1. Improving the Quality of Bedside Shift Report Behavior on the Medical-Surgical Unit at Woodland Healthcare
Amanda Waggoner, RN, MSN

2. Purpose Ineffective nursing handoff communication at shift change
Delay in or inappropriate treatment
Extended LOS
Increased preventable costs
Decreased patient and staff satisfaction
Patient harm
Leading cause of sentinel events
Importance of addressing patient safety risks as a priority

3. Microsystem Assessment
5P’s Assessment
Process Identification
Observation of BSR Communication
Assess quality report at bedside
Began on time, introduction, information exchange (SBAR), patient involvement, Safety San.
Lack of BSR altogether
Nursing Satisfaction Survey
Only 40% of day shift Nurses felt satisfied with shift report
50% of night shift felt report time is adequate

4. Microsystem Assessment
Press Ganey Scores
Reportable Events
At shift change, do patient’s feel included in the plan of care?
Yes; Total Mean= 89.3
July 03, 2017
Sex – 59% Females, 41 % Males
Language- 89% English, 11% Spanish
Kinked Foley
Patient Fall
Hypoglycemic Episode

5. Cost Analysis Kinked Foley= $4,500 Lab Testing Extended LOS x1 day
Patient Fall= $5,200
X-ray of hip
PT evaluation
Pain medication
Extended LOS x1
Hypoglycemic Episode= $13,300
Hypoglycemic management/ medications
Extended LOS x3 days
Cost Analysis
$0 to implement BSR
Total of $23,000 absorbed costs by the organization as a result of poor handoff communication related errors

6. Qualitative Costs Emotional Pain/ Suffering Physical Pain
Patient/Staff Satisfaction Scores
Daily living
Financial Responsibilities
Relationship Strain
Staff perceptions
Teamwork/ Communication/ Unit morale

7. Literature Review PICO Strategy Benefits of BSR tool
P: Medical-surgical nursing
I: Bedside report tool
C: Non-bedside shift report
O: Effective communication at shift change as evidenced by improved patient outcomes, prevention of events, and improved patient and staff satisfaction.
Benefits of BSR tool
Clarification of significant information
Physical examination of patient and environment/ safety checks
Improved nursing accountability/ teamwork
Improved patient and staff satisfaction
Reduction of hand-off related errors
(Ferguson & Howell, 2015)(Zou & Zhang, 2016)

8. Preparation
Oncoming RN arrives on time to prepare for report. This means before 0700 or 1900
Report begins at 0700 or 1900.
Introduction
Off going nurse uses AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank You) to introduce oncoming nurse to patient and family
Update Whiteboards with correct information
Other team members may be present (CNAs, RT, Lab, etc).
Information Exchange
Use of SBAR (Situation, Background, Assessment, and Recommendation)
Use of simple terms and language that patient and family will understand (including use of interpreter services as needed), avoid using medical terms that patient is unfamiliar with (i.e. NPO).
WOW (Workstation on Wheels) present during bedside report utilized to clarify any information.
Patient Involvement
Give patient and/or family the opportunity to ask questions related to care, clarify exchanged information, review plan of care/ goals for the day including expected hourly rounding.
Safety Scan
Review the patient, environment, AND EHR (Electronic Health Record) bedside.
Patient Assessment: Visually inspect any and all incisions, wounds, .dressings, drains, catheters, IV lines.
Environment Assessment: Visually inspect IV pumps, oxygen, bed alarms, suction equipment, fall mats, call light and personal belongings within reach. Make sure bed is low and locked in position.
EHR: Review of medication administration record to verify all medications have been given and documented correctly, vital signs, I&Os, etc.

9. Specific Aim Statement
Through implementation of a standardized bedside report tool, 95% of twelve-hour night shift nurses on the medical surgical unit at Woodland Healthcare will demonstrate proper quality bedside report at shift change by August 15, 2017.

10. Methodology Lewin’s Theory of Planned Change
Unfreezing: Presented evidence-based research during huddles, gained stakeholder interests, addressed staff barriers, provided education to staff.
Moving: Monitored and coached staff during BSR. Act as resource for support/ mentoring.
Refreezing: evaluate BSR utilizing competency checklist, post-implementation survey results of staff and patients. Enact sustainability plan.

11. Identification of Barriers
Pre-Implementation Survey
Nursing Survey Results
Time constraints
Nursing attitude/compliance
HIPPA violations
Language barrier
Patient compliance

12. Timeline Gantt Chart

13. Summary Report Evaluation of Outcomes What I learned
In the process of collecting post- implementation data and evaluating outcomes:
Nursing Competency Checklist
Press Ganey Survey
Nursing post-implementation survey
Review of reportable events
The importance of flexibility and networking
Setting realistic goals and objectives
Utilizing effective communication strategies
Application of the PDSA cycle

14. Sustainability Plan PDSA PDSA PDSS
Aligning with WHC Mission and Vision
-Dignity, collaboration, stewardship, justice, and excellence
Having a unit champion
- Key player and influencer
Continued perceived benefits for staff and patients
- Post results of improvement, storytelling
Maintaining stakeholder support
-Running reports and audits, benchmarking
Sustainability Plan

15. References
Ferguson, T.D. & Howell, T.L. (2015). Bedside reporting protocols for improving patient care. Nursing Clinics of North America, 50(4),
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Zou, X.J. & Zhang, Y.P. (2016). Rates of nursing errors and handoffs-related errors in a medical unit following implementation of a standardized nursing handoff form. Journal of Nursing Care Quality, 31(1),