Save time, energy, and frustration simply by performing bedside report! How you ask? Let me give you my take on this patient centered and evidence based initiative. I will leave my biased views at the door and share experiences from my career from using it, implementing it, and comparing it to other report modalities.
I love this pin! I would wear one and pass them out when other nurses shared stories of success. Find out how this initiative can save lives! Here is clue, when your listening to recorded report in the backroom can you see your patient? OK, keep reading to see how this initiative has helped me and thousands others save a life!
In simple plain old English, bedside report is the nurse leaving talking to the nurse arriving about a patient. Sounds pretty simple? Many feel it isn't, many make much more out of it than needs to be. I'm not being critical here, just after the many years of doing this, preaching this, studying this, and I hear the excuses as to why it can't or doesn't work. I don't want to get ahead of myself. We will discuss that later on.
AGAIN - Bedisde report involves the nurse leaving, the patient and/or family, and the nurse taking over care. Got it? Great! SO what do we talk about when we all present and in the room?
This is where thinks can often go south, become tricky, convoluted, opinionated, and biased. Let me break down the simple components that I feel should be included. Again, this is after implementing it following research for my BSN Capstone, implementing in additional units as a nurse manager, and performing it myself as both a clinical nurse at the bedside and a clinical supervisor who took patient assignments. Let's begin!
Bed Side Shift Components!
I like the good old fashion SBAR technique when given report. (SBAR will be a future component - Bare with me I need to write it!!)
SBAR= Situation, Background, Assess, and Recommend
Before we move right to SBAR I recommend using AIDET
Wait, What the heck is AIDET?
You guessed it, another best practice initiative. AIDET stands for : Acknowledge, Introduce, Duration, Explanation, andThank You! VEW MORE INFORMATION ON AIDET BEFORE CONTINUING
SO now lets use AIDET and SBAR for the first 2-3 minute of bedside report:
"Hi Mr.Smith this is Bill your nurse for the 3pm to 11pm shift. Bill as a great nurse and worked here at the hospital for five years. We are going to have report and discuss why you are here in the hospital, your treatment plan, how your day went and what our goals are for the next shift. Report is only a couple minutes."
"Bill, Mr.Smith was admitted yesterday to the hospital for right lower lobe pneumonia following 3 days of fever and then severe shortness of breath. Mr.Smith has a history of COPD, CAD, and osteaoarthritis. Heis a full code. His assessment presents with shortness of breath at rest and during conversation, with sats in the low 90% on 4 liters via nasal cannula. He has a harsh productive cough of thick green sputum in moderate to large amounts. He is voiding clear urine in good amounts, skin is warm and dry, abdomen soft and non-tender with good bowel sounds and he denies nausea. Vital signs have been stable, minus a fever of 101.4 this morning. That broke to 98.5 after 650 mg of oral tylenol. My recommendations for this evening is to monitor for fever with routine vital signs, encourage use of thera-pep and every 4 hour respiratory assessments. He does request his PRN nebs and cough med every 4 hours. A goal for this eve would be try and sit on edge of bed or stand at side of bed. Mr.Smith you will continue your I.V. antibiotics. Bill he has a #20 in his left wrist with good blood return and the site looks clean."
"Mr.Smith I will be rounding on you in roughly an hour. If you need immediate help please use your call bell."
The nurses have accomplished two very important task within minutes
#1 - Assessed the patient and obtained a clinical reference for the shift while discussing the plan of care
#2 - Assessed the environment to make sure the call bell is within reach, bed in low position with rails up and alarm on if indicated, IV pump correct with right fluids, walker closeby, nothing on the floor that can trip the patient or staff, and a quick update of the whiteboard. This is my favorite! I hear this one all the time - "Oh the whiteboard, if I have time!" So what is better writing a quick NPO in the room because thats the latest information or having someone feed your patient because the board stated regular diet. Now you can call the doctor and get crabbed at for not following orders, cancel the procedure, explain to the patient and family why they have to wait longer and keep the patient in the hospital longer. Which do you pick?? Ok, so what do you pick if your now the patient? That's what I thought.
