Bedside Report

[Mr. Murse]

I'm wondering if anyone else thinks the incessant push by unit managers to do a "bedside report" is ridiculous (I assume the facilities I work at are not the only ones doing it).

Don't get me wrong, I fully support the idea that both the nurses coming and going should visit each patient together before one leaves, but it's the push to actually do the full report at bedside that's just a good intention gone wrong. On many floors and ICUs the manager intentionally makes a round during shift change to nag and enforce this petty and unnecessary policy.

I understand the intended purpose, I really do, but inevitably bedside reports become unnecessarily long as the patient and family want to chime in about their great uncle who had really bad hemorrhoids or their friend whose cat just had kittens. Even if you manage to keep it on track, bedside report is a waste of everyone's time in my opinion.

Just let the nurses report in the hall or at the desk, then round through every room to visualize the patients, then move on with the day.

I know I'm venting, but surely I'm not the only one annoyed by this?

[Journey_On, BSN, RN]

Also not a fan of bedside report. I understand that it helps keep the patient involved in their care, but it takes up more time. And I am often leaving past my end time most shifts.

[Wade21, ADN, RN]

When we did bedside reports, it was part of a plan for the hospital as they worked towards Magnet status.

I think its ridiculous, too

[explorereb96, ADN, BSN]

Well I think for at least 6 months we should ALL do it and do it like they want us to,  When it starts costing them exorbitant amounts of money in overtime they will b*tch about it.   Then we can all chime in together to say, "well, lets just INVESTIGATE just where all this overtime is coming from...."  The only thing they understand is money.  Once WE as nurses understand that those bean counters really don't care about anything else....just the bottom line, we can find a way to make it hurt enough where they push legislation against certain regulatory processes.  We can protest all we want, but if we don't hit em in the pocketbook, they won't listen.  They are the only ones with the power to try to make change in regulation. 

[Tweety, BSN, RN]

13 hours ago, explorereb96 said:

Well I think for at least 6 months we should ALL do it and do it like they want us to,  When it starts costing them exorbitant amounts of money in overtime they will b*tch about it.   Then we can all chime in together to say, "well, lets just INVESTIGATE just where all this overtime is coming from...."  The only thing they understand is money.  Once WE as nurses understand that those bean counters really don't care about anything else....just the bottom line, we can find a way to make it hurt enough where they push legislation against certain regulatory processes.  We can protest all we want, but if we don't hit em in the pocketbook, they won't listen.  They are the only ones with the power to try to make change in regulation. 

I think some facilities have been doing it long enough to show increased patient satisfaction and not "exorbitant amounts of money in overtime".  Clearly they would have stopped it if this were the case.  My facility has been doing it for years.  (Like I said there is a lot of disobedience lately as nurses ignore what management says).   

What keeps me late is the insane amount of charting and having horrible RN to patient ratios, bedside report is just a blip in why I have to stay late some days.

[Guest1144556]

Having spent a considerable amount of time doing researching patient handoffs and the best practices associated with it, the research shows that the quality of patient handoffs is higher when the handoffs are performed at the bedside and when the format is standardized (sbar, isbar, ipass, shape, etc).

I remember reading an article stating something along the lines of that up to 80% of communication-based medical errors are a result of non-standardized handoffs. Whether we realize it or not, patient handoffs are a big safety issue that several regulatory agencies have tried addressing for almost 2 decades now. The difficulty is getting everyone on board - using the same standardized system (sbar, ipass, etc) and doing the handoff at the bedside. It becomes frustrating when there isn't a united consensus and everyone just kinda does their own thing.

I totally get it can be annoying doing the handoff at bedside as many have already mentioned, but sometimes the right thing to do can be annoying...

[SHH, BSN]

Anyone remember taped report on the old tape recorders?

I miss that. No questions ?

[JKL33]

nurseguest1 said:

Having spent a considerable amount of time doing researching patient handoffs and the best practices associated with it, the research shows that the quality of patient handoffs is higher when the handoffs are performed at the bedside and when the format is standardized (sbar, isbar, ipass, shape, etc).

This calls for citation.

nurseguest1 said:

I remember reading an article stating something along the lines of that up to 80% of communication-based medical errors are a result of non-standardized handoffs. 

Which really is a separate issue from location of hand-off.

nurseguest1 said:

Whether we realize it or not, patient handoffs are a big safety issue that several regulatory agencies have tried addressing for almost 2 decades now.

