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B d id Shift Report
Bedside
R
t
(
(BSR)
)
Bedside Shift Report
•
The Canadian Council on Health Services
Accreditation (CCHSA) suggests patient safety
can be impro
improved
ed b
by emplo
employing
ing effecti
effective
e
mechanisms for transfer of information at
interface points including shift change
change.
Purpose of BSR
•
•
•
•
•
To place the patient central to all information
involving their care
To promote patient safety (PALE)
To improve the effectiveness of communication
among caregivers
To allow opportunity for caregivers to ask and
respond to questions
To provide a standard approach to handoff
communication
Benefits Of Bedside Shift Report
•
Allows the incoming nurse to visualize their patients earlier in their
shift
hift
•
Allows confirmation of previous shift report information between
the outgoing and incoming staff members
•
Gives patients and families the opportunity to ask questions and
clarify information
•
Patients and families are seen as partners with staff and
Physicians in enhancing patient safety and understanding their
plan of care
p
Patient Participation Principles
Patients are encouraged and supported to participate in
the level of care and decision-making desired, building on their
strengths to enhance control and independence.
•
Will vary from patient to patient.
•
Can vary from day to day:
•
Physical/emotional/cognitive factors
•
Clinical condition
•
Competing
C
ti responsibilities
ibiliti
• Home and work
Patient Participation
p
•
•
•
•
BSR must happen in the patient’s room with the
patient and/or family.
This includes isolation rooms.
Involving patients in report must be individually
d t
determined.
i d
Some patients may prefer passive engagement
(
(e.g.
jjustt listening).
li t i )
Family Participation
•
The patient must give consent for any family members to be
present during the BSR
•
Families are seen as active allies/partners in the patient’s plan
off care
•
Families are encouraged and supported to
participate in the nurse change of shift report when consent is
given by the patient
•
Participation will vary from family to family.
Benefits of Patient and Family
Presence/Participation
•
•
Opportunity for the bedside nurse to receive
information from the patient and family.
Patient’s
Patient
s and family may clarify misinformation
• 4 Drains not 1
• CXR already done
• Doctor said he can go home
BSR Confidentiality Concerns
•
•
•
A Privacy Impact Assessment has been
completed by Covenant Health’s Information
and Privacy Department.
Consent/permission for the BSR will be
obtained with the patient at each shift change.
If family members are present during the BSR,
we need to ensure that we ask the patient’s
permission to have the family present.
Sharing
g of Sensitive Information
•
•
Use critical thinking/ judgment to guide the
information that is discussed and your response to
information that is being shared
shared.
If there is information that you feel should not be
shared out loud,
loud the outgoing/incoming Nurse can
speak outside of the room after the BSR is
complete.
p
The 4 Components of BSR
•
•
•
•
BSR Forms & Patient Status Update to Charge
Nurse
Shift Introduction
Outgoing Nurse & Incoming Nurse Roles
Charge to Charge Report
Bedside Shift Report Forms & Patient
Status Update to Charge Nurse
•
The Outgoing Bedside
Nurse will be filling out prior
to the end of their shift to
g
discuss with the incoming
Nurse.
Bedside Shift Report (BSR)
Diagnosis: _________________________________ ADOD: ______________
Patient Label Where the patient is from: _________________ Mobility: __________________
Goals of Care: _________ Additional Precautions: _______________________
Date:
Nights
Days
Evenings
Significant Vitals
(T, HR, BP, RESP, O2 sats)
Chem Strips
IV – Rate / Site / Solution
In/Outs
Drains/Wounds/Skin
Condition
Elimination
•
The Bedside Nurse will
update the Charge Nurse
with patient status changes
provide information for
to p
Charge Nurse to Charge
Nurse Report.
Diet
Tests/Procedures
Behavior
PRN Medications Given
Abnormal Lab Work
Patient Concerns/Notes
Safety Checks: (PALE)
Up date every Shift:‐ Medworxx Kardex medicus White board Patient
Identification
Lines/Drains and Airway
D
Name Band Visible
IV Pump & Line Verification/Dated
Allergy
Band/Allergies Reviewed
O2 (Connected, Modality, Rate, Position)
E
Fall
Drains/Foley/Suction (Patent, Connected, Empty)
Risk Updated
Alarms
Environmental Scan (Ask 3, Room Tidy, Call Bell)
N
Prior to Change of Shift
The outgoing/incoming Bedside Nurses
must review the Unit Assignment Sheet
to find out who they are giving/receiving
report to/from.
Shift Introduction
Is a quick two-five minute team
h ddl lled
huddle
db
by th
the Ch
Charge N
Nurse
at the start of each shift
summarizing:
GNCH “Shift Introduction” Agenda (Test Concept Units)
Date_____________
I.
