Running Head: MANAGING CHANGE TOWARDS BEDSIDE SHIFT REPORT

MANAGING CHANGE TOWARDS BEDSIDE SHIFT REPORT

Anauja Bell

University of South Carolina

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Being a health care professional entails many different responsibilities and expectiations.

Between caring for patients, providing education, and facilitating emotional support, the job of

nurses and other support staff members is essential. It is imparitive to ensure that the

professionals in these roles understand the immensity of importance that they have in patient care

and the vast room for potential errors. Many hospital errors stem directly from lack of

communication or knowledge of patient condition. To prevent these issues, many facilities have

started to promote the practice of bedside shift report. By definition, bedside shift report is a

report given during shift change between the oncoming nurse and the offgoing nurse that occurs

within the patient’s room (Reinbeck and Fitzsimons 2013).

Background

Within the last several years, many health systems have adopted bedside shift report to

promote effective communication, patient safety, and patient involvement in care. Through

research, observation and discussion with the unit manager on a neuroscience unit, it has been

reported that staff compliance towards adopting bedside shift report has been low. To promote

higher staff compliance with bedside shift report, patient and professional benefits were

discussed with the unit. This issue was chosen due to the large amount of studies and evidence

based research that supports the use of bedside shift report in the healthcare setting. In most all

cases this method has been seen as beneficial. This issue is relevant to the Step-Down

Neuroscience unit because much like many other facilites and units, implementing a new shift

towards a practice can be difficult in promoting compliance. With compliance from all staff

members, a decrease is expected in communication errors, medication errors and an overall

increase in patient safety and satisfaction rate will be evident.

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Identifying Issue

Management on the neuroscience unit has noticed that staff often continues with

alternative methods of reporting despite the suggestion to follow the implemented policy of

bedside reporting. Upon discussion with the unit manager, a gap analysis regarding the thoughts

towards bedside shift report outcomes was deemed to be the most effective way to assess the

reasons for noncompliance. Three questions were generated and addressed to ten staff members

on the unit. When asked the question “do you feel bedside shift report promotes patient safety?”

100% of staff said yes. When asked the question, “do you feel bedside shift report is beneficial to

you as a medical professional?”, 60% said yes it is benificial to them and 40% said no it is not

beneficial. When asked “do you feel like bed side shift report promotes patient satisfaction

outcomes overall?”, 40% said yes it improves outcomes and 60% said it does not improve

outcomes. This information was directly obtained from the patient support technicians and the

nurses on the unit.

Evidence Based Research

One of the largest drives in evidence based practice regarding bedside shift report is

moving towards patient centered care. As discussed by Baker, patient experiences have now

been heavily rated on score cards and general systems called Hospital Consumer Assessment of

Healthcare Providers and Systems (HCAHPS) to promote patient voice in standards of care

(2014). But despite the generalized questionnaires and their results, facilites have still seen a

struggle in implementing effective patient and family centered care models (Baker 2014). Many

of these issues stem from not knowing the proper components for implementing these care

models and shifting clinical mindesets to be patient focused versus treatment focused (Baker

2014). Many of the barriers presented based on patient reports were: respect for patient
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preferences, values and needs; providing education and appropriate information; coordinating

and integrating care and services; emotional and physical comfort; involvement and education

provided to families and caregivers; discharge transitions; and access to continuing care (Baker

2014).

One way discussed to improve patient centered care was through a three step process

suggested by Hall and Romp through a presentation at Kentucky One Health Center. Hall and

Romp suggested that nurses start by addressing the patient’s needs prior to shift change through

rounding and addressing the five p’s: plan, potty, position, possesions (2014). Secondly, they

suggested that the offgoiong nurse take managing up techniques for the oncoming nurse (Hall

and Romp, 2014). These actions include making sure all the medications required for a shift

were given or successfully rescheduled, making sure patient is repositioned and comfortable, as

well as making sure patient enviornment is clean and in order. Thirdly, they suggest that

offgoing nurses are sure to update the white board and discuss the patient’s current condition and

plan of care (Hall and Romp, 2014). With use of the whiteboard and discussion of plans anyone

in the patient’s room has access to knowledge of the care plan and goals provided for the day.

