Change of shift report - page 3

Hi; I am looking for input on how other hospitals conduct a change of shift report. We currently tape report for the next shift. We are considering going to a walking round or verbal report. ... Read More

  1. by   Cheyenne RN,BSHS
    [font="comic sans ms"]i work on a 36 bed med/surg floor. we have telemetry and dialysis patients on our floor as well. the nurse patient ratio is susposed to be 1:6 but will go to 1:8.

    i have used taped reports in a ltc facilty that i worked at for a few years and it worked well. there were very few real changes and the lab works were not done that frequently. it was however, a complete disaster to try and do taped reports on the medical unit.

    due to staffing ratios on nights and days, you may need to rewind and fast forward 3 different tape recorders to get your assigned group and afterwards you may still know very little. by the time you would try and find the nurse and get the verbal answers to you questions, report took over an hour at minimum. ((( some days the nurse had clocked out and left and here you were behind before you could even start the shift.)))

    our facility uses the computerized charting system and our kardexes are printed out at the beginning of the shift. the care plans are built into the plan of care on admission and may change based on the shift to shift nursing assessment.

    we give verbal report at shift change on only the patients we are specifically assigned and no one else. there may be thirty plus patients on the floor, but i will only hear about my own specific patients from the nurse/nurses directly involved in their care.

    each nurse has different priorities and some require more information than others so no one single way of doing report will substitue for the face to face verbal interaction, it just needs to remain focused on the patients....not where you went on vacation or bought on sale at jc pennies.

    even with all this, the report given is only as good and detailed as the nurse giving it. i have some days that i wouldn't know who has a foley and who is paraplegic or even if their iv's were started or what abnormal labs exist.

    when i have a nurse who wants to basically just say "well you got six patients on a hall and last time i saw them they were all breathing, then it up to me to know what questions to ask to obtain the information that i need.

    if i have been off a few days and will have a new group of patients, i deliberately come to work early so that i can review each of my patients lab results, any tests, scans, biopsies, or procedures done and the results. i also read over the history and physical that the doctor has done, and any information a consulting doctor has done on the same patient. i then put notes on my assignment sheet that i carry.

    it takes about 15-20 minutes for me to review everyones information, but then i am as prepared as i can be for taking care of all my patients and sort of know what has happened to them since admission.i feel that i am better prepared to give quality care, not just "get through" the shift.

    here is just one instance where taking the time to do these extras at shift start saves patients complications and possibly death.

    a patient is admittd with an anemia of 6.8 and has a gi bleed. he is ordered to have three units of prbc transfused as fast as possible. he is also scheduled for a colonoscopy the next morning and has to drink the notorious golytely solution.... but.... by my having read the patients history i know that he has a high potential for fluid volume overload and will need closer monitoring of his lung sounds, pulse ox, v/s, and intake and output to avoid exacerbatieing his chf. i can also give the doctor a heads up at the onset to see if he will give me a lasix order .

    don't know if any of this rambling helps or not. hope it does.
  2. by   snowfreeze
    I work on a telemetry unit, we are decreasing overtime by recording reports on voicecare a telephone system.. Voicecare also is utilized for transfers. I am learning to like this system, you arrive, get your assignment, listen to report while the prior shift monitors lights then is still there to answer questions if needed. Makes for better patient care during shift change. We put our report in voice care up to an hour prior to shift change and there is ability too add an adendum if necessary.
  3. by   Mississippi_RN
    I work primarily on a 16-bed postpartum/GYN/Med-Surg floor where we do written and verbal report. We have a report sheet that contains all the important info: Patient name, dr, diagnosis, diet, iv, labs (mostly the ones you need to look for that day), HHN or O2 use, Accuchecks, and other info (such as turn Q 2, plexipulses, SCD's, TED hose, ambulation, need assistance, dsg changes, bottle/breastfeeding, intact perineum or not, etc...). This works well to pass on information and to keep in your pocket for reference when you make rounds, chart, etc. We also sit down with the next shift and go over each patient. For 16 patients, this usually takes 15-30 minutes...usually 15-20 if we stay on subject and don't ad lib a lot (hard for women to do... Now, they have started these "Hand Off Communication Checklists"... biggest bunch of doo doo I ever saw in my life... I call them the "short stories" on my patients. It's ridiculous. And they don't even apply to most of our OB patients. I continued to do our report sheet though, cause I, nor our doctors, could live without it.
  4. by   BSN2004
    I work on a med/surg unit 5:1. we do bedside report. Being primary nurses, its hard. As a solid group on our shift, its hard to help someone elses patients having no clue of the patients status. We have pt c brain mass's telling us they have to use the BR, when we get the to the edge of the bed you find out they cant bare weight..... we just wasted 5 minutes, then it takes another 10 minutes to remind them that they cant get OOB and convince them they need to use a bedpan or wait for a BSC.

    Plus its hard to tell walking in the room during report if the people visiting them are family/friends/co-workers. Our supervisor will tell us to go back in the room when she see's us in the hallway. Asking the visitors to leave sometimes takes longer then the report cause they decide to say all their goodbye's to the pt and end up making plans c the pt while we stand their waiting.

    Bedside report can be good cause as the on-coming nurse, you can decide who to see first and who can wait.
  5. by   Animalhouse
    very good idea the personal notebook..I use a worksheet..I designed it on my pc and print out one before every shift ..with the latest changes noted..
    it has room numbers, names, v/s's , FSBS status and along the way I make notes on these patients and use that to form my report on the written report form we use...we give the verbal from the form..
    have experienced the tapes..useless..too many nurses with heavy accents..
    Safest: walking rounds..don't talk in front of patient..make report o/s door then go in and check patient..Always check IV site /doses on pumps and so on at this time..for accountability.

    Yes it takes time..but if patient is sick enough to be in a bed he deserves this time.

    Nursing is more then passing pills...nomatter what administration tries to say.

    I figured up one day that AI have at most 20 minutes with each patient over an 8 hour shift..I can use two of those for a solid report and assessment as I get one.
  6. by   Animalhouse
    I am new to this site..and joined to find out if anyone knows anything about the Compact licenses.

    I tried to call the boards of the two states I interested in and got no machines and no reply at one answer at the other..and no response from email sites.

    I could kind of understand about the 3rd state..Louisiana..but not Arizona and Texas.. and I already know that LA isnot in the compact.

    So does anyone know how this works? or what I am even talkign about?

    Compact License..supposedly if you licensed in Texas (or another state in the comact) you can work in the other states in the compact on that license..

    We knew LA not in it because when Katrina hit six of us were going to use vacation time and go to NO to volunteer and couldnt' go and practice becasue LA not in the compact.
  7. by   lovemyjob
    I work in a NICU where we give a face to face report. PRN I work at a place whewre they gived taped report. I def prefer face to face report at the bedside (that is easier in an open unit where babies dont know you are talking about them.) On the taped I dont feel like I told them everything, or worried I forgot. Also, we do a chart check b/t the 2 nurses to make sure that all of the orders form the previous shift were covered/ordercom'd. I really like a second check making sure meds/tpn/lipids were transcribed right.