bedside reporting

the reason i asked this question in the beginning was that it is mandated at our hospital and i have be drilled on it and called into supervisors office a few times and i just dont agree with it especially in semi-private rooms. as a nurse we are to give the best care at the maximum efficiency and giving an oncoming nurse a report that is simplyfied down enough that the patient and family can understand it is EXTREMELY time consuming. and on our floor where night nurse has 7 pt and day nurse has 4, which means that i have to give report to at least 3 nurses, will take if done per hospital protocol at least an hour.

and it may not be a hippa violation but i do not like giving out patient info with another person or family less than 5 feet away that can hear every word said.

We are trying to implement a new policy of the primary ED nurse for the patient giving bedside report to the primary ICU nurse of the patient when pt. is transfered from ED to ICU.

Here's the pros and cons as I see it:

+ Pro

* As others have pointed out, it's not a HIPAA violation (and with the individual rooms in the ICU, not a matter of consequence anyway). And bedside report doesn't have to include every blessed thing - use your nursing judgment!

* There are certain things which verbal (and worse - typed/faxed) reports cannot communicate with adequate gravitas. An example which instantly springs to mind is 'breathing patterns' (especially in kids).

* The patients are more involved in their own care. An added bonus is that they can see the transition from preceding shift to next shift - they'll have an easier pattern recognition of who is 'primarily' responsible for them.

- Con

# Time factor - nurses giving report are unavailable for other tasks/responsibilities. One method I proposed at my old job (but was never implemented/accepted) which might alleviate this problem to a degree was to stagger the "shift time" for aides and nurses - have the aides arrive 1/2 hour earlier for their shift change before nurses do. This way, at least the aides have an opportunity to go round on the patients, take care of comfort needs while also compiling a list of further pt. requests ("Mr. Smith in room 4 would like something for pain while Mrs. Jones in room 6 states she is still feeling nauseous" etc.) which the nurses can take into account when they round.

# Staffing factor (a related point to the Tim factor). Short staffing will be a major stumbling block to effective implementation of bedside reporting. Take my case at my hospital into consideration - RN providing care in the ED needs to accompany pt. to ICU for report.

Now previous to this new policy, whenever we were getting absolutely slammed in the ED, the charge nurse would designate any one of the PALS/ACLS certified nurses as 'transport nurse'. Upon receipt of confirmation that pt. has been readied for transport (report called to ICU nurse, pt. hooked onto portable heart monitor, RT called/present to accompany intubated/ventilator/CPAP-BiPAP pt, and aide present to help transport pt.), the 'transport nurse' would print the chart and transport pt. to the ICU while the primary ED RN would proceed to immediately receive the next patient from EMS/Medics/waiting room in the now vacant treatment area/room.

While this would work with adequate staffing and/or manageable pt. volumes - it presents a huge bottle neck when the ED is packed to the gills or if ED is shirt staffed. Because now the primary nurse has to accompany the pt. to the unit, that nurse's partner is responsible for the remainder of the primary nurses patients. If the primary nurse is transporting a very critical/difficult patient, said nurse maybe gone for over 20 minutes. That's 20 minutes that the partnering nurse would be responsible for double the patient load (up to 8 - sometimes more patients). Also, the aide assigned to that section of the ED will also be unavailable due to transport to the ICU.

Even if such a scenario were to be somehow manageable, the newly vacated treatment room/area cannot be assigned another patient from EMS/Medic/waiting area (because now that section of the ED is short two members of staff - the RN and aide who are doing the transport). This particularly isn't a new issue - but I'll elaborate upon request.

Conclusion:

I think bedside reporting is a great concept - provided staffing can be adequately provided and managed.

cheers,

**********A VIEW FROM A PATIENT**********

I have only ever had bed side report done once with me being the patient. It was when I was having an endoscopy, the 3 procedure room nurses were recieving report from the pre-procedure nurse.

I really liked it. I was aware of what was happening, and it made me feel good that she warned them of certian things e.g. "It took me forever to get that IV. If anything happens to it you are going to need to go in her foot and she is needle phobic so gard that IV with your life".

The bedside nursing also opened the door to the fact that, the nurses that were going to be in the procedure room with me, asked me questions of things that were unclear. I liked that. They were not just there talking about me, but included me in it. If they did not fully understand something in the history they asked for a little backround info.

However, I could see, if they did not include me like that, it being very akward for the patient. To have these (on the ward it would be 2) people just standing over them talking about them. Therefore I think if bedside reporting is going to happen it would be important to inculde the patient in delivery of information.