Running head: BEDSIDE ROUNDING

Bedside Rounding: A Quality Improvement Process

Megan Cross, Sara Huber, Molly Pacoloa, and Kelsey Spranger
Ferris State University

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Bedside Rounding: A Quality Improvement Process

With a goal of excellence, it is very important how our patients perceive our care. How
care is delivered is extremely important to how patients perceive the care that we give. This is
why it is so important to have patient-based and patient-focused care that includes bedside nurse
reporting. Reporting at the bedside by all RNs helps to include the patient and that patients
family in decision making, understanding of the plan of care, and helping them to feel involved.
Furthermore, bedside rounding improves patient safety as well as the time it takes to report off to
the oncoming nurse. In this paper, we will focus on reviewing nurse report with hopes to
improve the process to include bedside rounding and evaluate if bedside nurse reporting
improves patient satisfaction on the medical unit in comparison to non-bedside nurse reporting in
one year.
Several research studies show reasons why bedside nurse reporting should be
implemented. The most important of all the reasons include patient safety and satisfaction. With
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores driving
reimbursement within the hospital systems, it is vital that the patients perceive our care as
excellent. Improving patients perspective means having them as the center of care and including
them in the conversation. Other reasons to push for bedside rounding include shorter reporting
times, less nurse turnover and higher job satisfaction of the nurses.
According to the Agency for Healthcare Research and Quality (2013), Research shows
that when patients are engaged in their health care, it can lead to measurable improvements in
safety and quality (para 1). These improvements are what we are striving for. In addition,
Dearmon, Roussel, Buckner, Mulekar, Pomrenke, Salas, Mosley, Brown, and Brown (2013)
found that units participating in the original demonstration project experienced lower

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registered nurse (RN) turnover rates, fewer falls with harm, decreased 30-day readmission rates
and increased nursing time in direct patient care (p. 669). While some more research is needed
in evaluating bedside rounding, most of the research that has been done is showing positive
improvements. Rimmerman (2013) found that their program showed benefits including more
coordinated care, nurse empowerment, improved patient care, as well as improved HCAPs
scores (pp. 24-25). Bedside nurse to nurse reporting leads to improved communication between
the different shifts of nurses. One study found that more than 70 percent of adverse events are
caused by breakdowns in communication among caregivers and between caregivers and
patients (Agency for Healthcare Research and Quality, 2013). Seventy percent is a large number
and if the implementation of bedside reporting can decrease this number it will lead to better
patient outcomes. In striving to achieve similar results, we put together a process team to come
up with a plan.
The process design team will include patients, staff nurses, charge nurses, nursing
managers, and/or directors. The patients are a very important part of the team as they will be
providing the most critical feedback. Their feedback will tell us if we are successful or not and
hopefully will be able to help us improve the process as we go. The nurses, charge nurses and
nurse managers will implement as well as evaluate the project. They will serve as leaders,
teachers, and keeping the attitude positive about the changes to come. The nurses will also
evaluate and motivate one another with reminders of patient safety and satisfaction. The team
will be utilized as a unit based council so the staff nurses have the majority of the control and
autonomy in this process.
Implementing bedside reporting and rounding into every day practice for all nurses will
take time and effort. Nurses have to be willing to adapt to these changes in order to see progress.

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Once the nurses accept the change, management must be willing to make necessary changes to
the process in order for it to be used effectively. Before bedside reporting and rounding is
implemented into the nurses every day routine, management should be aware of the nurses
opinions related to the topic. If management can identify their opinions, they will be able to
provide the nurses with necessary education that will make the transition easier.
In order to identify the opinions or biases related to bedside reporting and rounding
bedside nurses should be provided with a questionnaire related to the topic, which will identify
problem areas that will need to be addressed. Once the problem areas are identified, management
can make a plan of how to present the new reporting and rounding system to the nursing staff.
For example, the nursing staff could be presented a PowerPoint at a staff meeting or to view on
their own time along with a video to demonstrate the process of bedside reporting or rounding
(Agency for Healthcare Research and Quality, 2013). The PowerPoint and video would provide
the nurses with important information related to increasing patient safety and the importance of
including patients in their own care. The Agency for Healthcare Research and Quality (2013),
suggests creating a brochure to provide to patients and their family members regarding the times
bedside report will occur and how it could benefit the patient. Providing this brochure to patients
and their families will allow them the opportunity to be updated on the plan of care and also
provide their own input regarding the plan of care.
The entire report does not necessarily have to occur directly at the patients bedside, but
could occur in the hallway prior to the nurses entering the room. A patient may not have been
made aware of a certain diagnosis or test result by the physician, but may be critical information
that the oncoming nurse needs to know, which would be appropriate to discuss prior to the
bedside report involving the patient and family members (Agency for Healthcare Research and

