Giving report....how much information is necessary to pass on?????

[BabyLady, BSN, RN]

As most of you know, I'm a relatively new nurse in the NICU. My question is regarding giving report.

Because many of the tests, procedures that are done, I am still not familiar with because of inexperience, it doesn't always 'stick' with me when I recieve report as information relevant to pass on.

In school, we were taught (and all of our instructors had 20+ years of experience) that when you give report, you pass on a very brief history (not the whole life story of the stay) of the patient and any pressing medical issues that the nurse is likely to encounter for the next shift. Our instructors even told us that we would encounter nurses that go on and on and on with report, especially with patients that were in for the long haul (which is typical in the NICU) and will go over every detail of the patient and that unless it was relevant, it was a waste of time.

I try to take notes when I get report and we have a sheet that stays in front of the chart to help us with current medications, etc. to make giving report easier.

However, I had this senior nurse that threw a fit because I overheard that I gave a "crappy" report. It was on an infant that we had for two months. She said that I didn't give her "critical" information like the fact that the mother was Group B +, that a PDA had been suspected in the first week of life...three echo's were done...PDA ruled out...Neonatologist had even charted that heart was perfectly normal...the only reason that the child is still in the hospital is to nippling all feedings...child isn't on any medications...no TPN, no LIPIDS..no O2.

Am I a nurse that just doesn't "get it" or is the fact that Mom had Group B on a 2 month old infant, that never showed symptoms but had a full course of A/B's...100% irrelevant at this point????

A PDA that was suspected and ruled out...something that had not even been addressed in the last 6 weeks...irrelevant???

When I gave her report...I gave her Apgars...respiratory history...feeding history....kid had A's and B's, but hadn't had any in two weeks...that was pretty much it.

Can someone please shine some light on why the other issues are important to pass on...or am I correct that once so much time has passed, they are no longer an issue?

Thanks

[hikernurse]

I usually try to hit the salient highlights about the past--I'd have probably thrown in "PDA, now resolved, mom GBS+, baby has a history of resolved sepsis, etc.". A lot of it depends on the nurse receiving report. If it's not a nurse I know I ask how detailed a report is desired. Some like hearing that blowby was given in the delivery room 5 months ago...however, most don't :).

Honestly, almost all of our kiddos have a hx of PDA...

I always do cover systems, even if they are WNL, meds, orders, any recent/upcoming events/activities.

It can be difficult giving report in a new unit, I think you did a good job. One hint is to ask the oncoming nurse if there is anything else s/he would like covered and if there are any questions. I will say there was one nurse that I would spend the whole shift freaking out if I had to give her report. It's funny now, we're friends, but boy, when I was new, I'd dread seeing her name on the list. However, I did decide to take her comments and run with them--I was bound and determined to give her the best report ever. I don't know if I succeeded with that, but I did improve :).

[RainDreamer, BSN, RN]

Like hikernurse, I go through all the systems, even if they're WNL.

Our Kardexes are lifesavers! They go through all the systems and what's happened in each category thus far. So as I go through the Kardex I am able to hit on each aspect. I would have mentioned the r/o PDA because it's in the cardiac section of the Kardex. It goes quick too because it's all right there (Neuro: HUS was WNL; Cardiac: Hx of r/o PDA, echo was WNL; etc).

We also have an history information sheet behind the Kardex that we keep a running history of what's going on. So any milestone or major event we add to that sheet (i.e. 9/1: Extubated to HFNC 4 L; 9/4 HFNC decreased to 3L; 9/6 Reached full feeds, etc, etc). We don't have to run through the whole entire history, but at least it's there if the nurse wants to go back and read through it.

It sounds to me like you are lacking a good Kardex that can help you go through each system. It's easy to forget things, especially when you're new and you're still trying to get a system down that works for you.

Just remember you can't please everyone. Some nurses want NO history and they get irritated when you go through everything. Some want to know what time the kid pooped last Thursday. As you get to know the nurses that you report off to you'll know what they like. A lot of times you can tell by their body language/actions if they like a long or short report. I go through every system and make sure I report off everything I feel is relevant. But if I know a nurse likes a quick report then I just quickly touch on the history of each system and move on. If I know they like a more detailed report, then I spend more time on it.

Also, like hikernurse mentioned, I also ask if there are any questions they have about that baby, before moving on.

Hang in there!

[babyNP., APRN]

Unfortunately, as mentioned, every nurse is different. When you work with mostly women, unfortunately the estrogen gets tossed around a bit

For me, tell me what I need to know to keep the kid alive for my shift. Maybe a little more than that, recommendations from the shift to pass along, etc, but if I'm that darned curious about the history that no longer pertains to the patient, I can read it myself!

