Running head: PRACTICUM SUMMARY REPORT FOR SYNTHESIS 1

Practicum Summary Report for Synthesis

Janet Heath

Bon Secours Memorial College of Nursing

Synthesis of Nursing Practice

4242

W. Liverman

July 12, 2017

I Pledge Janet Heath

PRACTICUM SUMMARY REPORT FOR SYNTHESIS 2

Practicum Summary Report for Synthesis

This was a QI project to improve compliance in the ED with giving bedside hand-offs at

shift change. The failed previous attempts get addressed in the background. In fact, prior to this

project, the department did not have a standardized approach for the transition of patient care

between incoming and outgoing nurses and it is usually given around the nurses station or in the

hallway. Specifically, the aim of this project is to transition from giving report at the nurses

station to bedside hand-offs in the Emergency Department 100 percent of the time by August

2017.

During the last week of June, 2017, preparations to discuss the importance of bedside

reporting during shift change in the Emergency Department were being organized for this

project. As a result, information was presented in order to reacquaint the nurses in the

department to the concept of bedside reporting, making them aware of the expectations imposed

upon them regarding the process. Efforts were made to raise awareness by providing an

educational in-service during Huddle, placing yellow signs around the nurses station as a

reminder to pass it on, shift to shift, ensuring a safe hand off by taking it to the bedside

(Rambo, 2017). Additionally, we stressed how bedside report improves continuity of care, as

well as, improving interaction between staff members. Before the initiation of this project,

change of shift hand-off was usually given around the nurses station in order in clear view of the

computerized chart. Research has proven that bedside reporting is an important part of

communication between nurses and that a breakdown in communication was the leading root

cause of sentinel events reported to the Joint Commission in the United States between 1995 and

2006 ("Communication among caregivers," 2008, p. 376).

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Prior to the pilot study, we observed approximately 15 percent of nurses practicing

bedside report. However, following the first PDSA cycle, the percentage of nurses giving

bedside report increased to 75 percent. After the project was introduced and the staff was made

aware of the importance of bedside reporting, each project member was assigned rooms and

times to monitor bedside report during change of shift. After obtaining baseline compliance data

and during the initial pilot, nurses assigned to a specific area were observed during all four shifts,

twice a week for two weeks. This took place from June 30th through July 14, 2017. Initially, the

nurses were resistant to change, however, adapted well after receiving positive feedback related

to the implementation of bedside hand-off and saw how it increased patient satisfaction. During

this short time frame, the majority of nurses were receptive to the change and understood the

importance of bedside report. The only barriers that were present were time constraints and

nurses who did not receive proper information about implementing bedside hand-off at the

beginning of each shift. Following the first PDSA cycle, the percentage of nurses giving bedside

report increased from 15 to 75 percent. Unfortunately, due to limited time, we were unable to

obtain necessary data in order to reveal positive patient outcomes related to bedside reporting.

However, much research has been done that connects bedside reporting to a positive patient

outcome. In fact, bedside reporting encourages teamwork and accountability of staff and is

safer for the patient because it increases the quality of hospital care (Rush, 2012, p. 44).

Additionally, research has proven that patient safety is improved with regard to BSRs and

leads to avoidance of adverse patient events, falls at shift change and medication errors are

reduced (Gregory, Tan, Tilrico, Edwardson, & Gamm, 2015, p. 543).

The pilot study went as planned and the change did lead to improvement considering the

time constraints we were under after getting a late start on the final project. As a result, we do
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not plan to do another cycle. However, continued reinforcement and emphasis on the importance

of bedside reporting will be ongoing for the future test cycles. Furthermore, nurses will be held

accountable and once the culture of the department changes, we can expect more consistent

improvement.

Finally, this project has been a valuable learning experience and I realize now, more than

ever, how important bedside reporting is. Additionally, using a team approach and the concept

being accepted by everyone, helped to make this project successful. Communication between

the department manager, shift coordinators, and relaying information through the daily Huddle

were paramount in making this Quality Improvement initiative effective. Hopefully, this

initiative will not stop here but will continue on a larger scale to involve the entire Emergency

Department.
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References

Gregory, S., Tan, D., Tilrico, M., Edwardson, N., & Gamm, L. (2015, February 5). Bed shift

reports: What does evidence say? The Journal of Nursing Administration, 44, 541-545.

http://dx.doi.org/10.1097/NNA.0000000000000115 Source: PubMed

Incorporating Bedside Reporting into Change-of-Shift Report. (2010). Retrieved from

onlinelibrary.wiley.com

Rambo, J. (2017). Pass It On Star. Richmond, VA

Rush, S. K. (2012, January). Bedside reporting: Dynamic dialogue [Journal Article]. Nursing

Management, 43(1), 40-44. Retrieved from

http://journals.lww.com/nursingmanagement/Fulltext/2012/01000/Bedside_reporting_Dy

namic_dialogue.11.asp

Strategy 3: Nurse Bedside Shift Report. (2013). Retrieved from

https://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy3/index.ht

ml

The Chronicle of Nursing [Journal Article]. (2008, July 1). The Chronicle of Nursing, 376-377.

Retrieved from https://www.asrn.org/journal-chronicle-nursing/376-377/communication-

among-caregivers.html

Transforming Care at the Bedside. (2011). Retrieved from

http://www.ihi.org/Engage/Initiatives/Completed/TCAB