And how do you give report?
Our docs sit in the middle of the unit and do their rounds and reports. I have suggested we keep the unit closed to parents and visitors at this time, but I'm sure that won't fly. Until we are sued for breech of confidentialitly.
And I never do report in front of a parent, but it seems my co workers have no problem with talking about all their patients next to anyone.
Any suggestions I can fly by my manager?
Mar 7, '02
The doctors go from bed to bed doing rounds once a week. Whatever NNP's are on that day as well as a dietician, social worker, RT, charge RN and bedside RN discuss each baby. They close the unit to visitors for an hour while they do this (during day shift only). At night, certain doctors will do a mini-round session just to touch base with the RN's to see if we have concerns, etc. before they go to sleep in the on-call room. We don't close the unit for that, we just move away from any bedsides that have parents nearby.
Mar 8, '02
Our unit is divided into 9 rooms or pods. Each has 6 beds. Our docs go from room to room and round at each bedside. We usually ask parents to leave the room....they don't need to hear about other kids and since we are a teaching hospital, they don't need to hear the residents stumbling over answers. We do give the parents a chance to talk to the team before they round.
We just started this as we had one mom over hear something about another mom and she demanded that her baby be moved because the other mom had AIDS and she didn't want her baby infected :imbar We have one attending that will round outside of the room and then go in and talk to the parents.
We give report at the bedside....if the parents are there and there is something that we need to discuss, we take it outside of the room, or to the front of the room. Or discreetly point it out on the Kardex. The charge nurses report off to one another in the conference room.
We too sometimes forget to be discreet, but I think that is because we are in one room most of the time with another person and you do tend to throw ideas back and forth with one another. That is a hard habit to break!
Mar 21, '02
In our Level III Unit, which is a Big open area (with half walls separating the outer (feeder-Grower Pods) from the Sicker kids in the middle, (we do have two isolation rooms as well).
Our Unit has rounds every morning from 0900-1200, the Docs usually do them up at the front in the Dr's area, and then come around to specific bedsides.
The NICU is CLOSED to visitors during Rounds, as well as during Nursing Report, (0645-0715, 1445-1515, 1845-1915, 2245-2315).
I think its very important to maintain pt confidentiality, so I agree with the closures during these times. And it also "helps" the parents take a (usually) much needed and well deserved break.
From what I have seen even if we were open 24-7 to visitors, most of our parents wouldn't stay for more than a few hours at a time.
Feb 2, '04
Theoretically, at least, our unit is "closed" during rounds and during shift changes (at least, that information is included in handouts given to parents) - but we still get inundated with visits and phone calls from parents during these times -
Rules are all fine and good, I guess, but useless unless enforced
Feb 3, '04
I started this thread before HIPPA and still nothing has changed.
We round and give report no matter who is there. You try and be discreet, but I know parents are listening.
Feb 3, '04
We have changed a lot since HIPPA...no parents can be around if there is a report , so we are having people in and out like every 4 hours. What a giant PITA. Also, parents have to leave if they round in the room.
Feb 5, '04
Long before HIPPA-rounds was done in front of parents and many times the parents would interrupt the rounds to ask about their baby. Now, parents can stay at the bedside but rounds are done far away from the bedside-at least out of hearing range. One hospital that i work through an agency-After rounds the parents are called and update and plan of care are discussed with parents. Most of the hospitals now close their unit to visitors during shift changes and the same goes for phone calls, but even with HIPPA, the nurses had to fight with the attendings to go along with it. I remember before the closing of the units during shift changes-parents will visit at 6:30-7pm when you are trying to wrap up for the day-whether hanging your HAL, calculating your totals, checking your IVs and they will demand your attention-right this minute. I am glad those days are over. However, one large NICU in the area -the attending refuses to close the unit at all-stating "this nursery should be open to parents 24/7".
Feb 5, '04
Our unit is closed to parents from 9-12 in the morning for doctors rounds. We do this so we can talk about the babies without the risk of other parents with big ears listening to everything. The docs then try to come and talk to the parents after lunch (and unfortunatly some of them speek so loud that the whole unit hears!!)
We dont close for nurses report but we try to go out of the room if there is something special to say about the babies. Otherwise we do it at the bedside.
Feb 5, '04
In our unit we close the unit for 1 hour at report times and close the unit when we admit. How do you get around the HIPPA rules with parents in the room at report time?
Feb 13, '04
Our docs round @ 0700 with all the extras that are in the unit(social workers, case managers, pharmacy, dietitian....)Our unit is closed for 45 min @ 0700, 1500, 1900, 2300. In our ICN htey round @ 0800 with the doc for the week, NNp's and the rest of the gang.
We have done this for the 5 years that I work there. Since HIPPA we are very good @ enforcing the parents stepping out @ report time.
Feb 13, '04
Our rounds are done each am, usually starting about 8:30-9am, lasts til about 11:30-12. The MD is there along w/NNP's, dietician, pharmacy, RT and RN, social worker, etc. We do rounds in a separate area, way away from the bedside, so the unit doesn't have to close. However, we do close from 6-8 twice a day during shift change, so the nurses do bedside report, and as the MD's/NNP's switch off, they do a mini bedside report w/each other as well.
I can't imagine having parents at the bedside during report.... :uhoh21:
Feb 13, '04
Believe it or not, until about a year ago, my unit let parents stay at the bedside 24/7! Nurse-to-nurse report and rounds were all done in front of the parents. I can't believe they would let parents sit there and overhear everything about everybody's baby! I don't think it was until HIPAA that they closed the unit from 9-12 each morning. Even that three hours was enough to send the parents into a fit, especially those who had been there for a couple of months at the time.
The docs and NNPs do rounds during that 9-12 period, in the middle of the unit. I always wondered why they don't go into the conference room instead, but I guess it's so that the nurses can also be a part of things without leaving their bedsides. Sometimes I wished I worked days instead of nights, so that I could listen in and comment when appropriate, especially if I have a primary with mulitple health problems.
Nurse-to-nurse report still remains a problem. 2-3 times a day we do a unit report in the conference room about all the babies (highlights only) and whatever else might be going on in the unit. But then we go to the bedsides to get report on our patients, and if the parents are there it is often very uncomfortable. Sometimes just hearing their baby's history can send a parent into a tailspin, even though they know it already, because it just sounds so overwhelming. Sometimes they interrupt and start asking questions about meds or feeds, and it's hard to tell them that we will explain later but must give report first. Whenever there is a social issue, we have to either write it down or take the new nurse aside and explain. We shouldn't have to do that! I am really hoping that with our next joint commission visit, we decide to close the unit for at least a half an hour during report times.
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