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Bedside Nurse-to-Nurse Handoff Promotes Patient Safety

Bedside Nurse-to-Nurse Handoff Promotes Patient Safety - Clinical Hub, Nursing Hub, Nursing Practice Tools and Resources, Bedside Shift Report, Creating Awareness and Interest, Resources


May-June 2012 Vol. 21/No. 3140
Pamela M. Maxson, PhD, RN, CNS, is a Clinical Nurse Specialist, Surgical Intensive Care Unit,
Mayo Clinic, Rochester, MN.
Kelly M. Derby, MS, RN, CNS, is a Clinical Nurse Specialist, Orthopedic Trauma Surgery Unit,
Mayo Clinic, Rochester, MN.
Diane M. Wrobleski, PhD, RN, NES, is a Nursing Education Specialist, Colorectal Surgery and
Dialysis, Mayo Clinic, Rochester, MN.
Diane M. Foss, RN, is a Nurse Manager, Colorectal Surgery Units, Mayo Clinic, Rochester, MN.
Acknowledgment: The authors wish to thank the Staff Development Committee: Amanda Nellaiappan,
RN; Amanda Beinemann, RN; Stephanie Kuchera, RN; Emily Isaacson-Carver, RN; Kasi McKay, RN;
Nicole Schneider, RN; Colon and Rectal/General Surgery Unit, Mayo Clinic, Rochester, MN.
Note: The authors and all MEDSURG Nursing Editorial Board members reported no actual or
potential conflict of interest in relation to this continuing nursing education article.
Bedside Nurse-to-Nurse Handoff
Promotes Patient Safety
H
istorically, nurses have pro-
vided patient information
to the oncoming nursing
staff to ensure continuity of care
(Chaboyer et al., 2009). Pertinent
information in the shift handoff
often includes patient diagnosis,
procedures performed, hemodynam-
ic stability, the plan of care, and any
topics for discussion during physi-
cian rounds (Caruso, 2007). Over
time, the practice of performing
change of shift nursing handoff has
varied. In most cases, the patient and
family were not present or part of
the handoff practice. Most nursing
handoffs occur in a conference room
or at the nursing station away from
the patient’s bedside in a process
that does not allow the patient and
family to be active participants in
the information exchange. Moving
the change-of-shift handoff to the
patient’s bedside allows the oncom-
ing nurse to visualize the patient as
well as ask questions of the previous
nurse and the patient. It encourages
patients to be involved actively in
their plans of care and implements
a standardized handoff communi -
cation between nursing shifts
(Anderson & Mangino, 2006).
Literature Review
Both CINAHL and Medline were
searched for articles pertaining to
nursing handoffs. Search terms used
were handoff, handover, bedside, com-
munication, report, nursing, shift, and
change. Results were limited to
English language journals published
from 1998 to 2010. Abstracts for the
243 identified articles were reviewed
and eight articles appropriate to the
topic of bedside nursing handoff
were selected. In addition, informa-
tion from the Joint Commission
National Patient Safety Goals (2012)
Pamela M. Maxson, Kelly M. Derby, Diane M. Wrobleski, and Diane M. Foss
Nurse-to-nurse beside handoff allows the oncoming nurse to visualize
the patient and ask questions of the previous nurse. It encourages
patients to be involved actively in their care and allows standardized
communication between nursing shifts.
CNE Objectives and Evaluation Form appear on page 145.
Background
Patient handoff between nurses at shift change has been an important process
in clinical nursing practice, allowing nurses to exchange necessary patient infor-
mation to ensure continuity of care and patient safety. Bedside handoff allows the
patient the ability to contribute to his or her plan of care. It also allows the oncom-
ing nurse an opportunity to visualize the patient and ask questions. This is critical
in meeting the Joint Commission’s 2009 National Patient Safety Goals. It encour-
ages patients to be involved actively in their care and it implements standardized
handoff communication between nursing shifts. Bedside handoff promotes
patient safety and allows an opportunity for patients to correct misconceptions.
Methods
A convenience sample of 60 patients was enrolled, 30 before the practice
change and 30 after the change. All nursing staff were invited to participate. Both
patients and staff were given self-designed surveys before and after the practice
change.
Results
Fifteen nurses with a mean of 2 years in the profession completed the pre- and
post-survey. A majority of staff were not satisfied with the current shift change
report, but statistical improvement was achieved after the practice change. Also,
statistical improvement was achieved with patients’ satisfaction with involvement
in their plan of care.
Conclusions
Use of bedside nursing handoff promotes staff accountability, two-person IV
medication reconciliation, and patient satisfaction.

