PATIENT- AND FAMILY-CENTERED CARE: Partnerships for Safety & Quality

Nurse Bedside Change of Shift Report

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“Communication breakdowns are a leading cause of medical errors…in 2005, a Joint Commission analysis found that 70 percent of sentinel events were caused by communication breakdowns, and half of those occurred during handoffs. To address the problem, the Joint Commission instituted a National Patient Safety Goal in 2006 calling on hospitals to implement a standardized approach to patient handoffs…” Anderson, C. D., & Mangino, R. R. (2006). Nurse shift report: Who says you can’t talk in front of the patient? Nursing Administration Quarterly, 30(2),

Nurse Bedside Change of Shift Report ▼ A safe, standardized approach to “hand offs,” (meeting the National Patient Safety Goal for communication). ▼ Encourages patients and families to partner in their own care. ▼ Serves as an example of patient- and family- centered nursing practice. “Nothing About Me Without Me.”

Nurse Change of Shift Report: Is This Your Current State? Change of shift report is an integral part of the nurses' daily workflow which often takes place in the nurses' station or break room. Impersonal (goals are directed by nursing; it is not a collaborative process with patients and families). Limited, and sometimes inaccurate information is shared (report often does not reflect the actual status of the patient).

Implementing Nurse Change of Shift Report at the Bedside ▼ The purpose is to share accurate, useful information between nurses and with patients and families and to engage patients and families in their care. ▼ Nursing staff conducts shift change reports at the patient’s bedside with the patient and family, in accordance with patient preference. ▼ The patient defines his/her family and/or other support person(s) and how they will be involved in care and care planning. ▼ Patient can share important information with nurses. ▼ Report should take 3-5 minutes per patient. ▼ Some units have an initial 3-5 minute huddle to provide an overview of key issues for the unit that day.

Nurse Bedside Change of Shift

Nurse Bedside Change of Shift Report Discussion questions:  What are the overall impressions of the bedside shift report?  What went well?  What could have been done differently?  How is this practice change helpful to the nurse?  What questions or concerns do you have about bedside shift report?

Benefits ▼ Better information and improved visibility to describe the patient’s condition ▼ Accountability ▼ Improved time management ▼ Patient safety ▼ Return to care at the bedside ▼ Efficiency

Bedside Shift Report Improves Patient Safety and Nurse Accountability ▼ Enhances patient and family involvement in and understanding of care. ▼ Builds trust with the patient and family. ▼ Enhances safety. ▼ Builds teamwork, accountability, and commitment to quality work among nursing staff. ▼ Opportunity for real-time conversations. ▼ Saves time after becoming comfortable with change in practice. ▼ Practical tips for implementation included in the article. Baker, S. J. (2010). Bedside shift report improves patient safety and nurse accountability, Journal of Emergency Nursing, 36(4),

Other Benefits to Nurses, Patients, and Families ▼ Provides nurses across shifts with hands-on, face-to- face interaction with the patient…key to individualizing care, building relationships, and avoiding misunderstandings. ▼ Offers up-to date information about the patient’s care to the patient and family, resulting in less anxiety, less uncertainty. ▼ Makes the nurse’s role in care transparent to patients and families. ▼ Increases patient, family, and nurse satisfaction.

Other Benefits to Nurses, Patients, and Families (cont’d) ▼ Reassures patients and families that everyone knows what is going on with them, that they are on the “same page” and working together.. ▼ Offers patient and family members up-to-date information. ▼ Reminds patient and family members that they should share their observations and concerns and ask questions. Nurses are available, they listen, and usually have answers.

Call Bell Analysis Memorial Hospital Miramar, Hollywood, FL 2010 – courtesy of K. Ennis, RN, MSN and S. Joyner, RN, MSN

Patient Satisfaction Memorial Hospital Miramar, Hollywood, FL 2010 – courtesy of K. Ennis, RN, MSN and S. Joyner, RN, MSN

Nurses’ Concerns About Bedside Report ▼ Unknown visitors or family members in the room. ▼ New diagnosis/information patient is not yet aware of (waiting for doctor to discuss). ▼ Patient and/or family are asleep. ▼ Patient is not following plan of care and you need to share this information with the incoming nurse. ▼ Patient or loved ones have complex questions that require lengthy clarification. ▼ Semi-private rooms/HIPAA concerns.

Semi-Private Rooms/HIPAA Concerns ▼ Health information can be disclosed for:  Treatment  Health care operations  Payment ▼ HIPAA acknowledges incidental disclosures may occur. This is not a HIPAA violation as long as you:  Take reasonable safeguards to protect privacy  Only disclose or use the minimum information necessary

HIPAA Concerns (cont’d) ▼ Can health care providers engage in confidential conversations with other providers or with patients, even if there is a possibility that they could be overheard? ▼ Yes. HIPAA does not prohibit providers from talking to each other and to their patients. Providers’ primary consideration is the appropriate treatment of their patients. Patient access to their health care information is important to quality, safety, and achieving the best outcomes. ▼ Patient access to their health information is important to quality, safety, and achieving the best outcomes. This must be balanced with the need to protect privacy.

HIPAA Concerns (cont.) ▼ Oral communications often must occur freely and quickly. Providers are free to engage in communications as required for quick, effective, and high-quality health care. For example, when:  Coordinating services at nursing stations.  Discussing a patient’s condition or treatment regimen in the patient’s semi-private room.  Discussing a patient’s condition during training rounds in an academic or training institution.

Exercise 1 ▼ Glenda, a 55-year-old female with asthma and type 2 diabetes, was admitted to the unit this afternoon from the Emergency Department. Her symptoms were severe wheezing and vomiting for two days, abdominal pain, and dizziness. She received a multitude of treatments with Albuterol and steroids before admission. Her blood glucose is 200 and ketones are negative. ▼ At evening shift change, Glenda says her breathing is better but her nausea is still present.

Debrief ▼ How did you each feel during this interaction? ▼ What went well? ▼ What could have been done differently? ▼ Anything else?

Wrap Up ▼ “Increased patient satisfaction was seen with the implementation of bedside shift report. By involving the patients in their plan of care and keeping all caregivers updated on that plan, patients feel more secure, and are more likely to participate in their own care and follow recommended health care options.” ▼ Acute care patients want more active involvement in their illness trajectory…today patients want to be involved or at least informed about health care options and alternatives (collaborative model). Bedside nurse reporting supports this model of informed choice and active patient participation.” - Anderson, C. & Mangino, R. Nursing Administration Quarterly, 2006