EP19-2 Joint Bedside Report from the Advisory Board
From: Nursing Professional Development Council Sent: Mon 12/5/2011
To: Nursing Practice Council, Managers Subject: Article from the Advisory Board
Successfully implementing joint bedside report on a critical care unit
Recently, Jennifer Stewart, the Center's practice manager, interviewed Donna Morehead, MSN/INF, RN, NE-BC, nurse manager at Baylor Medical Center at Irving, about her strategies for successfully conducting joint bedside report on her critical care unit. Joint bedside report was initially introduced on Donna’s unit in 2007 and isnow the primary method of handoffs at Baylor Medical Center at Irving. Joint bedside report offers an opportunity to enhance bedside nurse critical thinking, peer collaboration, and elevate care quality.
How would you describe your unit to someone unfamiliar with it? I manage a 14-bed critical care unit that generally cares for post-op patients requiring intensive care, along with patients experiencing renal, respiratory, and hepatic failure. My unit is staffed by a diverse team of 35 RNs (31 full-time, 4 part-time) who work 12-hour shifts from 7 a.m. to 7 p.m. and 7 p.m. to 7 a.m. My RNs range from having less than five years of experience to having more than 30 and 85% of them are prepared at the BSN level or higher. We do not have a dedicated clinical nurse specialist or clinical nurse educator, but we do have a unit supervisor who works nights and weekends.
What is your unit’s nurse-to-patient ratio? Most nurses are assigned to care for two patients. We occasionally have severe-acuity patients that require one-to-one nursing. Patient assignments are made by the previous shift; the night shift makes assignments for the day shift and vice versa.
Do you have any dual occupancy (or semi-private) rooms? All rooms on our unit are private. However, they are close together and there are doors between them.
How did joint bedside report begin? Believe it or not, we never set out to create joint bedside report. In 2007, we had a relatively high pressure ulcer rate. When the unit council evaluated possible causes, we noticed that because closing out a shift can take a nurse several hours, many nurses began the process early. For example, in preparation of the end of a shift at 7 a.m., a nurse might turn a patient for the last time at 5:30 a.m. Due to the change of shift, however, that patient might not be turned again until 9 a.m., putting them at risk for a pressure ulcer.
To solve the problem, we decided to have each patient’s on-coming and off-going nurse go into the patient’s room together at shift change to turn the patient and perform a skin and wound assessment. The nurses gradually improved the process from just focusing on skin and wounds to completing a head-to-toe assessment. It was a nurse-driven movement to take it to a full collaborative bedside report.