27 hours ago Bedside shift report improves patient safety and nurse accountability. Bedside shift report improves patient safety and nurse accountability J Emerg Nurs. 2010 Jul;36(4):355-8. doi: 10.1016/j.jen.2010.03.009. Epub 2010 May 14. Author Stephanie J Baker 1 Affiliation ... >> Go To The Portal
Bedside shift reporting process improves patient safety and satisfaction. The nurses who coordinated the CHAT roll-out admit that it can be difficult to accommodate such a big change in the way reporting has always been done—generally at the nursing desk where patients can’t hear any of the nursing report.
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Bedside shift report improves patient safety and nurse accountability Bedside shift report improves patient safety and nurse accountability Bedside shift report improves patient safety and nurse accountability J Emerg Nurs.
Bedside shift report improves patient safety and nurse accountability Bedside shift report improves patient safety and nurse accountability Bedside shift report improves patient safety and nurse accountability J Emerg Nurs. 2010 Jul;36(4):355-8.doi: 10.1016/j.jen.2010.03.009.
The majority of the studies on nurse bedside shift report that discuss patient experience with care have limitations.
Results demonstrated that patient fall rates decreased by 24%, and nurse satisfaction improved with four of six nurse survey questions (67%) having percentage gains in the strongly agree or agree responses following implementation of bedside report.
It puts patients at the center of communication and permits them to collaborate and participate in their own recovery. Bedside reporting encourages teamwork and accountability of staff and is safer for the patient because it increases the quality of hospital care.
Implementing BSRIntroduce the nursing staff, patient, and family to each another.Invite the patient and (with the patient's permission) family to participate. ... Open the electronic health record at the bedside.Conduct a verbal report using words the patient and family can understand.More items...
Bedside shift reports are viewed as an opportunity to reduce errors and important to ensure communication between nurses and communication. Models of bedside report incorporating the patient into the triad have been shown to increase patient engagement and enhance caregiver support and education.
Communication can save lives and the evidence does demonstrate that bedside reporting is an effective communication tool to increase patient communication, patient safety, decrease med errors, and improve patient outcomes.
Yet a simple strategy to improve communication is to bring the report to the patient's bedside. This facilitates earlier connection between the oncoming nurse and the patient and presents an opportunity for the patient to ask questions and clarify information with both nurses.
A real safety benefit of bedside handover is the fact that visualising the patient may prompt nurses to recall important information that should be handed over and it may also trigger oncoming staff to ask additional questions. Further, patients have the opportunity to clarify content.
It should include the patient's medical history, current medication, allergies, pain levels and pain management plan, and discharge instructions. Providing these sorts of details about your patient in your end of shift report decreases the risk of an oncoming nurse putting the patient in danger.
However, an evaluation of evidence-based literature reveals that the practice of bedside shift report (BSR) leads to a reduction in both patient falls and medication administration errors.
Federwisch gives an example of how BSR saved a patient's life at one facility. 9 A postoperative patient prescribed patient-controlled analgesia was given an antiemetic at 1910 just before change of shift. When two nurses entered her room at 1920 for the BSR, her respiratory rate had dropped to 6 breaths/minute. One nurse stayed in the room while the other obtained and administered naloxone as per protocol. The patient quickly recovered without complications. Had the nurses been engaged in traditional shift report away from the patient, the result could have been tragic.
Nurses are always on the same page during the report because they're both looking at the same information at the same time. 12. The patient benefits from BSR too.
By definition, BSR is the change-of-shift report between the offgoing nurse and the oncoming nurse that takes place at the bedside. This makes patients a part of the process in the delivery of their care.
The Agency for Healthcare Research and Quality (AHRQ) defines BSR as “an opportunity to make sure there is effective communication between patients and families and nursing staff.” It also states that one of the rationales for BSR is the creation of an environment where patients, families, clinicians, and hospital staff work together to improve the quality and safety of care. 7 Research has shown that when patients are that third voice engaging in decisions that impact their health, measurable improvement in safety and quality result. 8
Because nurses are the first line of defense when it comes to patient safety, BSR is an integral part of the care plan. The nurse is accountable for the communication that occurs during the change-of-shift report.
