Policies and procedures are review, revamp and implement constantly in health care facilities to ensure safe patient care is being deliver. Effective communication is a critical part in providing safe patient care. Usefulness communication is essential during shift report in order to provide safe care and meet goals for the patient. There is a trend where hospitals are bringing shift report to the bedside in order to improve the effectiveness of communication between the nurses. At Kaiser Santa Clara, the facility I currently work at, has a standard policy and procedure regarding the handoff communication during shift change, according to the policy the two nurses are to review information that is standardized to the following:
•Diagnoses and current condition of the patient
•Medications given or due
•Recent changes in condition or treatment
•Anticipated changes in condition for treatment
•What to watch for in the next interval of care
The purpose of the policy is to provide an interactive dialogue that allows for up-to-date information on the patient’s care. The policy is referenced to the Joint Commission-mandated focus on improving patient safety through effective caregiver communication. According to the Joint Commission, as estimated 80% of serious medical errors are attributable to miscommunication between caregivers when transferring responsibly for patients (Wakefield, Ragan, Brandt & Tregnago, 2012). Shift report happens two, three, or more times in a day, but nurses receive little formal training in this vital responsibility. Nurses may be found legally liable for failing to report necessary information during handoffs (Riesenberg, Leitzsch, & Cunningham, 2010). Therefore, it is imperative for a handoff procedure incorporate an effective way to communicate in order to provide safe patient care. Review of the Literature
Traditionally, shift report has been performed away from the bedside either at the nurse’s station or outside of the patient’s room where patient information is exchanged in an informal way varying from nurse-to-nurse. According to Laws and Amato, information provided, and the actual status of the patient were two different stories when the on-coming nurse came into the room to assess the patient after shift report (2010). Shift report often lack care planning and goals for the shift; these issues often leave the nurses with incomplete data to provide patients with the best possible care (Baker, 2010). Numerous studies and articles have been written in how to improve shift report to coincide with the Joint Commission national patient safety goals, there seems to be an array of information on facilities transition to bedside report, as in giving shift report right next to the patient’s bed.
At the University of Michigan Hospital and Health Center, a quantitative study was conducted to improve the practice of nursing shift-to-shift report by taking it to the bedside. Over a six month period, a group of nurses were observed during shift change to determine how the implementation of bedside reporting was being received by the nurses and patients. The results collected between the observation and a brief questionnaire filled out by the nurses, showed that there was a decrease in report time from 45 minutes to 29 minutes due to that nurses that did not have the privacy of socializing at the nurses station, which decreases crucial time to give a report on a patient. Nurse satisfaction with report process increased from 37% to 78% when moved to the bedside because nurses could give and receive much more accurate handoff without distractions. An intervention to relocate shift report to the patient bedside resulted in improved satisfaction for nurses and increased direct care time to patients (Evans, Grunawalt, McClish, Wood, & Friese, 2012).
A critical care quality committee at Regions Hospital in St. Paul, Minnesota, was concerned with an audit that showed 39% of medication errors were found after shift report. This evidence supported the development and strength for bedside report. A qualitative study was conducted by surveying the 69 nurses on two different critical care units. The report’s finding indicated improved communication at the bedside along with allowing the nurses to double check on the intravenous medications that were being administered to the patient.
84.2% of the nurses felt they were more confident about their report when giving it at the bedside because it gave them an opportunity to provide objective information versus subjected information on the patient (Triplett & Schuveiller, 2011). However, through-out the article there was no information regarding if the 39% of medication errors decrease after the implementation of bedside report. There was a mentioned that 55% surveyed did find errors at the bedside during report; however it was not discussed how these errors were addressed. Overall, bedside report has significantly affected nursing practice in a beneficiary way by nursing staff (Triplett & Schuveiller, 2011).
In an effort to improve patient satisfaction, an inpatient nursing unit in a Midwest academic health center made a decision to bring shift report at the bedside. A quantitative was conducted by surveying inpatients and 32 nurses on a step-down unit. A yes or no survey was given to the inpatients regarding the quality of the report that was given at the bedside, and 72% were satisfied with the information that was exchanged between the nurses (Wakefield, Ragan, Brandt & Tregnago, 2012). Following the implementation of bedside report there was a significant increase in patient satisfaction scores. While scores improved, transition to the bedside was not well received by nurses. Data collected showed that nurses were not following the new process of bedside report. 60% of the nurses did not do report at the bedside, however decrease by extensive planning, training and gradual implementation (Wakefield, Ragan, Brandt & Tregnago, 2012).
The studies strikingly prove that effective communication at the bedside provides safe patient care that has been well received by patients and nurses in most cases. The research proved that bedside report offered several benefits such as an increase in the following:
•Patient satisfaction scores
•Quality of care ratings
•Patient safety scores
(Wakefield, Ragan, Brandt & Tregnago, 2012).
Description of the Process
There is a considerable amount of information and studies that support bedside reporting. Bedside reporting has shown to increase patient participation and satisfaction, increase nursing teamwork and accountability, and most importantly improve communication between nurses. Kaiser Permanente prides themselves as being innovated in the health-care industry and keeping patients satisfaction scores high. Based on evidence, Kaiser could continue reach their goals by modifying their shift report policy to incorporate bedside report.
In order to modify or implement a new policy, the process seems straight forward with Kaiser; there is a protocol that allows the policy to be handled by the appropriate committee group. For changes in handoff communications, I would have to approach the director of patient safety with my recommendations based on evidence, and then this information is turned over to the nursing policy and procedure committee for review, which then is approved by Chief of Nursing or Services.
Why bedside report? Sounds simple, but many nurses are set in their ways and may be resistant to this new technique for number reasons. Let it be known, not only does evidence show that bedside report brings patient safety, it always brings ownership and accountably among the staff. Bedside report allows an opportunity for real-time conversations and transfer of trust of patient care in front of the patient. A clinical nurse leader (CNL) would play in a vital role in seeing the implementation goes smoothly among the nurses. A CNL can help the process by making sure the staff is engaged by providing the appropriate knowledge on how the system is going to be implementing, along with the evidence that supports this new change.
The key to successfully implementing bedside report is clearly defining the role of the nurses, standardize what is communicated, and allow for time for the patient’s input. A CNL can follow up on the success of the implementation by rounding on the patients and nurses for feedback and reporting back to nurses with opportunities or wins, which allows the nurses know how they are doing.
In conclusion, it has been provided by evidence based information to show that bedside report is a win-win situation for both the nurses and patients and meets the patient safety goals for Joint Commissions.