Don't miss key details: Do face-to-face reports
You might assume that if an oncoming ED nurse doesn't ask you any questions, she's got all the information she needs. A better practice is to verbally review the patient's situation while standing together at the bedside, says Laura Aagesen, RN, BSN, MBA, trauma coordinator at Northwest Community Hospital in Arlington Heights, IL.
"This gives not only continuity of care, but eliminates the dangerous length of time that patients are unattended during shift change," says Aagesen. "Bedside reporting ensures the nurse coming on duty is fully apprised on her patient's condition and status of patient's course of treatment."
This bedside reporting is a good way for both nurses to "get a visual" of the patient's current condition, including vital signs, intact intravenous lines, chest tube drainage, or medications infusing, Aagesen says.
"Both nurses meeting together gives the shift report a more thorough checklist," she says. "The patient, if responsive, is also involved in their course of treatment, diagnosis, and disposition, with the opportunity to ask questions and voice concerns."
Elaine Marshall, RN, BSN, MHA, an ED nurse at Rex Hospital, Raleigh, NC, says to take these steps:
1. Review why the patient presented to the ED.
"In addition, review this reason with the patient and family when you first introduce yourself," says Marshall. "There are times when there are discrepancies in the report."
Marshall once learned from a family member that a chest pain patient had fallen. "This piece of information led to the patient receiving an X-ray, which had not been ordered previously," she says. "The patient had a hip fracture as well as her chest pain."
If the patient has been in the ED for a lengthy time and has been through more than one nurse handoff, then "the original story is often lost," says Marshall. "I would equate it to when we played 'telephone' as children. The story changes as it gets passed along. Key details might be lost."
2. Review the documentation to be sure it supports the verbal report.
"Review by both nurses oncoming and off-going of all active orders should be done at the time of hand off," says Marshall.
Rex Hospital's ED nurses report off to each other in front of the open electronic medical record. "Our facility has created an 'SBAR Tab' within each patient record," says Marshall.
This tab compiles date from various parts of the record and organizes it into the categories of Situation, Background, Assessment, and Recommendation. Current orders for that patient also appear. "Our nursing staff is encouraged to use this tab for the initial report and then review the orders tab with each other to determine what active orders still exist for the patient," says Marshall.
3. Do not hesitate to hold others accountable for their documentation and report.
"This is not meant to be confrontational, but to provide the best patient care that we can," says Marshall. "No one should feel offended when one nurse reminds another to sign off on an order or chart a response to a medication."
Likewise, if you note a significant change when reviewing vital signs, don't hesitate to ask if the ED physician is aware of this change or if it already was addressed.
At a facility where Marshall worked previously, ED nurses didn't routinely review patient charts together. "This resulted in two medication errors that were of great significance, as a nurse had not charted a medication that she had given," she says. "I firmly believe that if the two had reviewed the orders and notes together, the errors would have been avoided completely."
Sources
For more information on bedside handoffs, contact:
- Laura Aagesen, RN, BSN, MBA, Trauma Coordinator, Northwest Community Hospital, Arlington Heights, IL. E-mail: [email protected].
- Elaine Marshall, RN, BSN, MHA, Emergency Department, Rex Hospital, Raleigh, NC. E-mail: [email protected].
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