According to the Inspector General Office, Health and Human Services Department, less-than-competent hospital care contributed to the deaths of 180,000 Medicare patients in 2010. However, the real number may be higher: According to one estimate, between 210,000 and 440,000 patients who go to ...
If the patient wants complete privacy during this time, the nurse can courteously ask family and friends to leave to allow interaction between nurse and patient. In addition, time should be set aside before or after BSR for the sharing of sensitive information that hasn't been told to the patient with the oncoming nurse.
Word and PowerPoint files are provided so that hospitals can tailor them for their organizations.
Nurse shift changes require the successful transfer of information between nurses to prevent adverse events and medical errors. Patients and families can play a role to make sure these transitions in care are safe and effective.
Research shows that when patients are engaged in their health care, it can lead to measurable improvements in safety and quality. To promote stronger engagement, Agency for Healthcare Research and Quality developed the Guide to Patient and Family Engagement in Hospital Quality and Safety, a tested, evidence-based resource to help hospitals work as partners with patients and families to improve quality and safety.
Systematic literature review studies point out that implementing nurse bedside shift report can improve the patient experience with care as related to nurse communication.8,9 ,11For example, Mardis and colleagues conducted a systematic literature review of 41 articles related to the use of bedside shift report and concluded that 49% of the reviewed literature identified an increase in patient experience with care as a self-reported outcome, whereas only 2% of the reviewed studies identified patient complaints with this practice.11Sherman and associates also found patient advantages in relation to nurse bedside shift report, such as patients being more informed about and engaged in their care, improved nurse-patient relationship, and improvement in overall patient satisfaction.8
Nurse bedside shift report, or handoff, has been defined in the literature as a process of exchanging vital patient information, responsibility, and accountability between the off-going and oncoming nurses in an effort to ensure safe continuity of care and the delivery of best clinical practices.2 -6There are different types of nursing reports described in the literature, but the four main types are: a written report, a tape-recorded report, a verbal face-to-face report conducted in a private setting, and face-to-face bedside handoff.3,4,7,8
The knowledge phase is defined as the time when bedside handoff is introduced to the nursing unit(s) and organization, and the following interventions take place: leadership support and commitment, relationship building, staff meetings, and nursing education.4,15,17,18-20,27Providing education can take the form of a journal club, formal training in bedside shift report practice through written and video materials, educational sessions that offer case scenarios based on nursing feedback, staff communication skill development training, and mandatory continuing education and annual performance competencies.2,9,11,16-18,20,27
The only nursing report method that involves patients, their family members, and both the off-going and the oncoming nurses is face-to-face bedside handoff.3This type of nursing report is conducted at the patient's bedside and has different variations. In broad terms, nurse bedside shift report can be classified into two categories: “blended” and face-to-face bedside handoffs.8,10The “blended” bedside shift report can be defined as a nursing handoff composed of two parts: Half of the report is written or conducted in a face-to-face approach in a private setting and the other half of the report is conducted face-to-face at the patient's bedside. The face-to-face nurse bedside shift report is solely conducted at the patient's bedside.8
The concepts that have been used in the literature for achieving acceptance and sustainability of nurse bedside shift report follow Everett Rogers' five-step approach to adoption of innovations: knowledge, persuasion, decision, implementation, and confirmation. 28
These included difficulties understanding the report and medical jargon, tiredness as a result of information being repeated multiple times, lack of privacy, anxiety over incorrect information or too much information, and inconsistency with how the nurse bedside shift report was conducted.8,22,23
Studies also reported a number of reasons why some nurses don't prefer bedside shift report, including that they may have little awareness of and skills with engaging in a patient-centered approach to care, and that they may feel uncomfortable talking in front of patients and intimidated if patients ask questions for which they don't have answers. 7,24They may also be afraid to unintentionally disclose medical information unknown to the patient and may have concerns about violating patients' privacy.9,21But the main nursing disadvantage in relation to bedside shift report that's been reported in the literature is longer change-of-shift report time as a result of patients interrupting nurses during the process.8
One barrier associated with bedside report may be related to patient privacy concerns. However, bedside report is already included in the Health Insurance Portability and Accountability Act (HIPAA) [4]. Another barrier may be the length of time associated with bedside report, but the majority of the literature found that report at the bedside took less time [2]. Other barriers of bedside report include fear of waking up patients, that medical jargon may confuse patients or increase anxiety, or that the patient or family may monopolize the conversation during report [6].
