Sustaining Bedside Report Collaborative Outcomes Council Update September, 2016
Background A well-established best practice that improves communication, supports patient safety and patient satisfaction Communication becomes more professional Improved HCAHPS in nursing communication Improves safety and supports early detection of deterioration Identified as a best practice at UCLA in 2011 and implemented 2011-2013 across the health system Attributed to increasing patient satisfaction scores in nursing communication 2
Feedback from Units Success stories Nurses getting out on time, length of report the same or shorter Great safety catches, i.e. disconnected IVs, disconnected chest tubes, bleeding, over sedated, neuro status, code stroke Positive comments from patients and families Decrease in number of call lights during change of shift Decrease in falls during change of shift Improvement in sepsis screening accuracy and bundle compliance Nurses like the process! 3
Barriers Common struggles Resistance to change RNs uncomfortable discussing sensitive information in a variety of situations and environments, i.e. semi-private areas, sensitive histories such as psych issues, cancer, drug use Report migrates to outside of the room Report needs tailoring to suit patient s needs i.e.: Some patients do not want to hear certain information over and over. Sustainability hardwiring the new process 4
Strategies for Sustaining the Process Set expectations Include in nursing orientation, onboarding process Include in employee evaluations Education and ongoing training Many units have developed creative training tools and videos, let s share successful strategies Lead nurses Lead nurse bedside report Include process in unit brochures, signs, patient education folders Part of annual skills 5
Strategies for Sustaining the Process Ensure CareConnect will facilitate bedside handover Continue to improve handover summary screens Leadership Rounding Observations/audits during change of shift Opportunity for coaching and real time feedback Tip sheets and scripting for nurses addressing unit specific concerns Written protocols and tip sheets were attached to assignment sheets in the beginning the tools helped during the transition, then were no longer needed after the new process was adopted 6
Guiding Principles Bedside report will work in most scenarios! There will always be outliers focus on the best case scenario The benefits of improved communication and increased patient safety override most concerns Leadership oversight It takes time 7
What about HIPAA A major concern for nurses Significant issue for semi-private rooms, hallway patients Knowing your patient s preferences will guide the process the patients own their information Nurses need reassurance and an opportunity to discuss scenarios and concerns Use plain language, involve the patient so they feel a part of the discussion, talk softly, do the best you can
What about Infection control Observe precautions as usual Notes can be made after as needed Opportunity to validate that proper precautions are in place
What about Sensitive data Psychiatric issues Issues not yet disclosed to patient Conflicts We are learning that some sensitive issues are okay to talk about Knowing your patient If it is truly sensitive, it can be part of a written report or quietly discussed away from the patient
What about What about Challenging patients/family Can be a helpful tool for limit setting Can prevent splitting of staff Can reassure an anxious patient/family Providing more information regularly may help the patient/family cope Confused or restrained patients Helps clarify LOC and orientation Ensures these patients are safe Non English speaking patients Can use interpreter services if necessary
What about Multiple family members in the room Knowing your patient s preferences Asking the patient what they prefer in private Asking for collaboration from family Multiple questions/needs from patient & family Scripted tools can help Rounding prior to end of shift to meet needs
What about Writing everything down? Writing vs. listening and looking Pre-printed report sheets can help Time after report to review chart and make notes Find the right balance Nurses talked about how they felt disorganized and at a loss when transitioning to bedside report. Some said that the act of writing everything down helped them synthesize the information. It was hard to transition to a more auditory/visual report, and it took some getting used to. They now use the time after report to sit down and review their report sheet to synthesize the new information. It has become easier over time.
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References Anderson, C., & Mangino, R. (2006). Nurse shift report: Who says you can t talk in front of the patient? Nursing Administration Quarterly, 30(2), 112-122. Athwal, P., Fields, W., & Wagnell, E. (2009). Standardization of change-of-shift report. Journal of Nursing Care Quality, 24(2), 143-147. Baker, S.J. (2010). Bedside shift report improves patient safety and nurse accountability. Journal of Emergency Nursing, 36(4), 355-358. Bolanos, R. (2008). Miami Children s Hospital handoffs happen with patients included. Retrieved from Nurse.com: http://news.nurse.com/apps/pbcs.dll/article?aid=2008301290015 Cairns, L., Dudjak, L., Hoffman, R. & Lorenz, H. (2013). Utilizing bedside shift report to improve the effectiveness of shift handoff. Journal of Nursing Administration, 43(3), 160-165. Caruso, E. (2007). The evolution of nurse-to-nurse bedside report on a medical-surgical cardiology unit. Medsurg Nursing, 16(1), 17-22. 18
References Chaboyer, W., McMurray, A., Johnson, J., et al. (2009). Bedside handover. Journal of Nursing Care Quality, 24(2), 136-142. Griffin, T. (2010). Bringing change-of-shift report to the bedside: a patient- and familycentered approach. Journal of Perinatal & Neonatal Nursing, 24(4), 348-355. Laws, D., & Amato, S. (2010). Incorporating bedside reporting into change-of-shift report. Rehabilitation Nursing, 35(2), 70-74. Radtke, K. (2013). Improving patient satisfaction with nursing communication using bedside shift report. Clinical Nurse specialist: The Journal for Advanced Nursing Practice, 27(1), 19-25. Staggers, N., & Jennings, B. (2009). The content and context of change of shift report on medical surgical units. The Journal of Nursing Administration, 39(9), 393-398. Wakefield, D., Ragan, R., Brandt, J., & Tregnago, M. (2012). Making the transition to nursing bedside shift reports. The Joint Commission Journal on Quality and Patient Safety, 38(6), 243-253. 19