Full bedside shift report in ICU?

[ViolettaCCU, MSN]

Our hospital had implemented bedside shift report for the regular floors.

Today, administration announced that we will do it now in ICU. The nurses are very concerned as some sensitive areas of the report (like test results) should be for the physician to tell the patient, not for them to overhear the nurses in the room.

Your thoughts?

[MaxAttack, BSN, RN]

Bedside report is another thing desk jockeys push that comes and goes in cycles.

There are certain results I'd want to have a provider discuss - cancer or HIV come to mind - but the vast majority of results I have no problem providing. Almost everything is available online for them to view anyway. 

In my experience, bedside report creates more confusion for patients and family. They don't know what half of anything means and I'm all about educating patients but, as an example, does the family really need to understand what pressure control vs volume control ventilator modes are? Probably not. And if they're curious shift change isn't the time for it. There's a lot of critical information being exchanged and the focus should be on a thorough and safe handoff.

The best I've found is a handoff at the nurse's station followed by a bedside review.

But, we don't make these decisions. So we do whatever the authorities tell us because they know best from their experience at the bedside (if they ever had any) 20 years ago. 

[ViolettaCCU, MSN]

Thanks for your reply, MaxAttack. We've had some concerns like you stated, also that we'd be getting more questions (from patient and/or family) that would interrupt our report and take more time for the previous shift to leave. We have been doing report at the nursing station and then bedside review, too. Has anyone else experienced a full bedside shift report in ICU?

[cinlou, BSN, MSN, RN]

Does your physicians come in early for their rounding? One of the ways I worked around this when they dropped that on us, was to go through patient report with the physicians at the nursing station so off going and oncoming nurses knew what was going on, then round with the physician and go over the rest of the specifics at the bedside, neuro, lines etc.

[JzK CCRN, BSN, EMT-I]

We've been doing bedside, by the book, handoff for as long as I remember... That being said, certain pieces of info that could be sensitive, we would say in private and then proceed to patients' beds/rooms. 

On the other hand, when patients ask why they are on antibiotics and those are emperic, for example, it gives me a perfect opportunity to call either the hospitalist or attending and have them deal with these Qs ~ above my paygrade ?

[Watki22]

I find that giving report outside the room works best for being able to focus on the information as well as being next to the computer to review results, chest X-ray info, dive into notes for questions being asked, and add last minute orders needed. Then I either go in with the nurse so they can take a look at them, if there's something to show them or if they need a turn or a co-sign for a change in insulin/heparin or hourlys needed to be done at 7. If I'm coming on I immediately look for anything not included in report that is important and check my drips and lines and order whatever drips are running low if needed and usually come up with a few more questions for the nurse that is about to go home. I find bedside report generally confusing and distracting especially if family is there or patient is awake or even intubated they may get agitated and wake up with our voices.