Patient Handoff Process

I have been asked to conduct an informal survey to see how one nurse hands-off a patient to another nurse at the end of their shift. Our hospital uses a mix of the following:

- Nurse-to-Nurse discussions (nurses meeting face to face to brief each other on their patients)
- Audio tapes where a nurse records notes and leaves the tape for the next nurse to listen to including start / stop times on the tape
- Written notes / charting from the current nurse left for review by the new nurse

If you have time, please let me know how your hospital manages this process. Also, if you have seen any process or products which are more efficient than others, please let me know.

Thank you for your input!
We do bedside report. "Hello Mrs. Smith, this is Jane, she is a registered nurse, and she will be taking care of you tonight. Is it okay if I discuss with her what brought you in to see us and what's been going on since then? You can feel free to contribute anything you'd like to the discussion as well..." There are a lot of pluses and minuses to the concept of bedside report imo. It's great because it reinforces the patients plan of care and allows them to ask any questions they have. It also holds the other nurse accountable. The patient is in pain, didn't receive dinner, and his water pitcher empty and urinal full? Oh you wouldn't mind taking care of that before you leave would you? Also if the patient has a piece of equipment or special instructions on the use of equipment it allows you to review that with the nurse who used it last shift and you can ensure the rational behind things (pts dose of coumadin was held, why was that? does the doctor know? Is there an order?) and you can get all your questions answered. The downside is on complex patients this can take forever. An hour to get report on 4 patients is not unheard of, especially as you have to wait for the offgoing shift to be available to report. Offgoing shift had a code/crt in the last five minutes of their shift? You can expect to be waiting for an hour or so to BEGIN to get report. Overall though I'd rather it take long and get my questions answered than anything else and it has improved our patient satisfaction scores.

We do written report. On the computer. The plus side is I can go back over several reports to see things that need following up. Esp helpful when all night shift writes is "pt slept". There is some talk of us going to bedside face to face. Have to admit, I'm dreading this. There are several people on night shift (this is NOT a night shift put-down) who are NEVER on time. One person is general can be up to 20 mins late. If I have to wait for her, then given bedside report, I will NOT be a happy camper!

We use a combination of written information as well as a verbal face to face. A report consists of 2 main categories; The Data, and The Story. The Data is best communicated in written form, but the Story is best communicated verbally in the form of a conversation. We can usually hand off up to 6 patients using this system in under 30 minutes.The Joint Commission does have standards you can refer to if interested, one of them requires that patient hand off's have an "interactive" component, with an opportunity to ask and answer questions.There are other hospitals in our system that still use a recorded report. I'm not sure how they get around the issue of patient abandonment which requires that the handing off nurse confirm that the receiving nurse has "received and understood the report" prior to discontinuing care, but maybe it is only my state that uses this requirement.There was also a recent meta-analysis of patient hand-off formats, while it didn't come to any clear conclusions about exactly what style should be used, it did find that in general a combination of written and verbal report was the most effective.

Seems that although bedside is the most complete...there would be some pts/families who try to siderail the report-also...certain areas might best be mentioned out of earshot of the pt...

Previously, all of the oncoming RNs and LPNs would sit in a report room and take report on EVERY patient on the floor (not just the ones they were responsible for) from the offgoing shift. Pros: You knew the basics of what was going on with every pt, in the event of an emergency (the pt's or the nurse's) you could step in and help without being totally lost. Cons: We have a 36 bed unit. Report typically took an hour which means the offgoing shift got a lot of overtime and the ongoing shift was already an hour behind.Now, we do bedside report, and take report only on our own pts. Pros: We get to meet the pt, the pt can remind the nurse of something he/she may have forgotten, report gets done in 15-20 minutes as opposed to an hour. Cons: Pts and their families can hold up report by asking questions, pt usually uses this opportunity to need to go to the bathroom, privacy concerns for pt if family is in room or even for pt, if Dr has not informed pt of something yet.

At two facilities where I worked the nurses did verbal report at the nurses station. At a third we were required to do walking rounds. I now work in home health. I give verbal report to either the oncoming nurse or the family member who will be taking over care of the patient. The written documentation from the previous shifts are available in the field chart to be read when the nurse gets a chance, as is the charting in the facility medical charts. Most nurses have to make time to be able to read any kind of written documentation.

We are an ICU so we do face to face report. The hospital is now pushing us to use SBAR (Situation-Background-Assessment-Recommendation) which is a specific verbal report format. Apparently JCAHO buys into this or we wouldn't be doing it.

I am a new grad nurse, and the floor I'm precepting on does no actual "report". We make sheets (similar to SBARS), fill in the information, and they get put in a pile for the oncoming RN to have. If they read these sheets and have questions they come and ask for some verbal info.This is my first nursing job, but I was a tech for 3 years where we ALWAYS did verbal report and during first and second shift, walking report. I loved that. I had an idea of what was going on, who was who.This whole paper sheet filled out and left in a pile, IMO stinks. I wanna see the patient and I want you to tell me a run down of the day. It makes life easier than just reading lab work, finding old notes and reviewing data to form a picture of the patient. I like taking care of people and that includes hearing what was going on, not just reading the guy in room XXX has a lab value of XXX.Kelly

When I worked in LTC we taped report for the oncoming shift. Worked well since we had 16-18 patients and generally it was the same thing day after day. In my new job on a stroke/medical floor, we do face to face report. It usually works well. It can take some time if you aren't giving all your patients to the same person. We do round after report to inform the patient who their new nurse will be and to check to see if anything still needs to be done.

In my LTC we use a combo of face to face and taped. I prefer face to face, hearing "patient is fine no problem" 48 times is not helpfull. Face to face allows me to question.. when was thier last PRN, BM, how is thier breathing today?? Takes longer but I feel more prepared to face my shift.