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Quality, 2013). Bedside report will be a time when one nurse shares vital information about the
patient to the oncoming nurse, including vital signs, medications, diagnosis, past medical history,
and current plan of care. The nurses can also do a quick assessment of the patient including skin
and IV access. This report and quick assessment of the patient will provide the nurse with
important information that will help prioritize their team of patients.
During the implementation process of bedside reporting it will be important that nurses
share their opinions of what is effective and what needs improvement. Once nurses have been
utilizing bedside reporting for a couple weeks it may be helpful to have a manager observe this
process to provide feedback to the nursing staff (Agency for Healthcare Research and Quality,
2013). During this observation the manager can discuss with the nurses how they feel bedside
reporting is progressing and what needs to be changed to remain effective. Nurse Managers
should also speak with patients and their families regarding this process to ask for their
suggestions of improvement. Once the information is gathered from both nurses, patients, and
their families the nurse managers will need to meet and discuss how the process can be improved
to lead to optimal results in patient care.
In order to gauge our progress, we have set a goal to be considered excellent in care
provided by at least 80 percent of our patients who participate in the evaluation survey at the end
of one year. An excellent evaluation would include a 5 out of 5 rating in the following 3
categories: nurse communication, comfort level with the nurse, and nurse knowledge of care.
These categories of patient satisfaction should be improved with good bedside rounding report
based on the evidence provided. Our survey will be given to every patient at discharge on the
medical floor and has limitation bias only because we will only get feedback from those who

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volunteer as we cannot make it mandatory. A key factor in reaching our outcome goal will be
based on our implementation strategies.
To help start the process one individual should be selected to be the lead for when
questions or concerns arise. The leader will also enforce what tools will be used for the nurse
bedside shift report. The leader will need to decide how to use and adapt the bedside shift report
checklist, adapt a brochure for patient and family use and decide how to use it, as well as plan
the bedside shift report training for nurses. The leader will need to design a checklist that will be
followed during bedside shift reporting and post it on the unit as well as provide the unit staff
with the handout. Next, the leader needs to make sure the brochure is consistent with key
elements of bedside shift report. Lastly, provide the nurses with proper bedside nursing. Nurses
should be given training, information, modeled behavior, practice time as well as constructive
feedback (Agency of Healthcare Research Quality, 2013). These steps will help the nurse feel
confident and competent when doing bedside report and lead to higher patient satisfaction when
they see the quality of care they are receiving. The Agency of Healthcare Research Quality
(2013) provides a very helpful guide to assist in this transition in stating:
It may be helpful to implement this strategy initially on a small scale (e.g., a single unit).
Identify lessons learned from the single-unit pilot implementation, refine your approach,
and then spread it to more units. In this way, you can build on your successes as a
pathway to broader dissemination and wider scale change. (Agency of Healthcare
Research Quality, 2013)
It is then important to evaluate the changes that have been set in place. The Agency of Healthcare
Research Quality (2013) discusses it is important to intensely assess the process for the first two
weeks, by using a standardized tool to keep track of the observations. Then periodic observations

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would be appropriate. It will also be important to get feedback from nurses, patients and families.
This will include what they believe is working well, what could be improved, and what tools are
or are not working. Based on the constructive feedback that is received the process may need to
be refined by problem solving and implementing the new changes (Agency of Healthcare
Research Quality, 2013).
The evaluation of the project will consists of many different dimensions. Staff will give
input after every shift exchange. Patients may also be asked to participate in a mailed survey of
their perception of the experience. The survey would consist of items asked if the patient was
satisfied with the bedside rounding, if they felt they were part of the decision making, if they
thought their concerns were heard. This is due to most patients feeling more comfortable to
input their thoughts without fear of repercussions. There also needs to be input from the patients
family members as well. How did they perceive it, if they felt like they were also given input
(pending patient gave them permission to be present for privacy reasons) and if they felt the
patient received more individualized care that met their loved ones needs.
The team will revisit the progress weekly as a unit. Nurses will give their input at the
weekly unit based council and adjustments or changes may be implemented then. Nurses can
freely give their input on how they feel the progress is going. The overall evaluation should be
over a six month to one year span. This will then provide a fair evaluation and a presentation can
then be made to upper management.
Implementation of bedside nurse reporting will be beneficial to both nurses and patients.
In order for bedside nurse reporting to be effective nurses must be provided with ample amount
of education and tools to support the new change in care. Bedside nurse reporting will provide
nurses with an opportunity to discuss important and critical patient information along with

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including both patient and family members into the plan of care. Inclusion of both patient and
family members will lead to more optimal outcomes for the patient along with providing them an
opportunity to provide their input on the plan of care. Nurse Managers must frequently discuss
with nurses, patients, and their family members the bedside nurse reporting process to receive
feedback on the positive and negative aspects. The feedback gathered will be utilized to make
necessary changes to the process that will be implemented to promote a safe and patient centered
environment.

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9
References

Agency for Healthcare Research and Quality. (2013). Strategy 3: Nurse bedside shift reporting:
Implementation handbook. Retrieved from:
http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy3/index.ht
ml
Dearmon, V., Roussel, L., Buckner, E. B., Mulekar, M., Pomrenke, B., Salas, S., Mosley, A.,
Brown, S., & Brown, A. (2013). Transforming care at the Bedside (TCAB): Enhancing
direct care and value-added care. Journal of Nursing Management, 21(4), 668-678.
doi: 10.1111/j.1365-2834.2012.01412.x
Rimmerman, C. M. (2013). Establishing patient-centered physician and nurse bedside rounding.
Physician Executive, 39(3), 22-5.