Picture this...a crowded room with five chairs, standing room only for two dozen nurses and ancillary staff, a noisy icemaker, talking, interrupting, loud laughter, last shift's crumbs and trash on the table, and trying to listen to report about the entire birth center. Add in a nice dose of claustrophobia and not being able to go out to the unit until 0712 to receive report on your own patients: four mother-baby couplets...just as the call lights start ringing incessantly. Furthermore, by the time the entire unit has finished report, it is late enough that couplet care nurses from the previous shift are not getting out on time. This is basically how report has been going on for years in my unit, and to my knowledge there have been no attempts or discussions on how to make it faster and less stressful.
First of all, if I could design and implement a way to streamline report, I would completely separate couplet care from L&D and nursery.
1. Nursery needs to go to report with L&D so they know the patient census and impending deliveries they will be attending. It is important that the nursery nurses know of any risk factors before deliveries, and if there are any scheduled c-sections to prepare for. They helps them plan their assignments.
2. L&D will be able to look at the patient census on the computer 'chalkboard' in the main report room, and discuss their patients, nurse assignments, and who will attend to triage and the OR. They will be advised of the couplet census and expected number of discharges (r/t room availability). If they have a delivery, the chalkboards have the room number their couplet will move to as well as the name of the couplet nurse for report. Nursery will discuss their plans r/t assignments and special care babies.
3. Couplet care will use a different report room to view the chalkboard for census and discharges, as well as impending deliveries and which nurses are expected to take the first few admissions. They will receive their paperwork/patient profiles. Any discrepencies or nurse/room changes can be worked out in a quieter, calmer atmosphere. This report will enable them to be out of the group report more quickly and to get their individual patient's report from the nurses on the previous shift.
4. Important notices: nurses will be notified by the charge nurses if there are patient name alerts, visitor issues, risk for violence, computer problems, maintenance in room 301 today, etc.
5. Not-so-important notices: Will be written in a binder in both report rooms. Each nurse is expected to sign or initial that she read them each day that she works. (Typically these include topics such as "sign your timecards", "there is a staff meeting next week", "we are taking up donations for our 'adopted family' for Christmas", etc. This would be very helpful to nurses in our unit because we work 12-hour shifts and many nurses are part-time or PRN. Often we are off for three or more days and don't know what has been going on.
Because the number of our staff has increased significantly over the past four years which causes space and communication issues, I believe that this could be implemented by our unit.
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