From implementation of these practices, Hall and Romp were able to provide a comparison of

pre and post HCAHPS. It was shown that there was an overall increase in HCAHPS scores from

73% to 83% in likelihood to recommend the facility, from 79% to 83% in providing clear

communication, from 62% to 77% in prompt bathroom assistance and 70% to 85% in pain

controlled this amount to this amount in these categories (Hall and Romp 2014).

Another large topics discussed in regards to bedside shift report is patient safety. Studies

have shown an overall improvement in patient safety related to many aspects for those units and

facilities that participate in bedside shift report. According to researchers Gregory, Tan, Tilrico,
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Edwardson and Gamm, many of the patient perspective articles focus on the improvement of

care understanding and patient empowerement due to the ability to directly ask questions about

their care and receive answers in real time with two professionals present, while others report

that patient benefit relies directly upon the ability to receive more prompt delivery of care

(2014). Also doing the report in front the of patients allows them to ask questions that may not

have been clarified on the previous shift (Jeffs, Acott, Simpson, Campbell, Irwin, Lo, Cardoso

2013). Other studies suggest that participants feel that bedside shift reporting allowed for an

opportunity for nurses to check and clarify information (Jeffs, et. al 2013). From this practice,

nurses and patients were able to find, intercept, correct and review potential and actual errors in

care (Jeffs, et. al. 2013).

Nurses also described that they were able to prioritize their care more effectly and

efficiently when using bedside shift report (Jeffs, et. al 2013). As a nurse, having the ability to

lay eyes and quickly do assessments on their patients during report allowed them to be able to

see who was in the most critical condition and in need of the most instant care (Jeffs, et. Al,

2013). This also allows for proper delegation practices on units.

Through bedside shift report, nurses were also able to compare baseline assessments

between when they were the oncoming nurse and when they are the offgoing nurse (Gregory,

Tan, Tilrico, Edwardson, and Gamm 2014) . Oncoming nurses were able to assess the enviornent

for cleanliness, intravenous lines, fluids, wounds sites, and chest tube drainage systems to ensure

everything was in working order and where it should be (Gregory, et. al, 2014). This led to a

higher level of accountability and the information needed to know what tasks should be done

during the shift (Gregory, et. al 2014).

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Through research it has been shown that the overarching theme and largest benefit for

participation in bedside shift report is better communication. According to Reinbeck and

Fitzsimons, communication is a vulnerable aspect of patient safety (2013). In the past

centralized shift reports were given in a nurses station, in an alcove or within empty rooms,

which did not allow for patient participation and left many holes in report (Radtke 2013) . Many

nurses have voiced frustration in regards to the lack of information being shared during these

types of reports (Radtke 2013). It is said that nurses tend to feel like they are behind before they

even begin their shift due to the gaps and unexpected findings upon first entering the patient’s

room (Radtke 2013). Nurses often are presented with questions before even seeing their patients,

messy rooms, skipped medications with no explanation, soiled dressings, and I.V. fluids set at

the wrong rate (Radtke 2013).

According to Reinbeck and Fitzsimons, the most effective communication tool is SBAR.

SBAR stands for situation, background, assessment, and recommendation. When describing

situation, the offgoing nurse would introduce the oncoming nurse (Ofori-Atta, Binienda, and

Chalupka 2015). This would allow for the oncoming nurse to greet the patient, address the

patient’s name, verifying their wristband with name and date of birth, hear the diagnosis and

update the patient information board (Ofori-Atta, et al 2015). During the background phase

nurses are able to directly involve the patients. In this phase nurses exchange brief but pertinent

information regarding the patient’s health history, comorbidities and events leading to

hospitalization, and how long the patient is expected to stay in the facility (Ofori-Atta, et al

2015). Nurses should ask the patient to first hear the information being discussed, then further

their knowledge if needed by asking quesions at the end (Ofori-Atta, et al 2015). The next phase

would be assessment. This is where nurses conduct a full review of systems to the next nurse
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being sure to include pertinent information about vital signs, tubes, invasive lines, surgical

drains, urinary catheters, and venous access devices (Ofori-Atta, et al 2015). This is also the

section where nurses observe the I.V. sites, the medication pumps, the infusion rates, and address

patient’s about whether they are experiencing any pain (Ofori-Atta, et al 2015). The next step

would be recommendation. This is where the offgoing nurse relays information regarding the

patient’s cultural and communication needs, pending orders, goals and plans of care (Ofori-Atta,

et al 2015). At the end of SBAR the patient should again be asked if they have any questions or

concerns before the nurses leave the room (Ofori-Atta, et al 2015).