SO much can happen in this 3-5 minutes! It is an initial investment that can save you so much time. PLUC the first 30-40 minutes of your shift, you will have visually seen and talked with all of your patients. I have to share this statement nurses would say to me when I was a supervisor:
"I haven't seen all my patients yet and the night has been crazy!"
This is what happens when a nurse enters a room and tries to do everything in 1 room without knowing what is going on in the other rooms. Emergency Room nurses triage patients all the time, the same goes for nurses everywhere else. Go see all of them first, then you know which ones need you first and which ones are stable! Think about that
So what do Nurses say about Bedside report that is not all positive??
I would like to tackle these concerns and fears right away. I fielded every kind of excuse or reason not to do bedside report under the sun.
I love this picture...Sorry but it often the truth! Some nurses have really put great thought into why they will not do bedside report, even when they know it benefits the patient. Instead of the excuses just say "I don't want to do it because I don't care about the patient" WOW, Harsh, but true!
EXCUSE #1 - I can't talk about the patient in the room because the room mate will hear
This is one of my favorites! So when you go into the room to change a dressing or give a medication do you use sign language or write on paper to explain what you are doing? Think about it, you are disucssing things with patient's throughout the shift that is their own personal medical information. It's not like your pull the curtain back and say "hey Ms.Smith, I am talking about your room mate and she has pneumonia and a history of depression." You don't go into a room and tell the room mate your giving the patient their oral oxycodone for a pain of 6. They might over hear it, but that happens. You try the best you can to keep the discussion with the patient whether it's bedside report or four hours into your shift.
Still don't buy it? Simply ask the patient if it is ok that they do report at the bedside. If family is present, ask it they should step out or if the patient is comfortable with them present.
EXCUSE #2 - I'm not going to discuss patient sensitive information with the patient such as their alcohol use or HIV status.
This is fine! I'm pretty sure the patient knows that they drink and have HIV. Especially if their there for those reasons. Again, you are a nurse who can use judgement. I tell nurses to have side bar conversations before or after report to discuss things that are uncomfortable. Focus on the clinical picture, the AIDET portion and the environment. You can tailor your report based on the patient. But go in the room and talk about the plan, pain control, concerns, and so on. This can't be done at the nursing station or sitting in a back room listening to a tape reported report!
EXCUSE #3 - Bedside Report Takes Longer!
I love this one too! So sitting at the nurses station chatting about how the weekend was, throwing in peices about the patient, then more chit chat is quicker than a focused report in the room? I can never understand when I hear this. Believe me as a supervisor and charge nurse for years, report at the desk is 60% chatting, 10% laughing or complaining, and 30% patient focused. This does not happen in the room, unless you have that great patient who wants to chat and then you just need to use your skill and refocus the conversation.
I worked at a place where report was recorded. I would watch the night nurses on the phone listening to report for an hour or so. By then the evening nurses have left and the night nurse was full of questions. Again, who are we doing this for? Ourselves or the patient?
EXCUSE #4 - The patient is going to want things during report and this will slow down!
Well, quite frankly the patient is going to want or need something whether your in the room or at the desk talking. Which would you rather:
#1 - The patient needs to go the bathroom as your in the room during report. You ambulate them in while still talking, assessing their gait and motor function. Settle them back into bed or grab a support staff memebr as you move on.
#2 - The patient has to go the bathroom so they get out of bed and fall walking into the bathroom. The bed alarm was left off since the last time a staff member toileted them. Now the patietn needs to be lifted back to bed, ital signs every few hours, a note, a call to the patient's family and physician and so on.
Again, why are we doing this?
EXCUSE #5 - I'm going to be asked something that I don't know and look like an idiot!
Yup, I hear this one a lot! WHat would you do three hours into your shift if you were asked something that you didn't know? Say let me go find that out. OR, here is an idea, let the patient tell you their side of things before you go read the chart. I often love when I hear that the patient asked about a lab value and the nurse felt dumb or on the spot. Today we have al electronic medical record a our finger tips. USE IT!
Mr. Smith, I'm not sure what your potassium was this morning. As soon as I'm done with report I will look it up and let you know.
Wow, terribly hard!
There are more excuses that the above 5, however I am done entertaining them. People can make excuses to get out of anything in life. You just got to want to do the best for the patient and leave your whining at the door!
Remember when I said Bedside report saves lives? Well let me share a few stories to prove this.
