7AM–8AM: Bedside Shift Report and Prioritization (Nursing)

00:01 Let's now get down to the nitty gritty.

00:03 How do we do bedside shift report? And this is how we're going to start our day.

00:08 So if you take a look at this image on one side of the screen, you're going to notice throughout the presentation, there's a little clock there just to kind of let you know where we're at in our 12- hour shift.

00:18 So of course, before we start, we want to make sure we knock on the patient's door before we go in.

00:25 Make sure of course, to introduce yourself and your colleague and explain what you're doing.

00:30 So who this is usually going to consist of is the off-going shift nurse and the oncoming shift nurse.

00:36 Next, this is a great time to go ahead and open up the electronic health record if you have one in the patient's room.

00:43 And then we can check in here.

00:45 This is also helpful to have the patient's data in front of us and make sure we have the right patient identifiers.

00:52 Now with the oncoming and the off-going shift nurse, we're going to conduct a verbal handoff report.

00:59 Now, this is really important because this is going to help include the patient and we're going to talk from the night shift nurse about what occurred to the day shift nurse, so we know exactly what went on in the previous shift.

01:13 Now during this time, this is a great time to perform what we call a focused assessment.

01:19 Now here's the difference guys, we talked about a head to toe assessment, right a thorough one, from head to toe in nursing school all the time.

01:28 But at this point, this is right when we start our shift, we have our upcoming shift with us we're in the room with the patient, and we're doing what we call maybe a general survey.

01:38 So we're going to look at, hey, what infusions are hanging? Are they breathing okay? What lines, what catheters do the patients have? I also kind of like to say that this is eyeballing the patient if you will, because we're not necessarily doing a full head to toe assessment here.

01:55 Because again, we're just making sure and checking on the patient's safety at this point.

02:00 Next, this is a great time to review the plan of care and the orders as well.

02:05 Then this is again, we've talked about this earlier, but this time, if we want to include the patient in the conversation, you may think, "Okay, well, that's a little odd to talk about the patient, they're standing there." This is a key piece of bedside shift report.

02:21 Now the reason why we do this is this is meant to include the patient in the plan of care.

02:27 Also, they're going to check us for accuracies actually, they may say, "Wait a minute, the night shift if you remember, we actually did this.

02:35 This medication didn't work for me, we try this instead." "Oh, yes." So it's also really good to make sure you include them in the conversation.

02:43 Now once we've done that, just keep in mind all of these steps, this was for one patient or we're going to give thank our patient and then move on to our next patient that were assigned to.

02:55 Once we perform bedside shift report on all of our patients, what are we going to know after this information? Well actually guys quite a bit, we're going to know the physical condition of the patient from our focus assessment.

03:07 And again, guys, I can't stress this piece enough, I will tell you, there's many times that right when you come on shift or right when you're exiting shift, sometimes there's some single events or some adverse effects that happened to the patient.

03:21 So it's important at this time frame that we go in, do a quick general survey or focus assessment to make sure the patient's safe.

03:30 Now, after that bedside shift report, if you remember, we talked about key events in the plan of care, we know a little bit about their medication, or excuse me, their medical history, their information, the baseline condition of the patient, and any immediate needs that the patient may have.

03:49 Now, once we've gathered bedside shift report, here's the thing to keep in mind.

03:53 This could be a report on one patient, it could be on seven, it just depends on where you're working at that point.

04:00 So typically, when you're talking about, oh, maybe a team of five, for example, it's going to take at least like a half an hour or so give or take on your time of the day.

04:12 But once we gathered that information, what do we do next? Remember, we have to prioritize.

04:17 This is one of the biggest things for new students to learn.

04:21 Now, if you remember when we prioritize, what are the first things we got to know? Oh man, those ABCs, right? Airway, breathing, and circulation, that's super important in the condition and the status of our patient.

04:35 So make sure once you've gotten that information, you're considering these 3 things on who you may need to see first.

04:43 So consider the whole picture of your assigned patients.

04:47 Now what's going to matter what you gotten bedside shift report of who you're going to see first.

04:52 So of course, we talked about the ABCs.

04:55 It's going to depend actually, what your patient feels like? What their condition is? Maybe are there any stat orders meaning they have to be done right now? Are there medications that have to be done quickly? Are there critical lab values that have to be addressed? Also keep in mind any outcomes and your patient goals.

05:14 So here's a great example of this.

05:16 Maybe you get a report on a few patients, maybe one patient is...

05:22 maybe they're struggling with constipation after surgery and their vitals are stable.

05:26 Their condition is stable.

05:28 They're just trying to facilitate about mimin.

05:31 Maybe your other patient, however, is having active chest pain overnight.

05:36 They're stable for the moment, but we may need to go see them first over the constipation patient.