Bedside Reporting

Psychtrish39, BSN, RN · Oct 7, 2010

I wish they did this in long term care but as stated above with an eyeballing no major HIPPA violations would be good... no surprises like I get left with and I used to do a first round thing myself with my only 8 to 10 patients I used to have when worked acute care and I would take a look see and introduce myself it helped alot but I dont know how it would work in LTC with 20 to 28 patients a shift... just my :twocents:

SweetPEI · Oct 7, 2010

:twocents: I'm not yet a nurse (soon)... but I figured I can give my two cents...

My facility implemented bedside reporting as well and at first we hated it. It just wasn't the thing to do on a pscyh unit. We used to record report so by the time the next shift would come on we would cover the pts while they went in to listen (we have a 30 delay on our shifts i.e 8 1/2 or 12 1/2 hr shifts). I actually hated this method because if there was something that you had to ask about a perticular pt that his nurse forgot to mention in the recording, they were already gone. Eventually we switched to having report where each nurse would come in individually to get report from everyone on the next shift. That worked out nuch better (at least for me because there was time to voice questions or concerns while the person was still physically there. Finally, beside reporting was implemeted and we had all thought it was a joke. Honestly, we did. Can you imagine giving a report about a paranoid schizo when they're right there? Do you think they would have just stayed still and say, "Oh you guys are just changing shifts... no problem"? I think not!!! Or how about if you're giving report about something that a roommate shouldn't hear? Well, we knew we had to do it and at the same time be professional and repect our pts confidentialtity. So, we tweaked beside reporting in a way that would work. We still have report at the nurse' station and then each nurse/mental health tech would go around with the next shift's staff and visit each pt (more like search for each pt) and let them know that if they needed anything they should direct their concerns to the nurse for that shift. At the same time, that created a time specificly for the exiting shift staff to bring up any concerns they might feel the need to pass on and answer any specific questions the entering shift had to ask. The great thing about this is that it has resulted in more communication between shifts and less errors direclty related to lack of communication.

My thoughts: bedside reporting stays!!!! You just have to find a way to make it work for you...just like everything else in nursing.:igtsyt:

SweetPEI · Oct 7, 2010

Sorry for the typos

OttawaRPN · Oct 7, 2010

I prefer what you're calling "bedside reporting" as is also known as "Walking Rounds" in my neck of the woods. No; you don't stand in front of God and Zeus spewing out the most intricate details. Once a person has it down it's actually quiet easy.
In my experience most of the reporting/exchange of info happens while walking the halls and then going in to see if all is well. You could also do a short summary exchange prior to the actual eyeballing. Here's an area where you need to use your common sense skills. Carry a clip board to take notes. This type of report lets you see the patient first hand and ask questions right there as opposed to doing rounds after the other shift leaves and you find (as it inevitably happens in many cases) not all is as reported. I believe you'll be pleasantly surprised.

Maybe I wasn't clear. The purpose of this bedside reporting is to promote explicit transfer of accountability and enhance patient satisfaction by promoting nurse-patient communication... ergo ALL communication takes place at the bedside including plan of care, past hx, complications, shift orders, consults, system assessments, etc. as well as patient questions/concerns. Any communication during "walking rounds" defeats the purpose and is not acceptable. This was not designed to assist the nurses but rather increase patient involvement. So definitely no pleasant surprises yet!

Ruby Vee, BSN · Oct 7, 2010

one of my facilities recently implemented a mandatory "bedside reporting" protocol which has created a lot of chaos and bad tempers.
my issue has and always will be the breach of confidentiality. we are not allowed to discuss patients in elevators and cafeterias but can do so in a ward room with 3 other patients (and sometimes their families) eavesdropping?
then there's the time management factor. administration says "2 minutes max per patient." my a$$. when patients start asking questions, it's more like 20 mins.
not to mention that there is often information needed to be passed on that is simply not suitable for patient's ears. this is a reality, but maybe less talked about, fact of nursing.
so far it's a pilot project to be evaluated after a trial period. can't wait for it to be tossed out the window!

i feel your pain. my facility is initiating this starting next month -- and they want us to quit using our "brain sheets" because "everything you need will be in the computer." balderdash! i don't remember anything i haven't written down. once i write it, i rarely have to look at it again, but i do have to write it down. nevertheless, our policy is to be no more brain sheets.

have you brought up the confidentiality issue? i would think they'd at least have families exit for report -- especially if you have more than one patient in a room. if you turn your backs to the patient, talk softly and stare at the computer screen it will discourage most patients (unfortunately not all) from butting in. and those that it doesn't discourage will often be discouraged by you saying "mr. jones, i'm giving report to the next shift. i'll be sure to answer your questions as soon as i'm finished, or betsey here will help you with that when we're through." but there are some that are going to try to butt in no matter what. sometimes ignoring them works -- then just pretend i was concentrating on report so hard i really didn't hear them. of course, depending upon how "with it" and/or how entitled they are, that may or may not work.

good luck -- keep us posted. i want to know how it goes so i can marshall my own arguements when we start next month!

tyvin, BSN, RN · Oct 7, 2010

Maybe I wasn't clear. The purpose of this bedside reporting is to promote explicit transfer of accountability and enhance patient satisfaction by promoting nurse-patient communication... ergo ALL communication takes place at the bedside including plan of care, past hx, complications, shift orders, consults, system assessments, etc. as well as patient questions/concerns. Any communication during "walking rounds" defeats the purpose and is not acceptable. This was not designed to assist the nurses but rather increase patient involvement. So definitely no pleasant surprises yet!