Nurse leaders are responsible for ensuring the success of their team through effective communication, meting quality measures, and improving patient satisfaction. Our organization used innovative ways to increase participation of bedside report. The process that has been described concerning implementing bedside report may give other institutions an example on how bedside report can be implemented. Innovative leaders should encourage and monitor this handoff process to maintain the practice of bedside report hospital wide.
Bedside shift report (BSR) enables accurate and timely communication between nurses, includes the patient in care, and is paramount to the delivery of safe, high quality care. Hospital leaders and healthcare organizations are making concentrated efforts to change their environments to assure patient safety and patient and nurse satisfaction. In the literature, changing the location of shift report from the desk or nurses’ station to the bedside has been identified as a means to increase patient safety and patient and nurse satisfaction. Shift report, when completed at the patient bedside, allows the nurse to visualize and assess the patient and the environment, as well as communicate with and involve the patient in the plan of care. Bedside shift report (BSR) enables accurate and timely communication between nurses, includes the patient in care, and is paramount to the delivery of safe, high quality care.
Patient participation in the report is paramount to delivery of safe, high quality care. After the literature review, the team defined BSR as the accurate and timely communication between nurses and also between the nurses and the patient. Patient participation in the report is paramount to delivery of safe, high quality care. Furthermore, through reading and discussion of the articles, the team concluded that report, when completed at the patient bedside, allows the nurse to visualize and assess patients and the environment, with better communication and patient involvement in care.
BSR is a significant change to the current shift report practice and culture of most organizations, but it is associated with both improved patient safety and patient and nurse satisfaction. A limitation of this project was that the evidence-based quality improvement design prevents generalization of findings to other settings; however, the knowledge gained may be transferred to other units or hospitals.
Sixty-four (95%) of the nurses completed the pre- implementation survey, and fifty-seven (85%) completed the post survey. Table 2 represents the number of nurses who reported having enough time for report was significantly decreased, from 80% pre BSR to 59.6% after implementation of BSR ( p = 0.008). In the post survey, staff members were able to express concerns about BSR; 70% ( n = 45) of the nurses who responded to this question believed that BSR increased the time it took to individually give and receive report. Thirty-nine percent ( n =25) of staff reported concerns about patient confidentiality; 44% ( n =29) responded that BSR was inconvenient for nurses due to many factors (e.g., multiple nurses needing report, patient requests delayed report, and nurses preferring the status quo).
BSR was associated with decreased fall rates , and this finding is consistent with the literature ( Jeffs et al. 2013; Sand-Jecklin & Sherman, 2013 ). Since falls occur for many reasons, it is not surprising that a single environmental scan at change of shift did not eliminate all falls. However, in one instance, nurses found a patient trying to climb out of bed during BSR and timely intervention may have prevented a fall. In the staff satisfaction survey, a nurse reported discovering a patient who had experienced a change in neurological status during BSR. It would be important to note in future studies or projects that the importance of the visual assessment component of the patient and the environment in BSR should be considered as an outcome measure.
Patient falls decreased by 24% in the four months after BSR implementation compared to pre-implementation falls. The orthopedic unit experienced the greatest reduction in the number of falls at 55.6%, followed by the neuroscience unit at 16.9%, and the general surgery unit at a 6.9% reduction. Patient falls results are presented in Figure 3.
Three units were selected for implementation of the practice change based upon the directors’ desire and willingness to participate. The populations served on the chosen nursing units were patients undergoing general surgery, and those with orthopedic and neuroscience diagnoses. Members of these units volunteered to be part of the BSR team.