Bedside rounding in-front of patients

[Nurse-84]

Ok, this is new for some hospitals, nursing homes and not new for others. What do we feel about bedside rounding in front of the patient, family members? Not to mention the patient in the next bed who isn't deaf by curtain?? Myself I don't like it at all. I think its a violation for the patient and as nurses we all speak a certain language that we understand and the patient can be left with more questions!...Plus as a patient they can't help but interrupt about what we are talking about, 'Their plan of care" My nurse manager is pushing hard for this to be done. The nurse aides also have to do this and I over hear "this patient is incontinent of urine and stool, has a bed alarm on, ect" which if I was the patient I would be mortified.

[pockunit, ADN, RN]

Not everything needs to be stated at bedside. The huddle is good for discussions of alarms, incontinence, etc. There is no violation of HIPPA because the information isn't any more than docs discuss with pts at bedside already. For pts who want bedside it's pretty nice, and I have to say that I haven't clocked out late since we started doing it

As for "special language," it's our job to translate for our pts. If they have questions, we should be able to answer them in a way they understand. If they interrupt, it's because they want more information. Give it to them!

[guest64485]

I'm actually a fan of bedside report both as a nurse and as a patient. Generally what I've always done with bedside report is that I'll meet up with the oncoming nurse at the nurses' station and we'll go over any sensitive or embarrassing information, such as STDs, behavioral problems, etc. Then we'll go into the patient's room and the rest of report will be given. One of the biggest pros from a nursing perspective is that you can ensure that what you see when you enter the patient's room for the first time is not a major change from the last shift, and that the patients are doing OK. So many patients look or sound a little 'off'... for example the patient may sound raspy, or seem sort of out of it, or a little shaky, but the previous nurse can confirm that it is baseline for the patient and not cause for urgent concern (this is also great to see wounds). You can get a good overall view of what is going on with the patient just by looking at them with the previous nurse. Its also helpful to have the second nurse there to help boost your patient up in bed, and if they need pain medicine the previous nurse can get that for them so the oncoming nurse isn't inundated. Then at the end of report you can say you've already seen all your patients and you can more safely categorize which patient needs your attention first, having had that confirmation that there are no other urgent patient needs, and that the rest of your patients will be ok without you for x amount of time.

As a patient, I really appreciated bedside report, mainly because by the nurses talking to each other it gave me much better understanding of what was going on with my care. Think of how many times the doctor has talked to your patient in the room, and as soon as the doctor leaves, the patient asks you what the doctor just said!

pockunit did a great job of responding to your HIPAA question, but if you still have concerns you can always introduce the next nurse to your patient and then ask the patient if its OK to give the nurse a quick report in the room.

[englishgeek]

I agree with the others. I think bedside reporting is a good thing. It helps the patient feel better and more informed about the case they were receiving.

[krisiepoo]

We do bedside reporting but I always give a brief synopsis prior to going in. At the bedside I can introduce their new nurse and point out IV's, dressings, settings on machines, how much O2, etc. Sometimes things all run together after a 12 hour shift with little things. I include the patient in the report and always ask them if there is anything they want to add or anything I've forgotten. Sometimes I have and it's great to include the patient. I think it helps with continuity of care, too. We have single/private rooms though so that might make a difference.

[Ruby Vee, BSN]

Do you mean change of shift report at the bedside? Or do you mean multi-disciplinary rounds with nurses, providers, RT, PT, OT, Pharmacy and whom ever else is on the team?

[Nurse-84]

all our rooms are doubles, just day shift and night shift nurses.. I like and dislike it.. as you all stated its def nice to point out IVS and introductions.

[calivianya, BSN, RN]

I hate it. Management expects us to say everything at the bedside... and I do mean everything. One shift we were discussing a patient's overdose at bedside, and he actually became violent and started screaming at us about it. Some things are just better not discussed in front of the patients. They can get updates on their care absolutely any time - I explain everything I do and what the plan is to every patient. That doesn't mean I should sacrifice my report time to them.

What about management being upset about staff not leaving on time? If the patient interrupts fifty billion or so times for clarification on things, it doesn't exactly help staff get out the door faster. Just saying.

[misstrinad]

When I was a student The hospital I did all my clinical rotations at did bed side report, however a large portion of report was conducted in the hallway right outside the room in hushed tones. We poked our heads in so the pt could be informed of shift change and meet their new nurse and ivs and such could be checked on, but the rest of the info was passed on outside of pt ear shot.

I liked the system, however we frequently had to pause and wait for visitors, pts, and non medical staff to finishing passing by so they did not over hear.

[GoldenRoya]

There are good and bad things about it. Ever since my hospital instituted bedside rounding, I've gotten out later than my "official quitting time," which then becomes donated time, because there's no way I'm logging back into the computer to change my timecard for five or ten (or fifteen, sometimes) minutes. Finding three nurses (or five, or six), walking to each room, sometimes split down several hallways, and then giving report in front of the patient all takes time, and doesn't cover those frequent times when the patient thinks, oh, there's two of you now, you can help me to the bathroom... no matter how many times they were asked if they need to go before shift change, or asked to please respect shift change as a time when the nurses may not be able to immediately fulfill their requests. It gets even more fun when surgicals hit at or around shift change, so that you're trying to get the initial vitals, share what the PACU told you, get them settled in the room, and hash out who gets to chart the first assessment. And answer questions from visitors. And the patient. And the hovering other nurse that the next shift is getting report from because she has a bus she needs to catch...

On the other hand, there has been more than one occasion that something critical has been caught by doing the bedside report; an IV not turned on, or a nerve block set to the wrong drip rate, or a wound that has started to bleed through the dressing. Or a behaviour that I find odd, but that has crept up on the previous shift so gradually that she didn't notice it until it was pointed out.

All in all, the pros much outweigh the cons (and please forgive my complaints; I've just had to become resigned to never catching the "early" bus). Like all new changes, the bugs have to be ironed out first. Everything is hard before it becomes easy.... if it ever does! (dark humor there, ignore me...)

[ICURN3020]

Tried this at my hospital...it was required of the nurses, not optional. However, we were to ask the patient (if they were awake, oriented, etc) if they wanted us doing bedside report (coming into their rooms, sometimes at late/early hours and waking them up). If they said no, there was a sign we put on the outside of the door stating they would prefer we not do it. Before long, almost every patient's room had a sign posted......hmmmm. It kind of fizzled out.

[ausrnurse]

Compulsory at my hospital. I've seen it in both ICU and wards and it seems to work wherever nurse managers are reasonable. On the wards the nurse would handover each patient then when we stepped outside the bay we would hand over anything you wouldn't want to say in front of the patient. If the patient had a lot of questions, we could say "Oncoming Nurse will be able to answer your questions as soon as she is free." In ICU we would be able to open the patients notes to anything you might not want to say and be able to read it with the other nurse in silence. I've seen places it doesn't work though, as my old dialysis unit expected bedside handover even if you had to say in front of the patient "Patient X only had 1 hour treatment on Tuesday after being removed by security for trying to punch Nurse X in the face." You can imagine how well that went down.