Inevitably two things happen after the off-going shift leaves. The first is that lots of people will impatiently ask you many very specific questions about this person you only just met. Keep in mind that all these questions they’re asking, all that happened when you weren’t around.
1.) PATIENT DEMOGRAPHICS
Begin with the patient’s demographic info. “Suzy Que, 78 yo female, MRN 866952”
2.) HEIGHT, WEIGHT, IV ACCESS and ALLERGIES
Next give the height (in cm), weight (in kg), IV access and any allergies. This way, if Suzy Que decides to up and code in the middle of report, your relief nurse knows the necessary information needed to pull and administer meds.
3.) REASON FOR ADMISSION
Next give the reason for admission and admission date and try to be brief. Two sentences kind of brief, if possible. “Suzy was found down on 11/8/23, in the shower at her nursing facility. She was obtunded, EMS intubated in the field and …”.
4.) HIGHLIGHTS OF HOSPITAL STAY
What are the highlights of their hospital stay? Did the ED intubate, cool them, rush roll them to OR? “…when she got to the ED, they scanned her head, saw a SDH and a 6mm midline shift to the left so sent her to the OR for an evacuation and EVD insertion. She got back to us and we’re transducing ICPs and art line pressures and doing q1hr neuro checks.
5.) WHY THEY ARE IN YOUR UNIT
Why are they still here? “We extubated her yesterday, and are still monitoring her ICPs and titrating her off phenyl” or ,”They’ve already got transfer orders. We’re still waiting on a medsurg bed. “
6.) HEAD TO TOE
Talk your relief through a thorough head to toe, system by system.
- Neuro
- Cardiac
- Respiratory
- GI
- GU
- Skin – Include all lines, drains and tubes with volumes and visual description of outputs as well as any bruises, wounds, lacerations, dressings etc.
- Restraints – Do they need a new order? How is the skin underneath?
- Consents – Who signs them? If it’s not the patient, get the contact info for the patient who does.
There will be a later entry about how to give a thorough head to toe. It will be linked in here when it’s posted.
7.) IMPORTANT SHIFT TIMEPOINTS
Tell them the important timepoints to know.
- next labs
- next meds
- upcoming scans/procedures
- dressing/line changes
8.) BEDSIDE MEET AND GREET
Actually meet your patient and introduce yourself. If off-going nurse is awesome, they should talk you up to the patient. After meeting them, check out the real estate and with the off-going nurse, assess their lines, tubes, drains, incisions, dressings, and anything else that the patient wasn’t born with. Look at their sacrum and evaluate it for pressure ulcers. Look at their heels and the back of their head if they’re bed bound.
Please don’t rely on the chart because the reality is that too many nurses copy and paste their assessments and they’re not always accurate. If you don’t look over these things, with the off-going RN, how else are you going to know if something has changed? When it comes down to it, it’s your job to know these things, and the last thing you want to tell the attending, when they ask you about these details is, “I don’t know.”
9.) VERIFY DRIPS AND DRIP RATES
Verify IV drip rates at the bedside. If a bag is close to running out, have a new one ready for them to spike. It’s the kind thing to do.
BONUS - "ARE YOU BACK?"
Cross your fingers that at the end of your shift, you get to give report to the same nurse. Jackpot if your report is, “Nothing’s changed at all with patient, all dressings and lines are up to date and I just hung fresh bags of all fluids/meds. Foley is tipped. Questions? No?,” then bounce out immediately. Strong work, pat yourself on the back.