With the shift towards bedside rounding, many nurses and hospital staff were concerned

with the potential increase in time for patient hand-off (Reinbeck and Fitzsimmons 2013). In

studies conducted by Reinbeck and Fitzsimmons, it was shown that interruptions from

physicians, interpersonal team members and phone calls were greatly reduced in comparison to

the former practice of reporting (2013). It was also shown that time was actually reduced due to

the streamlined effect of SBAR (Reinbeck and Fitzsimmons 2013). Nurses were also

appreciative for being able to visualize all of their patients within the first 30 minutes of their

shift (Reinbeck and Fitzsimmons 2013). Another positive aspect of bedside shift reporting was

building nurse-nurse dyatic relationships such as increased socialization by sharing stories and

experiences, providing emotional support and bonding, increased staff communication,

mentoring, coaching and networking opportunities (Reinbeck and Fitzsimmons 2013). Although

this seems like a minute aspect, nurses having the ability to overcome feelings of discomfort,

express feellings of stress, and exchange thoughts on patient care led to an increase in employee

satisfaction rate as well as reduction in costs to healthcare facilites from less paid overtime and

legal costs related to falls and medication errors (Reinbeck and Fitzsimmons 2013).
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Although many benefits, there are still oppositional barriers to bedside shift reporting.

Often times bedside shift report happens very early in the morning and this become diruptive to

patients who are attempting rest (Radtke 2013). Patients can become agitated with the practice

and constant interruption and even request that the reporting in their room cease entirely (Radtke

2013).This also becomes an issue for patients who are unresponsive, or unable to participate due

to cognitive or sensory limitations (Radtke 2013). Another issue that nurses run into with bedside

rounding is disclosing information that has not been discussed between the patient and the

healthcare provider (Radtke 2013). This can be troublesome due to the lack of detailed

explanation the nurse can give about the next steps in care, as well as the potential inability to

give a clear answer about when the physician will next be available to see the patient. This can

potentially increase patient anxiety. Many nurses have also stated that they may feel skeptical

discussing certain issues in the medical records in front of the pateints such as certain infectious

disorders to alert drug abuse and psychosocial issues (Radtke 2013). Confidentiality is one of the

largest concerns regarding bedside shift report (Radtke 2013). Often times patients may be in a

semi-private room or are in the room with family members or friends and it can be an

uncomfortable situation for the patient and the nurse to ask certain individuals to be dismissed

(Radtke 2013). Patients over 18 years old can decide whether they would like their family

members or friends to have knowledge of their condition and medical records (Radtke 2013).

This becomes a privacy issue when revealing certain test results, disease processes, and plans for

treatment (Radtke 2013). Finally, there is often the issue of staff compliance. Like with any

practice or policy change, staff can be resistent in participation (Radtke 2013). This poses a

safety issue for patients and can increase staff tension for those who do want to properly

implement the new policies (Radtke 2013).

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This evidence is all very impactful in regards to the issues faced in the Neurosceince

Step-Down unit. It goes in depth to why the unit should continue to adopt the new policy of

bedside shift rounding and work towards adherence. It also addresses the issues and reasons why

staff may be resistent to adopting the policy. This infornation can now be compiled and

formulated to directly address the obstacles that the neuroscience unit faces regarding

compliance with bedside shift report by promoting the research behind how it promotes patient

centered care, patient safety and increased communication.

Recommendations

Based on the evidence found regarding bedside shift report, it has been concluded that

this practice can lead to many positive outcomes for the patients as well as the nursing staff. It

has been shown that by continuing to ask patient opinions on care allows for progress towards a

successful model of patient centered care. This can be implemented by using the “background”

phase of SBAR to allow patients and family members to ask questions and address concerns.

