their business.

PacoUSA, BSN, RN · Feb 27, 2015

I feel very uncomfortable with bedside report. As a patient, I would not want a nurse outlining my medical history within earshot of my roommate. I would not agree with it as a nurse either. Do full report outside of rooms and then round together after. That is the best solution!

seanynjboy, BSN · Feb 28, 2015

We did bedside report on the floor the patients (most) LOVED it. It gave them a chance to be a part of their care and have a small sense of what will be going on during the day and a recap of what happened. It has happened a few times to where the patient also reminded me of something to tell the nurse coming on to.

I worked the night shift and one of the things I used to ask the patient is whether or not they wanted to be disturbed in the morning for bedside report. Most wanted to be woken up for it. Every now and then a patient declined and we did report outside of their room.

I personally liked bedside reporting.

Wrench Party · Feb 28, 2015

It's not so bad when implemented- I've worked on units that utilize it. You can get about half of your assessment done through a quick visual (VS, dressings, IV drips, problem areas on the patient), get the patient involved and set up a game plan for care, and also cuts down on the "you didn't do ___ before shift change" because you can't exactly fight in front of the patient.

Bedside also cuts down on the chances of getting a patient drastically different than the one you imagined in report.

MECO28, BSN, RN · Feb 28, 2015

Oh no! No My Chart bedside! I can see this coming to my hospital; it's just the kind of b.s. our administrators would eat up with a spoon. On my particular unit this would be a total nightmare and I could so see it happening. And if it does I will quit hospital nursing and find a clinic job. :nono:

mandy13086 · Feb 28, 2015

It has its positives anf negatives. It does in fact take longer to give and get report, especially when you are waking the patient up by just walking in & they ask to be taken to the bathroom (I work at a hospital in a primarily elderly area). Or when you may have to explain things in layman's terms instead of quickly going thru in medical terms. However, it is a good thing when patients have had surgery or have some kind of wound-especially if things aren't healing right..so u can lay eyes on it with the offgoing nurse, who can say it looks better/worse/unchanged..so i can let the dr know. & I've had it happen where a patient was stable, no issues the day before, we did bedside report and the nurse saw he was ok..but not long into her shift, he had drastic changes & i transferred him to ICU the next morning. It definitely has its uses..and it can help us as well..but it still is often quite time consuming. I imagine nearly every hospital will eventually be doing it. But having it so patients can text the nurse? Bad idea...constantly ringing cell phones with docs, techs, family members, telemetry, UC's, transport...etc is already too much some days..I can't imagine having my patients constantly text me.

sistrmoon, BSN, RN · Feb 28, 2015

Haha, guess who got asked to be one of the core staff who validates the new bedside reporting? This girl right here! They may have mistaken me for an eager beaver because I did the reading on it so quickly.

I'm not sure what it entails but I was told it would be during my normal work hours. I'm hoping I'll be out of an assignment(I can dream) and will just listen to everyone's report. You can bet I won't be enforcing those horrible scripts.

dudette10, MSN, RN · Feb 28, 2015

As a patient I like the idea of My Chart Bedside. It would make me MORE independent. Instead of having to ask the nurse what my labs were and how do they compare to yesterdays labs, I could just look If I forgot the name of the abx that I'm getting, I could look instead of bugging the nurse
As far as elderly patients not being computer literate you might be surprised. My 93 yo uncle is very computer literate building complex excel files to analyze and track stocks, sending emails, posting on facebook to reconnect with old school friends, etc. My 83 yo dad is very computer literate - setting up his own wireless home network, doing excel, word, email, etc. The senior generation I know is pretty computer savy.
As a patient I would love the ability to text my nurse. About the only time I called the nurse was to request pain med. I'd always call and ask that the nurse bring my pain med when it was convenient or when she was coming this way. I always called when the pain was starting to come back but before it became excruciating. As long as I got the pill in the next 30-45 minutes, I'd be fine. I'm pretty sure that when the request was passed on to my nurse it was passed on as Room 1203 needs her pain meds now, because the nurse always brought them in minutes. If I texted, I could say pain beginning to return. Can you bring pain med when it's convenient.
I think most people see test messaging as something that gets answered at the receivers convenience. If you want an immediate response, you phone someone. Maybe patients would understand that the nurse will respond to text messages as her duties permit.

I don't see a problem with providing that information...the problem comes in when patients can't interpret the information. Labs are interpretive, which is the reason I don't give out the lab values. Instead, what doctors do is say, "You are dehydrated," "We are concerned about your liver," "We are concerned about your kidneys." Trends can also be misjudged. A person with a GI bleed that's been treated may have varying Hgb from one day to another, but if GI has already done an EGD and colonoscopy with interventions, "stability" could be misjudged by the patient.

If that lab value is red (it's out of range), how will the patients interpret it, especially when they are being discharged?

What about when nurses cluster med timing? Will patients freak out 59 minutes after a med is due? Will our judgement be questioned, when, from a medical and nursing standpoint, our judgement is rock solid?

I'm all for patients understanding their own conditions and what we are doing to treat it, but providing them raw lab values isn't the way to do it. In addition, the accrediting bodies require that written patient education be provided at the 8th grade level, so does providing raw numbers for labs make any sense at all?

firstinfamily, RN · Mar 6, 2015

When I returned to my acute care facility this was in place, at first I found it a little intimidating, but now I am use to it. The white boards are updated every shift and giving the pt information about their tests, current status, discharge plans does make them feel more empowered and participants of their care. It does seem to lengthen the shift change and I usually have to add another 45 minutes to my clock out time. It does help when I am following the same assignment in consecutive shifts.

icuRNmaggie, BSN, RN · Mar 6, 2015

Bedside report is very good for building trust with the patient. Ask visitors to give you some privacy during report.

Put yourself in the patient's shoes and remember that we base what we do on this simple idea:

Say nothing about me without me.

ArtClassRN, ADN, RN · Mar 7, 2015

Love beside report. Won't do it any other way. I get a ton of assessment data just by talking to the patient. Even when the nursing giving me report refuses to participate, I just start asking the patient questions, forcing the outgoing nurse to jump in. After the report, I use the information gained to focus my workup of the patients. It's a huge time saver and helps me prioritize the start of my shift.

The culture on my floor is to refuse to implement any change and see what happens. So far, the anti-bedside report contingent is winning.

Oh well.

ShelbyaStar · Mar 7, 2015

I haven't read the whole thread yet, but clicked on it since we've been discussing this in class. I'm under the impression that a lot of the movement has come from my state since Mayo started implementing it and had good results.

The messaging sounds ridiculous at first, but then I can actually see how it's helpful. Instead of a pt using their call light and you going in there only to find they just want water, they can message you with the problem so you know what exactly it is that they need. You know if it's something you can delegate or if it's something you need to bring supplies for. I can see how it would actually save time, just as long as you aren't actually expected to message back...

I also think it would be helpful if there was a menu of specific things they could say and they could only do it once, so that you aren't getting constant messages of WHERE'S MY COFFEE when you have more important things to do. Maybe they could get a popup saying "nurse has viewed your message", too.

People abuse their call lights, how is abuse of messages any worse? At least now you know what it is that they want and it can help with prioritization.

Overall I can see some concerns but can mostly see how bedside report would be helpful. How often do you go in for care and feel like the changing staff has no idea who you are or what you're in for? I do, especially when I'm asked the same questions 10 times.