Project Progress Report Katy Ridge, RN, BSN

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Presentation transcript:

Improving Nurse/Patient Communication During Bedside Care Handoff: A Performance Improvement Project Project Progress Report Katy Ridge, RN, BSN Acute Care of the Elderly (ACE) Unit

Opportunity Statement Bedside handoff has been the standard of care on our unit for several years, but there is no standard practice for involving the patient and family in the discussion It is not known how much patient and family involvement is occurring during bedside report

Background Improved staff communication is a Joint Commission national patient safety goal (www.jointcommission.org) Bedside handoff has been found to increase accuracy of information (Tobiano, et al. 2013) The Patient Protection and Affordable Care Act uses patient satisfaction surveys as part of the calculation for the value-based incentive payments to hospitals (www.CMS.gov) Bedside handoff has been found to increase patient and family satisfaction (Tobiano et al. 2012)

Purpose To measure the quality of RN bedside handoff To monitor the frequency of RN bedside handoff To improve communication, patient safety, and patient satisfaction To improve staff readiness to assume care immediately following bedside handoff

Methods-Baseline Data Collection Staff survey regarding perceptions and practice of bedside handoff Patient interviews regarding bedside handoff and staff communication Audits of EPIC documentation of bedside handoff HCAHPS for responsiveness of hospital staff

Methods-Intervention Bedside handoff video for staff education presented at staff meeting Poster presentation of the process improvement project Email and one-on-one sign-off of education on the LOOK Report Checklist w/ scripted questions for patient involvement How is your pain? What are your goals for today/tonight?

Methods-Post Intervention Evaluation Staff survey regarding perceptions and practice of bedside handoff Patient interviews regarding bedside handoff and staff communication Audits of EPIC documentation of bedside handoff HCAHPS for responsiveness of hospital staff

Instruments The staff survey and patient interview were developed in consultation with the leadership team on the ACE unit. Many of the questions were adapted from previously published research studies on the same topic. The EPIC documentation audit tool is the same used by other members of the handoff communications champions committee. HCAHPS for “responsiveness of hospital staff” were taken for the time period 7/2013-1/2014

Pre-Intervention Data HCAHPS for responsiveness of hospital staff for the time period 7/2013-1/2014 were: Never 1.8 Sometimes 7.7 Usually 29.2 Always 61.3 EPIC documentation of bedside handoff for 1/2014 through 2/2014 was 94%

Pre-Intervention Data Staff Survey

Pre-Intervention Data Patient Interviews

Patient Interview Questions Yes/No Questions Did your nurses come into the room together at the last shift change? Did the nurses ask you about what could have gone better over the last 12 hours? Did the nurses ask you about what you would like to have happen during the next 12 hours? Did the nurses ask you about your pain? Lichert Scale I was informed of my plan of care for the day There was open communication between the nurses about my plan of care I feel involved in my plan of care My care providers worked together as a team Comments about communication between nurses and patients

Did your nurses come into the room together at the last shift change?

Did the nurses ask you about what could have gone better over the last 12 hours?

Did the nurses ask you about what you would like to have happen during the next 12 hours?

Did the nurses ask you about your pain?

I was informed of my plan of care for the day

There was open communication between the nurses about my plan of care

I feel involved in my plan of care

My care providers worked together as a team

Patient Comments The nurses work together, the doctors seem separate Please introduce yourself, need more communication about delays I think the nurses are doing great, I want more frankness, I appreciate continuity of care Every time they come in they explain things, feels reassuring I think the communication is on the spot, you guys do a good job

Next Steps Finish pre-intervention patient interviews Conduct unit education on scripted questions to increase patient involvement in the bedside handoff conversation Allow time for change to be implemented into practice Collect post-intervention data

References Tobiano, G., Chaboyer, W., McMurray, A. (2012) Family members’ perceptions of the nursing bedside handover. Journal of Clinical Nursing 22, 192-200. CMS (2014) HCAHPS: Patients’ Perspectives of Care Survey. Available at http://www.cms.gov/Medicare/Quality-Initiatives-Patint-Assessment-Instruments Joint Commission (2014): Hospital: 2014 National Patient Safety Goals. Available at http://www.jointcommission.org/hap_2014_npsgs/