I have not done the research that you have done. But common sense would suggest that, if one is not coming at it with a particular agenda (such as appearances/patient satisfaction), bedside hand-off could be considered a "safety issue" in and of itself, for the interruptions alone. How many "now where were we?" constitutes a "safety issue?"

nurseguest1 said:

I totally get it can be annoying doing the handoff at bedside as many have already mentioned, but sometimes the right thing to do can be annoying...

My observation has been that 1) Admin will want something for their own reason 2) they will look for ways to legitimize it and for ways to belittle the plain-as-day obvious concerns about it 3) they will refuse to provide the resources that could allow the thing to work in an at least reasonable manner 4) it doesn't accomplish its purported purpose because of #3 5) everyone feels confused/angry/like they are living in alternate reality because the thing they are told to do is never going to accomplish anything but continues to be touted as some great and very important thing that only those who don't want to "do the right thing" would ever "complain" about.

That's how this goes. It is probably scientifically reproducible.

 

[klone, MSN, RN]

LovingLife123 said:

They aren't.  When you work 3 12 hour shifts that's 36 hours.  Say you are 7-1930 and the next shift is 1900-0730 that's thirty minutes for report.  Even if your report takes 90 minutes each shift, you would still only be at 39 hours…….

Probably. already addressed, but if you are working greater than 12 hours in a shift, you will get OT for that, even if you work less than 40 hours in a work week. Depends on the individual work rule. Some work rules (or some state laws, such as in California) pay OT for anything over 8 hours in a shift. But I'm pretty sure ALL states require that the company pay OT rates for any time over 12 hours in a shift..

Been there,done that said:

Bedside report is a HIPAA violation. Unless it is a private room. Report should not be given in a hallway or at a desk. Anybody could over hear the information. I am surprised the powers that be don't consider that.

That's covered under "incidental disclosure" and is not considered a HIPAA violation. If it's a shared patient room, people are allowed to discuss the patient even if other patients are in there, they just have to make every effort to be discreet.

[klone, MSN, RN]

Okay, a few things now that I've read through the whole thread. When I was an inpatient manager (and yes, I always came to work no later than 0645 so I could participate/observe report - how do you know what's happening on the floor or what issues night shift is having if you aren't there to talk to them?), my requirement was what many of you describe here - go in together, lay eyes on the patient, look at IVs, wounds, bleeding on the chux (postpartum moms), pump settings TOGETHER. It helps discover a LOT of issues, and for lack of a respectful way of saying it, helps pinpoint fault if *** has gone sideways (such as a newborn's infiltrated IV, or Pitocin being administered to the floor instead of the person, or a postpartum woman who is lying in a bed full of blood - all things that have been caught during the handoff). Other than those things, I don't give a flying *** where you guys talked about psych-social stuff and the things you don't want to say around the patient.

Just another example of people not doing the job, telling the people who do  the job how to do their job, and it being wildly unrealistic.

[klone, MSN, RN]

https://www.ipfcc.org/bestpractices/HIPAA-Factsheet.pdf

 

Concerns: In rooms with multiple beds, does rounding or change of shift at the bedside (in earshot of other patients) violate HIPAA rules or Joint Commission standards? How do we ensure patient privacy when interacting with family members?

  HIPAA allows for normal hospital and physician operations. Clinicians are freely allowed to discuss patient care for treatment purposes, and conversations may take place with patients and designated family members, unless the patient
objects. Consider that, in multi-bed rooms, patient health information is commonly/frequently shared in ways that could be overheard by others in the course of providing care (for example, a nurse may comment to a patient on her blood pressure, or a physician may discuss discharge plans with a patient).

  HIPAA is intended to support greater patient control over their health information, and the sharing of patient information to improve care and safety. Participation in rounds or change of shift reports allows patients and family members to take greater control over their health and health information by: (1) learning about the patient's condition, medications, treatments, symptoms, and problems to look out for, and (2) providing additional helpful information to providers.

  There is nothing in the Joint Commission standards that prohibit rounding or nurse change of shift report at the bedside. In fact, the Joint Commission has expressed explicit support for family involvement.

 

[chare]

klone said:

Probably. already addressed, but if you are working greater than 12 hours in a shift, you will get OT for that, even if you work less than 40 hours in a work week. Depends on the individual work rule. Some work rules (or some state laws, such as in California) pay OT for anything over 8 hours in a shift. But I'm pretty sure ALL states require that the company pay OT rates for any time over 12 hours in a shift..

[...]

Not necessarily the case.  While some states, as you noted, pay overtime for hours worked in excess of a designated length, the Fair Labor Standards Act defines overtime as >40 hours per week.