I believe you are shouting (is that what the caps mean?) I call unessessary roughness. I haven't met anyone who takes it to such an extent. Nurses are capable of implementing this without having to resign themselves to exactly what management says.

Sorry this has turned into such a conundrum for you.

lkwashington · Oct 7, 2010

The main reason why we do bedside reporting because oncoming nurses have found their patients in a bad situation such iv infiltrated, ivf bags empty, iv catho out of place and patient bleeding from site, and making sure the safety of the patient is maintained. I am sure there are others.

Sparrow23 · Oct 7, 2010

I love bedside reporting. Our hospital too has recently initiated this and I have to smirk when I see so many nurses all in a huff about it. First of all, you don't have to do the entire report in front of the pt (and whoever else may be in the room). Go in the room, introduce your pt to their oncoming nurse and do a brief overview - e.g. "as you can see, so-and-so has a foley, a dressing to that leg which is c/d/i, is on oxygen at 2L, an iv to this arm that was just placed this shift, and oh look, they are going to be needing a new bag of fluids in about an hour, and, as you can see by the IVPBs hanging, they receive these medications." I use what can be plainly seen as a guide and use the time to give the pt any brief updates. Then tell the pt the oncoming nurse will be back in a little bit and ask if there is anything they will need at that time. As long as you make it clear to the pt that this is just a brief introduction/overview and that the nurse will be back soon for the actual assessment etc., it shouldn't take more than a few minutes. Go through any sensitive details in quiet voices when you are outside the room. Pick and choose what info you feel is appropriate to be discussed in front of the pt and whoever else is in the room.

Why I like bedside reporting:

- Makes the pt feel better. They feel involved in their care, they are introduced to their next nurse and thus do not wonder why, and get angry because, everyone disappears at 7/3/11 every day.

- The nurse can be more prepared. When you go in the room briefly, you can see what is needed for when you actually get your day started. Saves you from running back and forth because you didn't know that the pt's IV was nearly dry, or their dressing became saturated, or they were in pain/distress/freaking out because they didn't get their snack, etc, etc. And the nurse leaving cannot so easily dump a bunch of undone things in your lap.

OttawaRPN · Oct 7, 2010

I believe you are shouting (is that what the caps mean?) I call unessessary roughness. I haven't met anyone who takes it to such an extent. Nurses are capable of implementing this without having to resign themselves to exactly what management says.
Sorry this has turned into such a conundrum for you.

Take a look at my post again. Not caps, simply a font gone wonky.

What you call "walking rounds" and the type of bedside reporting expected by my management team are obviously two different things - that was the point of that reply - the "walking rounds" concept sounds more practical and efficient.

When management threatens disciplinary actions to nurses who do not comply, it makes it a wee bit harder to not do "exactly what management says." Following policy is certainly not a new concept for nurses.

onetiredmomma · Oct 7, 2010

At the last place I worked we were told walking/bedside rounds was a JACHO mandate. Now that I am agency I find only one of 5 different facilities I have been to do this. I am sorta ok with it, ok with what every paperwork the facility prints out for report but I WILL continue to use my own report sheet during the shift.

HamsterRN, ADN, RN · Oct 8, 2010

There seems to be some confusion about the difference between "walking rounds" and "safety checks". Many have responded that they like walking rounds in terms of checking drips, dressings, equipment settings, etc but they don't do the whole report in front of the patient. These are "safety checks", not walking rounds are seem to be universally agreed upon. Walking rounds involves doing the entire report in the patient's room, which they love at 1130 at night, as do their roommates.

As with many Joint Commission suggestions, walking rounds are often seen as a mandate, when really there are no true mandates from the Joint Commission; there are goals, standards, and suggestions as to how to meet those goals and standards. Walking rounds is a suggestion as to how to meet the standards of including the patient in their care planning but is by no means a mandate.

While it's definitely not optimal in terms of privacy, walking rounds are not a HIPPA violation, although I wouldn't be opposed to making this sort of thing a HIPPA violation if it would require facilities to do away with multi-patient rooms.

We tried Walking rounds for about a week, we found we weren't getting adequate information without access to patient information and the ability to discuss and write comfortably, we basically said thanks for the suggestion but we get final say on how we do report; it's the floor nurses that are responsible for making sure they get an adequate report, not the administration, although we kept the "safety checks" part of it and we involve the patient in the plan of care by discussing their goals during the initial assessment.