1. Abstract Patient safety is a very broad and general term used to ensure that all aspects of patient care, from medical and nursing services to social and spiritual, are provided with the best interest of the patient. The aim statement for the project is improving patient safety by ensuring the implementation of bedside shift report by 80% of nurses by August 2016. Kurt Lewin’s change theory is going to be used to effect the change. There were in-services given to nurses on the floor and the project was also discussed in staff meetings. Flyers were posted around the units to help build up and maintain enthusiasm for the implementation of BSR. Implementation was initiated behind schedule due to conflict in schedules and bureaucratic hoops. The implementation was started on April 28, 2016 and so there are no exact numbers at this time because there is a two week trial period. But I have had conversations with the some nurses that have started the project since initiation. So far they seem to be very receptive of the change. Most of the patients have been neutral at this time but we’ll see if that’s going to be the case in two weeks.

2. Abstract Cont. There are numerous publications that support the efficacy of bedside shift report in relation to patient care and safety. Publications from the Agency for healthcare research & quality (AHRQ), MEDSURG Nursing, American nurse today, Journal of Clinical Nursing and the Nursing journal are some of the articles that were used to investigate and develop ideas and policies for the project. Patient experience with the bedside shift report (BSR) will be tracked and the data collected will be used to improve the process in order to enhance the patient experience. Patient experience would include if the patient felt more engaged in their care, if they felt safer and had more confidence in the personnel helping out with the care. Also nurse satisfaction is another benchmark that would be measured by sending out surveys periodically in an effort to gauge the opinions of the staff members. The data collected from the surveys will be used to develop improvements to the process and increase the comfort level of the nurses in giving BSR. We would also track if the nurses feel more accountable for the care they delivered during the shift and if the accountability translates to nurses being more responsible in the care that they deliver.

3. Abstract Cont. Periodic collection of data will be used to monitor patient satisfaction and nursing compliance. The data would be monitored by the appointed BSR champions because they would be able to monitor and collect data on compliance of the floor nurses in real time and compare it with data collected from patient satisfaction surveys. There are going to be bi-weekly meetings to analyze and improve the process by applying PDSA cycle. Analysis of the data can also help to recognize fallouts earlier and provide opportunity to make corrections. In conclusion, sustainability is what is important. One of the ways I recommend to ensure continuity of the project by making sure that the new employees, regardless of experience, are trained during their eight to twelve week floor orientation. After conducting a failure mode effect analysis coupled with experience, I concluded that continuity is also dependent on proper training of new employees. I concluded this because nursing is a high turnover profession and if the current nurses don't teach the new nurses before they leave the facility then the whole process will have to be restarted.

4. Title of Project: Bedside Shift Report Student Name: Maroof Abiola Olanigan RN MSN Improvement Theme: Patient Safety and Nursing Accountability Fishbone Diagram: Process Maps and Flowcharts: SWOT Analysis: Global Aim: Patient Safety Specific Aim: Improving patient safety by ensuring the implementation of bedside shift report by 80% of nurses PDSA Ramps: Results: From PDSAs and Data: Implementation newly initiated. Still collecting data at this time Conclusions: No conclusion can be made at this. Project has just being newly Implemented Timeline: 80% compliance by August 2016 Theoretical framework for Change: Kurt Lewin’s Change Theory i.e. Unfreezing, Moving and Freezing. References: See next ppt. Acknowledgements: See next ppt. Patient safety Plan To Implement BSR on NIMU unit Study Analyze data collected by BSR champio ns Do Develop guideline to help the nurses. Use evaluation tools to collect data weekly Act Determin e if improve ment is needed and introduce new plan Patient safety comprom ise Floor Nurses Nursing Turnover Patients People Patient rooms Nursing station Chaos Environment Tele-monitor Restraints medication Equipment Observation Physical Touch Verbal Report Methods Stationary Computers Kardex Materials Small unit focused on teamwork and patient care Nursing turnover and float nurses from other units Inconsistency when float nurses are assigned to the unit New nurse hire and training. Supportive Management Confirm room # and name at the door Give classified information of patient e.g new dx that the Dr. has no disclosed. Enter the room, observe that persons in the room can listen. Start report. Planni ng Teach ing Imple ment ation Data collec tion and analy sis Re- imple ment correc ted versio n

5. References Agency for healthcare research & quality. (2013, June). Strategy 3: nurse bedside shift report |agency for healthcare research & quality. Retrieved March 25, 2016, from http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy3/index.html Eckbold, L., & Dombroski, G. (2012). Bedside shift promotes and increases...bedside shift report promotes teamwork and increases patient safety. AARC Times, 36(8), 30-32. Retrieved from http://eds.b.ebscohost.com/eds/detail/detail?vid=19&sid=43420cb0-8dce-44be-aabd- 0b9c6f2e15a1%40sessionmgr112&hid=103&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=ccm&AN=104490483 Evans, D., Crunawait, J., McClish, D., Woods, W., & Friese, C. R. (2012). Bedside shift-to-shift nursing report: implementation and outcomes. MEDSURG Nursing, 21(5), 281-292. Retrieved from http://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?sid=43420cb0-8dce-44be-aabd- 0b9c6f2e15a1%40sessionmgr112&vid=16&hid=103 Ferris, C. (2013). Implementing bedside shift report. American nurse today, 8(3), 47-49. Retrieved from http://eds.b.ebscohost.com/eds/detail/detail?vid=13&sid=43420cb0-8dce-44be-aabd- 0b9c6f2e15a1%40sessionmgr112&hid=103&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=ccm&AN=104290847 Hospital Safety Score. (2013, October 23). Hospital errors are the third leading cause of death in U.S., and new hospital safety scores show improvements are too slow. Retrieved March 27, 2016, from http://www.hospitalsafetyscore.org/newsroom/display/hospitalerrors-thirdleading-causeofdeathinus- improvementstooslow Ofori-Atta, J. (2015). Bedside shift report. Nursing, 45(8), 1-4. doi:10.1097/01.nurse.0000469252.96846.1a Sand-Jecklin, K., & Sherman, J. (2014, June). A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation. J Clin Nurs, 23(19-20), 2854-2863. doi:10.1111/jocn.12575 Shin, R., Woods, K., & Young, S. (2015). Report at the bedside: investing in patient and family centered care. Critical Care Nurse, 35(2), 51. Retrieved from http://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?sid=43420cb0-8dce-44be-aabd-0b9c6f2e15a1%40sessionmgr112&vid=18&hid=103 Shreve, J., Van Den Bos, J., Gray, T., Halford, M., Rustagi, K., & Ziemkiewicz, E. (2010). The economic measurement of medical errors. Schaumburg, Ill.: Society of Actuaries.

6. Acknowledgements Enedra Allen-McBride MSN,RN. (Clinical Director of Patient Care, Neuro Service Line) Gesno Ulysse, MSN, RN. (NIMU Clinical Nurse Manager) The NIMU staff Professor Carlee Balzaretti