Report in the pt's room?

[1BunnyRN]

Recently where I work as an RN we went from giving one to one verbal change of shift report at the nurses station, etc. (somewhere private), now we are told by administration it must be given at the pt's bedside and any info. that the pt. does not yet know or we don't want them to hear must be given outside the door. The problem is your standing there with a clipboard trying to write and alot of the nurses I think are uncomfortable with this and I feel I'm getting so little in report that I spend alot of time looking up important info I used to get in report. I have talked to my Boss twice to see if it would be okay to do the report the old way then introduce the oncoming nurse to all my patients, this was unacceptable. I just want to know does anyone else do report like this, any suggestions on how I could better adjust?

[lorazepam]

One of my patient's Doctor was discussing the patients condition and what procedures were going to be done with the patient while the patient's girlfriend was in the room and she ends up finding out that the patient has Hep C that he "neglected" to tell her.

Wow, that must've been an interesting conversation after.

Pt: Oh baby...di-didn't I tell you???

[jjjoy, LPN]

From the US DHHS website:

Can health care providers engage in confidential conversations with other providers or with patients, even if there is a possibility that they could be overheard?

Answer

Yes. The HIPAA Privacy Rule is not intended to prohibit providers from talking to each other and to their patients. Provisions of this Rule requiring covered entities to implement reasonable safeguards that reflect their particular circumstances and exempting treatment disclosures from certain requirements are intended to ensure that providers' primary consideration is the appropriate treatment of their patients. The Privacy Rule recognizes that oral communications often must occur freely and quickly in treatment settings. Thus, covered entities are free to engage in communications as required for quick, effective, and high quality health care. The Privacy Rule also recognizes that overheard communications in these settings may be unavoidable and allows for these incidental disclosures.

For example, the following practices are permissible under the Privacy Rule, if reasonable precautions are taken to minimize the chance of incidental disclosures to others who may be nearby:

- Health care staff may orally coordinate services at hospital nursing stations.

- Nurses or other health care professionals may discuss a patient's condition over the phone with the patient, a provider, or a family member.

- A health care professional may discuss lab test results with a patient or other provider in a joint treatment area.

- A physician may discuss a patients' condition or treatment regimen in the patient's semi-private room.

- Health care professionals may discuss a patient's condition during training rounds in an academic or training institution.

- A pharmacist may discuss a prescription with a patient over the pharmacy counter, or with a physician or the patient over the phone.

In these circumstances, reasonable precautions could include using lowered voices or talking apart from others when sharing protected health information. However, in an emergency situation, in a loud emergency room, or where a patient is hearing impaired, such precautions may not be practicable. Covered entities are free to engage in communications as required for quick, effective, and high quality health care.

http://www.hhs.gov/hipaafaq/limited/196.html

[CRNI-ICU20]

Oh bruther.

What is the rationale that administration gives for report being in the patient's rooms? How is it more efficient, precise, or clear...

As far as the above HIPPA rules written above:

Yes...discussing with family members over the phone is okay....as long as you are clairvoyant and know ahead of time who it is you are really talking to...I once had a local reporter from a well known paper (Chicago) who posed as a family member and asked the 'condition' of the patient over the phone....(we assign a password, and without it, no one gets a peep of info!)

So, you see, for all their rules, there will be people who will unscrupulously bend them...and there will be stupid Drs. who have the social bedside manner of a gnat that will go in and unload a devastating diagnosis on the patient within earshot of whomever is standing there...

In our hosp. we have many ethnicities...Polish, Russian, Hispanic, and more than on several occasions, I have observed polish housekeeping staff discussing a patient's 'condition' with family, that led to a nightmare situation with doctors and staff, because the housekeeper was sharing a jaded view of what actually was said and what actually was going on with them....and once the seed was planted, it was impossible to undue...

Administrators need to wise up....before they do get sued....and this is probably what it will take.

[lsyorke, RN]

Ah, deja vu all over again. There was a big push for this back in the 80's. It didn't work then, and won't work now. "walking rounds" were found to result in information being missed, massively time consuming with little benefit to staff and patient, and a violation of privacy.

Another rehash of a previously tried policy.

[oeue2007]

We're supposed to be doing this too. (Key word "supposed".) When we pretend to be doing it, I have seen it frighten and confuse some of the patients because they think their condition has dramatically changed. Also, little old southern ladies don't want their husbands to know they even have bowels and bladders, much less that they aren't functioning properly! RIDICULOUS!

[cisco]

With reporting at the bedside, how does the charge nurse on a 34 bed unit know what the heck is going on...how can this be a timely and safe way to do report? We use to listen to a tape recorder that the previous shift would report on each pt. This way the charge could take notes on every patient and would know what was going on. Report took only about 15 to 20 minutes. This bedside reporting and trying to find each nurse for all your patients doesn't make any sense to me at all!!!

[jjjoy, LPN]

Even without bedside reporting, in some units, the off-going nurse only reports to the oncoming nurse, without the charge nurse listening in... as opposed to a report where everyone hears everyone else's report, either in person or taped... so the issue of how the charge nurse gets informed exists even without bedside reporting.

Also, I'd hope that nurses could use their discretion to decide what to report in front of the patient and what information they feel would better to pass on to the nurse outside of the patient room.

[RogueWolf]

Well as far as the Charge Nurse issue, on my unit the charge nurse comes around an hour or two (we work 12's) before end of shift to get report from his/her nurses and then at shift change she/he gives report to the oncoming charge.

[CRNI-ICU20]

"also, i'd hope that nurses could use their discretion to decide what to report in front of the patient and what information they feel would better to pass on to the nurse outside of the patient room."

this might work in some cases....but now you are putting the brunt of the responsibility of patient confidentiality on the bedside nurse....and asking for a nebulous policy to be followed in a subjective framwork....this is a recipe for failure, with the nurse being blamed when something goes very very wrong....

you are counting on people not getting the wrong perceptions, wrong information, or partial information....this is not a good idea...

if we are going to be asked to fulfill adequate bedside report, then the hospital should not ask the nurse to rely on her/his own discretion to fulfill those tasks....what may be discretionary for one, will not be for another....

[ginger58, ASN, RN]

Nothing much stifels me but this would. Then if the pt interrupts with a question report gets prolonged and maybe derailed. Or nature calls and you have to get the person up. You would also need to get visitors out of the room. Doesn't sound like much fun.

[cisco]

I'm just used to charge nurses making rounds with the doctors answering questions and making requests that the staff nurse wants for the patient buts is tied up with another patient. Also, having as much info ahead of time when having to make phone calls, making decisions as far as assignments when new pts come in, knowing which nurses already have the heaviest loads etc. How report is done can really make the difference from a shift running smoothly or sheer chaos!!

[P_RN, ADN, RN]

I wonder if these edicts that come down from on high are actually from people who are nurses? We were not allowed a dry erase board in the nurses' station that listed FS blood sugars, but were supposed to keep bedside charts and do walking rounds. Doors were to be kept closed but we were to observe patients as we walked down the corridor. On beepers (or bleepers as the English say) we could only say or enter a room number, no name, no specific need. Tangled web it is.