What gets me is when the nurse pulls up the assessment and goes over, "fontanels are soft and flat. Baby opens eyes spontaneously. Baby has normal tone. Baby has equal movement and facial symmetry..." and on and on.

On a normal assessment an infant, I'll page through the assessment (to make sure I'm not forgetting something) and might say something like, "Fontanels soft and flat, slept for half the shift, clear breath sounds, no retractions, nice pulses, no mumur, no events, belly is soft, no skin issues, no pain issues, just has a Piv in the right hand saline locked, stooled once, peeing well." Of course I'll say something about the pertinent history and what the parents are like, but it's more of a 1-2 liner, especially if the medical issues have resolved with no lasting effects.

[texas2007, BSN, RN]

I don't see anything wrong with how you gave report. I would have done the exact same. Heck, we don't even usually talk about a current PDA (or Apgars) unless it's a current concern (MD's thinking about indocin or ligating bc the baby's lungs are flooded, or significant Apgars of 0,0,0,1..). I guess we will say that a baby was ligated or indocin X 1 or whatever just for history but NOT if it spontaneously closes! Sounds to me like that nurse probably had other issues going on outside of that report and blamed it on you.

[BabyLady, BSN, RN]

Thanks for all the replies...tonight when I came home from work, I was giving report to a senior nurse.

I asked her, "Do you want the whole kitten kaboodle or just the quick down an dirty?"

She laughed and said, "I want the whole thing", which I was happy to give to her.

We have a large staff so it will take me awhile to get a groove to where I'm consistent....but I always end with asking if they need anything else...I figure in the end, that is all I can do.

Rome wasn't built in a day!

[WittleOnesRN]

Every nurse on our unit uses the same report sheet...so nothing is forgotten. It makes giving report much easier and we tend to have less overtime as a result. If the same nurse is coming on we just update because they have all the info needed already.

AND when we have a float nurse she gets the info she needs and passes it over properly at the end of shift.

[iHeartNICU]

Like RainDreamer, we have a great Kardex. It has every single thing all lined out by system and we also keep a running history.

It starts off with dob, gestation, birth weight. Then we have the running history of which we generally hit the highlights of or what is happening at the moment. Next list things that are needing to be done or on hold like PKU, hep B, car seat study, hearing screen, eye exam...on that we just mention what has been done and if anything needs to be done that shift. Then you open it up and you have all of what labs and x-rays the baby had that day or needs to have. Then we have current respiratory & cardiac, then we have lines & fluids, then feedings, and finally at the bottom we have any special notes like 10/1 discard all residuals unless bilious, or NNP plans to put in pick 9P on 10/3.

This systmen works really well because all reports no matter who gives it is very consistent and of course if there's more complex things that need discussing you can still discuss that. Plus, you don't have to use extra time writing everything down because it's all on the kardex already. We update it as the orders are written so it's always up to date.

[NICURN29]

After you have been at it for a while, you will learn who wants a ton of information and who can and will read it off the Kardex. I have been working in our NICU for three years, so I know who of my coworkers want every little detail and who want just updates.

Things I always throw in...birth date, GA at birth, adjusted age, last echo results, last head u/s results, any pending cultures, any history of feeding intolerance, any out-of-the-ordinary procedures (PDA ligation, Indocin or Neoprofen courses, MRIs, CT scans). We go through respiratory, GI, labs, and meds with our report sheet. If a baby is pretty new, I throw in stuff like Apgars, GBS status, delivery type, resuscitation. I always share significant social issues. Once a baby is a feeder/grower, some of that gets dropped.

I happen to be one of those nurses who doesn't need to know everything that ever happened to the baby. I tend to pay a lot of attention to what goes on in the unit, even on the babies I haven't recently had (some might call it nosy), so I often have a basic idea of what's going on with most of the patients. I also use the Kardex to get the background information I need, and I read over the chart every time I am taking care of a new baby. I rely on my coworkers to share with me what I really need to know, and I fill in the rest myself. We only have 15 minutes scheduled for report, and that is sometimes on three or four babies, so we have to make it succinct.

[Jerico, BSN, RN]

I just want to know the barebones UNLESS the baby is less than 24 hours old; or it is a highly critical baby (just short of circling the drain....) :

Problems the baby has had during the shift: As&Bs? How many times has the baby needed blowby?

IVs and lines? Can't get a good peak on the UAC? What is running into the kid, how fast, any changes?

When was the last suction? What kind of vent and settings?

Are you getting pee?

Feeds: NPO or NOT? What, how much and how often, how tolerated?

Elimination: Does the kid possibly have belly issues?

What Meds and what time and for what reason?

What tests and what time?

Social train wreck or not?

Basically, I want to know what I need to know to keep the kid away from Heaven for another 12 hours.:redpinkhe

I don't CARE if the kid had a PDA....all kids in an NICU have a PDA pretty much!