/clinical/,/clinical/nursing-hub/,/clinical/nursing-hub/tools/,/clinical/nursing-hub/tools/bedside/,/clinical/nursing-hub/tools/bedside/promote-action/,/clinical/nursing-hub/tools/bedside/promote-action/resources/,

/clinical/nursing-hub/tools/bedside/promote-action/resources/UW-Hospital-Bedside-Shift-Report-Observation-Feedback---Staff.pdf

20150370

page

100

UWHC,

Nursing,Quality,

Clinical Hub,Nursing Hub,Nursing Practice Tools and Resources,Bedside Shift Report,Promoting Action and Adoption,Resources

Bedside Shift Report Observation Rounding Log – Staff

Bedside Shift Report Observation Rounding Log – Staff - Clinical Hub, Nursing Hub, Nursing Practice Tools and Resources, Bedside Shift Report, Promoting Action and Adoption, Resources


UW Hospital Bedside Shift Report Observation Rounding Log – Staff 
Date_________________ 
To____________________________  From_______________________________ 
I have rounded on some of your patients today. I have asked them about their care and how bedside 
report has been. Here is your personal feedback, based on your patient’s perception and my 
observations. 
Room numbers_______________________________________________________________ 
Activity/Behavioral Items  Excellence Achieved  Opportunities for Improvement 
Introduced oncoming nurse to patient 
 
  
Managed up the oncoming nurse 
 
  
Nurses stood near patient so they could 
be seen by patient 
 
  
If visitors were in the room – asked 
patient permission, or asked them to 
step out 
 
  
Included patient in the report 
 
  
Checked all high alert medications 
 
  
Completed line reconciliation 
 
  
Incorporated SBAR in report 
 
  
Overall Comments: 
 
 Instructions: 
1. To be completed by the Nurse Leader or Nurse Champion through observation 
2. 3 observations every 3 months for a total of 6 months 
3. More observations if additional coaching is needed 
4. Assure all staff have process hardwired into practice 
5. Maintain staff check off list for each unit and float pool staff