Unit____________
Key Concepts for the Day:
A. Key Messages
B. Commitment to Action
C. Patient Safety
•
•
•
•
Key Concepts for the Day
Operational Review (How we
are doing on measures of
interest)
What’s happening today on
your unit
Staffing Variances
II.
III.
IV.
V
V.
Introduction of New Staff to the Team:
Education:
Family Conferences:
What’s
What
s Happening Today:
A.
Today’s Discharges/Patient Transfers
B.
Potential Next Day Discharges
C.
# of OCP beds
D.
Observation/Certified Patients
E.
Patient Appointments (Refer to Fasting Book)
F.
# of Isolations
G.
Diagnostic Imaging/Procedure Patient Preparations
(Refer to Fasting Book)
H.
Sickest Patients on the unit/ Compassionate Care
Charge Nurse to Charge Nurse Report
After the Shift Introduction, the Incoming Charge
Nurse and Unit Clerk will receive shift report
(patient status updates) from the Outgoing Charge
Nurse on each patient.
p
The Charge to Charge report will occur while the
g bedside shift report
Bedside Nurses are receiving
Bedside Shift Report-Every
Report Every Shift Change
Outgoing
Outgo
g Bedside
eds de Nurse
u se
Prior to end of shift completes the
Bedside Shift Report Form &
provides Patient Status Updates
to the Charge Nurse for next shift
At Patient
Patient’s
s bedside provides
bedside shift report with Incoming
Bedside Nurse & Patient
Completes Patient “Safety Check”
Incoming Bedside Nurse
Receives shift report at the
Patient bedside
Updates the Patient
Whiteboard
Completes
C
l
P
Patient
i
“S
“Safety
f
Check”
BSR Introduction Script
Outgoing
Outgo
g Bedside
eds de Nurse
u se
“Hello Mr./Mrs. XXX, I’m going home
now. XXX will be yyour nurse
today/tonight. Is it ok if I discuss our time
together with XXX ? Could you please
Incoming Bedside Nurse
“Hello (patient’s name), it’s nice
to meet/see you”
(as you are checking the patient’s
wristband 2 p
patient identification))
tell XXX your full name and date of
birth”.
“Please
Please listen and share any other
information you would like us to know”
***“I am going to update your bedside
whiteboard”.***
hit b d” ***
Giving Bedside Shift Report
Outgoing
Outgo
g Bedside
eds de Nurse
u se
Describe why the patient was
admitted (Diagnosis/plan)
Provide the patient status update
from your shift (using the BSR form)
Safety checks (PALE) with Incoming
Nurse
Prior to departure
p
from room-“You are
in great hands. Thank you for
allowing me to care for you”
Incoming Bedside Nurse
Receives report
Safety checks (PALE) with
Outgoing Nurse
Prior to departure from room- “I
will
ill b
be b
back
k shortly,
h tl I will
ill need
d tto
receive report on my other
patients”
Handoff Between Different Shifts
As yyou are waiting
g to g
give/receive yyour BSR :
•
Start to update your bedside whiteboards (date
and names))
•
Review your patient MAR and organize your
medication carts
•
Answer any call bells
•
Tidyy up/prepare
pp p
p
patient bedside for the shift
Bedside Shift Report Video
http://www.youtube.com/watch?v=hbxPRhttp://www
youtube com/watch?v hbxPR
ra6RE
Frequently Asked Questions
What if the patient asks too many questions during the
BSR?
“Mrs. Smith, great question. Let Becky and I check
all of these IV drips so we don’t
don t make a mistake
and then I will answer your questions”
Frequently Asked Questions
What if the outgoing
g g nurse is delayed
y due to
an emergent situation (code blue on the unit at
shift change)?
•
It will be the charge nurse’s
nurse s responsibility to
reassign patients or provide the BSR for the
incoming
g Nurse ((as they
y would have received the
patient status update from the outgoing nurse prior
to shift change)
Frequently Asked Questions
What if the patient has not slept all night or has had a
difficult/exhausting day?
•
You may choose to give the BSR outside of the
patient room,, but the safetyy checks must still be
p
completed by the outgoing and incoming Nurses
together.
Frequently Asked Questions
How do we get report for our partners patients?
•
You buddy nurse and other Nurses on the unit
will have access to the BSR sheet to refer to at
all times if need be
•
You will also give your partner nurse a handover
report on your assigned patients when you leave
the unit for a break.
BSR Scenarios/Role Play
Getting
g Started: Create g
groups
p of threes & designate
g
roles
• Outgoing Nurse -fill out a BSR form for one shift
& review the outgoing nurse script on process
tool & scenario cards
• Incoming Nurse - review incoming nurse script
on process tool
• Patient
P ti t / family
f il memberb
review
i
scenario
i card
d