Bedside Reporting

[sydylo]

Does anyone give report at the bedside? Our hospital is starting this, and I just don't understand the point.

[cheshirecat]

I work on a ward with 4 six bedded bays, and 8 siderooms. We give report at the end of the bays. It is a bad idea as far as I am concerned. There is no privacy at all and if there is any sensitive information to be given, we end up whispering it as we do not want everyone else in the bay to know.

This could mean information is missed/missheard. The directive to give bedside reporting came from our Director of Nursing. I suggest she gets her hands dirty for a change and see how unworkable this kind of reporting is on an open ward.

Right, vent over, time for the glass of wine I have been promising myself as my hubby prepares the bbq ( we have lovely weather over here for a change).

[Ayvah, RN]

My hospital does this. I think the point is so that we can both eyeball the patient and look at dressings/ask questions and the patient can interject information and feel like more of a part of their care team.

If there is information that would be awkward or inappropriate giving in front of the patient/family, we share it prior to going into the room.

One of the benefits that I have seen for myself is that when we do bedside reporting, I no longer have to take the time to "eyeball" my patients and their fluids at the start of the shift. Being able to see things about the patient and ask questions is nice too. Also, any immediate problems the patients have can be solved by both nurses collaboratively.

[KulRN]

when we first heard of doing bedside reporting (SBAR), most of my colleagues were against it and some (seasoned nurses) were very apprehensive about it and most of the time "don't do it". But believe me, it's for your own benefit and as well as your patients. I have learned my way (the hard way), the nurse I followed did not want to do it and we did our reporting outside the patient's door ( we can still see the patients but not clearly because lights were off because patients are still sleeping..I work days). All the reports given to me she did not mention that one of the patients is not in great shape and just basically told me that all the patients are stable, so I did not have any concern. After the reporting I went to check on my meds/ labs/orders and started assesing my other patients (I had 8) report ended at 0730, come 0855 my CN told me that one of my patient's coding...When I looked at the nurses documentation, she had mentioned that at 2100, patient had coughed up thick brownish sputum and lungs were wet and O2 saturation on 2L was only 88% (nowhere in her chart that she mentioned that she had increase the patient O2 (patient is not a COPDer) and notified the MD...all the intervention she did was "encouraged the patient to DBC", even when a Doctor came 2 hours later to check on the patient, nowhere in her documentation that she had mentioned it to the Doctor or at least reassesed the patient, her documentation ended at 2100, nothing followed. So it's really, really important to do bedside reporting even if you've known the patient the previous day, as patients condition can change any time. I don't want to judge this nurse ( I don't know what happened during her shift), but maybe if this was corrected right away, we could've saved the patient. Now since the patient coded on my shift within 1 hour and 20 minutes of my shift, I'm still beating myself and sort of blaming myself...that I should've pushed that nurse to do her reporting at bedside...so from now on, I WILL!!!!! If the nurse I'm following is not up to it, they I will just have to report it to the unit director or I will not accept my assignment. And I also found out that this patient's CO2 Level was so critical at 11, blood was drawn at 0430, lab did not report it until 0730 AM ( I did not get the report, then night nurse did and she called the MD and gotten an order for 1 amp bicarb.....I found the lab and order at 0745, checked the medicine but not available yet so I called the pharmacy and told me that it's being prepared..somehow the order was not scanned as a STAT! order)....So another thought came in my head that this poor patient has been deprived of CO2 from 0430 until he eventually coded...or maybe even way before that especailly if the patient was already experiencing wet lung sounds begininng at 2100....he was already drowning). So many thoughts....so many what ifs....SO PLEASE DON'T THINK OF BEDSIDE REPORTING AS A PUNISHMENT OF SOME SORT BY THE MANAGEMENT...JHACO WOULD NOT PROBABLY ENFORCED THAT IF THEY THINK IT'S A WASTE OF TIME......VERY IMPORTANT! Just wanna share this with all of you so that we can not only protect our selves and our license but most especially our patients.......

[RNperdiem, RN]

Sometimes I will do a "show and tell" at the bedside after I have given report at the nurses station.

Complicated wounds, multiple drains and certain unusual equipment is easier to show the nurse than to explain. I guess that counts as bedside report.

The nurses station is where you can report things like "she is HIV positive and hasn't been told that yet". or " her baby died in the accident and her family does not want her told yet."

[SweetOldWorld, BSN, RN]

We've been doing bedside reporting for a couple of months now, and I have to tell you that the response I've gotten from patients has been overwhelmingly positive. They really like it and say it helps them understand what's happening and what the plan for their care is. They also seem to have more confidence in their nurses. I often hear comments like "I never understood why you were doing that before, but now I do." Just my own anecdotal evidence, but I think it's made a difference for the better on my unit.

[EmerNurse, BSN, RN]

Bedside reporting also gives the off-going nurse a chance to say good-bye and the on-coming nurse to introduce herself. The patient feels like their care is being continued, rather than an abrupt change in faces at their bedside.

That said, if you have to get report from more than one nurse, it can get a little hectic. As was said above, we give sensitive info before going to the bedside. So, to the patient, bedside report seems like more of an introduction/good-bye thing, rather than a running list of issues at the bedside.

We were also told that bedside report was so that the on-going nurse could make sure things were done before the off-going nurse left (due to c/o the "last shift didn't do XYZ". We were told if we found things undone that should have been done, the off-going nurse should do it. Right.

All in all, it's not too bad... usually.

