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Bedside Shift Report
Bedside Shift Report
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Created by Qualaris Staff
Inpatient Nursing
Learn more about managing Nursing data with Qualaris
Table of Contents
Audit Form
Audit Form
Bedside Shift Report
Description
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Required
Observed Date
Unit
ED
ICU
Med-Surg
PACU
Rehab
End of which shift?
Day
Evening
Night
Was the bedside shift report conducted in the pt room?
Yes
No
Were all appropriate staff in attendance?
Yes
No, outgoing nurse missing
No, incoming nurse missing
Checklist
Mark all as...
Did staff invite patient and family to take part in bedside shift report?
Yes
No
Did staff open the EMR in patient's room?
Yes
No
Did staff identify themselves and give their positions?
Yes
No
Did staff state and confirm the patient's name?
Yes
No
Situation: Did staff give a clear, concise overview of the patient's current situation?
Yes
No
Background: Did staff state the relevant history pertinent to the problem?
Yes
No
Background: Did staff describe treatment/clinical course summary & any pertinent changes?
Yes
No
Assessment: Did staff offer their conclusions about the present situation?
Yes
No
Recommendations: Did staff explain what they think needs to be done, what the patient needs and when?
Yes
No
Did staff review patient's goal from previous shift report to see if it was met?
Yes
No
Did staff visually inspect all wounds, incisions, drains, IV sites, IV tubing, catheters, etc?
Yes
No
Did staff visually sweep the room for any physical safety concerns?
Yes
No
Did staff review next steps?
Yes
No
Did staff state who is responsible for which tasks?
Yes
No
Did the staff ask the patient and family about their needs and concerns?
Yes
No
Did staff ask the patient and family what the goal is for the next shift?
Yes
No