Bed Side Report Saved My Life!
This is one of my favorite stories to share about bedside report. I have changed details, rather used a general theme to avoid any HIPPA violations. Enjoy!
I worked the night shift and just wrote down my seven patient assignment. I grabbed the nurse and told her to let's go do report. Of course her reply was, well the patients are sleeping and good so we can at the desk. No, we can do most of the talking after but let's go see the patients.
I love saying that as the eye rolls and sighs don't bother me. Why? Because I am not there to be friends and to do whats best for the nurse, I am there to make sure the patients are doing well. To make a long story short, as we walked into the third patient's room, who was just taken off telemetry an hour or so prior, I noticed something strange. As we walked close it hit me. The patient wasn't sleeping, he was dead!
We called a code and performed ACLS procedures and were able to get him back. He was vented, but alive. As I helped transfer him to the ICU, the previous nurse looked at me with those eyes. I will never forget it. She said "thank god you were pushy or he would have died!"
Imagine the alternative. Sitting at the desk, then figuring out which sleeping patient to see first, I means since the were all doing so well. By the time I found this patient it would have been too late.
Bedside report literally saved this mans life and I am proud of that!
As a manager and supervisor I glow when the nurses share their experiences with me. I often hear, "I am so glad I met the patient and had a baseline validated by the recent nurse because I was able to pick up a change in condition quick!"
OK so don't lie here! Honest reflection. How many times do you enter a room and think "have they been like this all evening shift or is this new." hen ou read the chart and try to ask others as time goes by. You figure out it is a change and now your back peddling to improve things. Imagine if the nurse who cared for the patient all evening was right there to say "that's not how he looked 20 minutes ago!"
BAMM...Quick response with no guessing. I love it
Bed Side Report - Extra Perks!
If you new company was coming over would you clean our house? Chances are you would. The same thing goes for report.
You receive report at the desk and the nurse goes home. You enter a room to find the IV blown, the patietn lying in wet linen, with garbage on the floor. UGH! What the heck!!
I tell the nurses this. Let this happen once and see how the nurse leaving you like will respond. Of course you need to point this out. "SO before you leave we need to clean this room up"
Next time I think the nurse may have things more in order. Make them accountable by going into the room together.
If your the messy nurse who doesn't care about what I just mentioned. SOrry, maybe nursing isn't for you!
MSN Students Capstone Project - I enjoyed reading this. The authors did an amazing job
Bedside Report Improves Patient Care and HCAHP Scores! Read this Medscape Article
Premier Health Nurse Newsletter - Great Article on Bedside Report
i recommend John Kotter change theory to help implement bedside report.
Step 1 of this theory is to increase the urgency. Before you roll out bedside report or even discuss it, the first thing you want to do is show the nursing staff that change is needed. Look for trends to show change is needed, such as poor patient feedback, staff comments on report issues, lack of updates whiteboards, even trends is falls or pressure ulcer, Once you identify issues you want to fix, the nursing staff is on board with a solution. Why? Because this is how nurses think. We want to fix things, even when we don't know how.
Once this buzz is generated, help the nurses find the solutions. Trust me it will point to bedside report. The literature is everywhere on how this initiative improves many things from staff satisfaction to improved patient outcomes.
Now the level of urgency is set that a solution is needed. As you "discover" bedside report, it will be seen as a solution rather than something administration is making us do.
Build a team of clinical nurses and managers to help share this much needed initiative to the rest of the departments. You will build a vision and share this to establish buy-in from majority of the staff and the rest will be simple.
Of course planning the education and training is not simple, however getting buy in and people to actually show up and do this should come before, not after. This is where implementation often fails many places. Start the buzz first then plan a solution and people will help out and want to get on board. Then monitor it and show data to support how the initiative worked. There you go, implementing bedside report in a nutshell. Now go do it!
I worked with an implementation team who really followed this and bedside report did great. We shared quick wins and success stories and even got some of our late adopters to be on board. When this initial investment is not done, disaster can happen. I have worked where everyone thought bedside report was happening, yet the nurses didn't even understand what or why they were to do it. If nurses don't understand the why and how, they will resort to what they know best. Put in the initial energy, plan it out, create work groups o start the buzz and then implement!