[BrnEyedGirl, BSN, MSN, RN, APRN]

We tried it,.everyone hated it,...it took to long,..if I came in at 1830 I might need to get report from 3 different nurses!!,...there was a huge privacy issue as well,...I think the idea of the pt being involved and interacting is great,.but durring shift change/report is not the time to explain, again, why the Dr ordered a low sodium diet, or why meds are given at 0700 when "at home I always take the three white pills at 0600 and the blue one, the green one and that long pill I take at 0930",....we even had pts over hear the report for the roomate and ask "why is Mr Jones taking XXE$@ for his blood pressure?? I haven't tried that,.do you think it might work better?",.. it was just a mess,.we quit doing it.

[RNsRWe, ASN, RN]

Does anyone give report at the bedside? Our hospital is starting this, and I just don't understand the point.

Our hospital does not do this, and won't from what I've heard. Frequently the information given is not even something the PATIENT should hear; if there's something that has been told to us but NOT told to the pt (that the MD will discuss later, etc) then we obviously cannot discuss that in front of said patient. Additionally, the specifics of what's under each dressing is not something the patient usually WANTS to hear. Beyond that, passing on to the next shift that the patient has been banging on the bell for narcs every hour, be aware, or that the patient is an Anxiety Puppy, or that she is the daughter of So-and-So VIP, watch for PITA Syndrome, is not for the pt's ears either. How often have I heard in report: "don't call Dr. Thisandthat for Patient X; he won't give her anything else, don't you dare bug him about her again unless she's ACTUALLY dying"?

If we gave only factual information that you'd find in the documentation section of the chart, none of the other useful information but not crucial, then it's still a privacy concern: these are almost always semi-private rooms, meaning that the OTHER patient can hear, and the other patient's VISITORS can hear. I don't care if you're standing outside the room during this; patients and visitors are around every corner, good luck hiding from them to guarantee a private discussion in a hallway.

Next, from a practical standpoint: the nightshift leaving gives report to the outgoing charge to give to dayshift. We don't EVER have ANY hope of doing rounds with the oncoming nurses; if I had nine patients last night and I have to give report to three oncoming ones (since the assignment will invariably be broken up) I would have to wait until each nurse is ready to get MY report, as they'd be getting from others as well. Who has an hour or more to hand off report?? As it is, dayshift nurses usually don't get out of the report room until 8 or 8:30 (even 9!!). I sure am not going to stay two hours after my shift ends, thanks.

Same for evenings: I come on at 7pm, and have taken report from two nurses frequently. It's hard enough to get together and go over what we need to at the nurse's station, let alone all of us running criss-cross around the unit to do this at bedsides (with visitors, etc all over the place).

No, not doing it, don't see it ever being instituted on our unit.

[Daytonite, BSN, RN]

i've worked in several facilities that did this. they called them "walking rounds". i never understood nurses that felt this was an inconvenience to them. we are, after all, there for the patients and should be involving the patients in their care. having been a patient several times in the past three years i have to tell you that i was really surprised that most of the rns never took the time to introduce themselves or even let me know that they were my nurse for the day! it is not at all very pleasant to feel like an object and a problem in someone else's day. i have to wonder why nurses who treat patients like that became nurses in the first place. they certainly don't seem to have any compassion at all.

a bedside report is one way that managers have found to solve the problem of sit down reports that are filled with unimportant information that goes on and on and on. they also solve the problem of some nurses that habitually leave things undone for the oncoming nurse to deal with. during a bedside report, or walking rounds, iv levels can be checked, dressings can be quickly inspected, and patients can be queried about what has gone on with their day. patient focused problems such as dry iv's and treatments and orders that didn't get carried out can get identified and a plan of action developed immediately. those slacker nurses who tend to conveniently dump the oncoming nurse with all their unresolved problems get identified, called out and confronted on the spot with this kind of report.

this is not the kind of hand over report where it is appropriate to gossip about the patient or the doctor or relay personal judgments. statements about a patient being a pain in the butt, constantly ringing their call light or what an sob their doctor is are usually given as judgments and have no reason to be repeated in a report. if a doctor or patient's behavior is a concern then it should be addressed--tactfully with the doctor or patient, not gossiped about among the nursing staff. i didn't do this when i was a staff nurse and i stopped it if i heard it going on among the staff nurses when i was a manager and i sent a couple of nurses who insisted on continuing to do this for inservicing with the nurse educator. behavior problems, particularly patient behavior problems, are something we all should have learned how to deal with in nursing school.

[medchick]

We do bedside reporting but don't have the issues with patients listening in as it is a NICU. We also restrict visiting hours during shift change. No visitaton allowed which gives the nurses the time to prepare themselves and allows for the privacy of the other babies in the area.

[jjjoy, LPN]

Except for a those very difficult patients, nurses should be able to politely curtail those patients who tend to go on and on when you need to get on with things, so that shouldn't be a reason not to do bedside report for most patients.

In regard to privacy, HIPAA does allow that uninvolved may overhear private health information at times and that health personnel neednt' turn themselves inside out to avoid anyone ever overhearing anything about anyone else. Patient safety and clinical effeciency also matter. Of course, if there's a sensitive situation or a patient has made a specific request, then you can take extra precautions but otherwise, it shouldn't be the end of the world if someone sharing a room with someone overhears something. So that shouldn't be a reason not to do bedside reports for most patients.

Finally, having the patient right there can be a real benefit. You can get a mental picture of a patient from a verbal report (LOL with IV in L antecubital, dressing to R foot...) but what a better picture if you can actually see the patient! And no surprises like finding an already infiltrated IV or dressing change that hasn't been done, only after the previous nurse has left.

(Just for the record, while I pointed out that these aren't good reasons not to do bedside reporting in general, they might be in some cases.)