This will allow the patients on the unit to feel heard and have a sense of autonomy within their

care plan. Through research it has also been shown that bedside shift report will increase patient

safety. This can be implemented by using the “assessment” phase of SBAR to do a two person

skin check, I.V fluid check, and relaying pertinent information about vital signs, tubes, invasive

lines, surgical drains, urinary catheters, and venous access devices. The next research based

recommendation is for nurses to increase communication for overall better outcomes. Based on

the information found, increased communication leads to improvement in all areas of healthcare.

Nurses and technicians should ensure to adopt the format of reporting through SBAR and make

sure they are delivering this information at the bedside. Using this system will allow them to
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avoid any gaps in information and hold each oncoming and offgoing nurse accountable for

patient’s current state when they are transferred to the next caregiver.

This will change the staff practices and patient outcomes in many positive ways. This

will lead to improved HCAHPS scores for the unit. It will also lead to increased staff morale

from the ability to address feelings and concerns to one another. This will improve time

management because of the structured delivery system, which allows for a smoother transition

from shift to shift. It will also increase patient and family education from listening to the SBAR

transaction. This practice will decrease falls due to the presence of two people being in the room

for assistance as well as decrease the rate of pressure ulcers faced by the unit from doing a four

eyed skin check. There also will be a reduction in medication errors from having two

professionals check the accuracy of delivery.

There are many approaches in how this practice can be implemented. By addressing the

reasons staff does not want to participate, management can formulate a plan to address staff

concerns. After adressing these issues, meetings can be set to make a system to change the

outstanding concerns and make the system flow more smoothly specified to the unit. Once the

issues are addressed a plan is made to improve compliance, a follow up gap analysis with the

same three questions, “do you feel bedside shift report promotes patient safety?”, “do you feel

bedside shift report is beneficial to you as a medical professional?”, and “do you feel like bed

side shift report promotes patient satisfaction outcomes overall?”, should be implemented. The

results should be compared and contrasted to the results obtained prior to implementation and an

increase in safety promotion, benefience, and patient satisfaction should be noted. Management

should also implement a penalty for consistent noncompliance with bedside shift report, unless it
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is a patient specific issue. These recommendations will be delivered to the unit through brochure

to take into consideration.

The details discussed in the brochure include why bedside shift rounding is beneficial,

oppositional barriers to the practice, the results from the gap analysis from the staff, statistics

from other implementations, and considerations and recommendations to improve compliance.

This deliverable will be left in the break room for staff to obtain as they please and will also be

presented and passed out throughout three shifts during morning and night huddle. During the

presentation, a positive approach to the situation will be taken. The discussion will be centered

on how staff can improve their compliance with bedside shift report and what the positive

outcomes are related to patients and staff members when they are compliant.
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References

Baker, G. R. (2014). Evidence boost: a review of research highlighting how patient engagement
contributes to improved care. Canadian Foundation for Healthcare Improvement

Gregory, S., Tan, D., Tilrico, M., Edwardson, N., & Gamm, L. (2014). Bedside shift reports:
what does the evidence say?. Journal of Nursing Administration, 44(10), 541-545.

Hall, K., Romp, C. Bedside Shift Report: A Pilot Evidence Base Practice Project. Poster session
presented at: Kentucky One Health; 2014; Louisville, KT

Jeffs, L., Acott, A., Simpson, E., Campbell, H., Irwin, T., Lo, J., ... & Cardoso, R. (2013). The
value of bedside shift reporting enhancing nurse surveillance, accountability, and patient
safety. Journal of nursing care quality, 28(3), 226-232.

Ofori-Atta, J., Binienda, M., & Chalupka, S. (2015). Bedside shift report: Implications for patient
safety and quality of care. Nursing2018, 45(8), 1-4

Radtke, K. (2013). Improving patient satisfaction with nursing communication using bedside
shift report. Clinical Nurse Specialist, 27(1), 19-25.

Reinbeck, D. M., & Fitzsimons, V. (2013). Improving the patient experience through bedside
shift report. Nursing management, 44(2), 16-17.