May-June 2012 Vol. 21/No. 3 141
was also included. The practice of
patient handoffs between nurses at
the change of shift has been an
important process in clinical nursing
practice. It allows nurses to exchange
necessary patient information, en -
sures continuity of care, and pro-
motes patient safety. Most handoffs
occur outside patients’ rooms, with-
out their involvement or input
(Timonen & Sihvonen, 2000).
The Joint Commission’s 2009 and
2010 National Patient Safety Goals
(Joint Commission, 2012) included a
requirement to encourage patients
to be involved actively in their care
and to implement a standardized
handoff communication process
when a change of care providers
occurs. Developing a standardized
process for bedside nurse-to-nurse
handoff is one way to address these
two patient safety standards. Patients
who have experienced bedside
handoffs report feeling safer. They
also appreciate knowing their plans
of care and being introduced to
the oncoming nurse (Anderson &
Mangino, 2006; Caruso, 2007).
Patients who actively participate
in bedside nurse-to-nurse handoffs
are more likely to provide input to
their plans of care. Timonen and
Sihvonen (2000) found patients
often did not participate actively in
handoff sessions. Most patients per-
ceived the information was for the
nursing staff only; use of jargon also
was confusing, so they did not con-
tribute to handoff. Other patients
indicated they were simply too tired.
Chaboyer and colleagues (2009)
found patients perceived participa-
tion in bedside handoff if they were
encouraged explicitly to ask ques-
tions and make comments during
the handoff. The author described
an Australian hospital that started
bedside handoff in 2006 and now
has the patient leading the handoff
on the rehabilitation ward, with nurs-
es adding information as needed.
Historically, nurses have been
hesitant to implement bedside shift
change handoff because they
believed it would require a signifi-
cant time commitment. However,
Anderson and Mangino (2006)
found the implementation of bed-
side handoff decreased overtime by
100 hours in the first two pay peri-
ods. The handoff process only takes
2-5 minutes per patient (Anderson &
Mangino, 2006; Athwal, Fields,
& Wagnell, 2009; Cahill, 1998;
Caruso, 2007; Timonen & Sihvonen;
2000). According to Anderson and
Mangino (2006), staff nurses found
bedside handoff a better way to pri-
oritize their shift work because they
had visualized all their patients. This
study also found staff nurses had
increased satisfaction in accountabil-
ity, interpersonal relationships, and
information receipt. An unanticipat-
ed finding was increased physician
satisfaction because nurses were
more prepared to respond to ques-
tions shortly after change of shift.
In summary, identified benefits
of bedside nurse-to-nurse handoff
include improved communication
between caregivers, increased ac -
countability, and a feeling of greater
safety for patients (Chaboyer,
2009). The potential also exists for
reduced overtime (Anderson &
Mangino, 2006). Bedside nurse-to-
nurse handoff can provide an oppor-
tunity for patients to contribute to
their plans of care (Chaboyer, 2009).
All these benefits enhance quality
and safety at the bedside.
Purpose
The purpose of this study was to:
1. Determine if bedside nurse-to-
nurse handoff increases patient
satisfaction with the plan of care
and increases patient perception
of teamwork.
2. Determine if bedside nurse-to-
nurse handoff increases staff sat-
isfaction with communication
and accountability.
Method
After approval was granted by the
institutional review board, data were
collected through surveys to patients
and staff nurses. Staff members were
invited to participate in the study
through a letter of invitation sent to
their work mailboxes. Signing the
letter of invitation was considered
consent to participate. All 18 staff
members who received invitations
consented to be included. Two staff
members on medical leave were not
invited to participate in the study.
Patients’ consent was obtained
verbally during their hospitalization
on the surgical unit. Inclusion crite-
ria included age 18 or older, no cog-
nitive impairment, and the ability to
understand and speak English. No
patients declined to participate in
the study. An investigator-developed
survey was used to collect data for 30
patients before implementing bed-
side nursing handoff, and another
30 patients 1 month after bedside
nursing handoff was implemented
(see Figure 1). Patients were asked if
they believed they were informed
about their plans of care for the day.
Questions also addressed their per-
ception of open communication
between members of the health care
team about their plans of care, their
satisfaction with the amount of
input they had in their plans of care,
and their perception of the profes-
sionalism and confidential manner
used in report between care pro -
viders (see Figure 1).
Staff nurses were surveyed using
an investigator-developed survey
before and after implementation of
bedside nurse-to-nurse handoff.
Questions were used to measure
changes in accountability, adequacy
of communication at change of
shift, prioritization of workload, per-
formance of medication reconcilia-
tion, and ability to communicate
with other health care providers
immediately after handoff (see
Figure 2). Additional space was
included for narrative comments.
Findings
Data were obtained before and
after the practice change. Patients
(N=60) were surveyed, 30 before and
30 after the practice change.
Demographic information was col-
lected concerning patient sex, diag-
nosis of benign or malignant disease,
type of surgery, and length of hospi-
tal stay (see Figure 3). The majority
of patients had colorectal surgeries
with a benign diagnosis (pre-practice
change 67%, n=20; post-practice
change 60%, n=18) and an average
length of stay of 5.5 days. The sex
distribution was similar in the two
Bedside Nurse-to-Nurse Handoff Promotes Patient Safety

May-June 2012 Vol. 21/No. 3142
groups of patients (female pre-prac-
tice change 50%, n=15; female post-
practice change 53%, n=16). No sta-
tistical difference was found between
the two groups of patients using chi-
squared analysis.
The patient survey had five ques-
tions. Each question was answered
using a five-point Likert scale (1=best,
5=worst) (see Figure 4). Mean scores
before the practice change ranged
from 1.5 to 2; all scores after the
practice change had a mean of 1.
Significance was noted in the ques-
tion referring to the patient being
informed of his or her plan of care
for the day (p=0.02). The results for
the patient survey were analyzed
using the Wilcoxon rank-sum test.
Due to the small size of this unit,
20 nurses were invited to participate
in the study. Eighteen gave informed
consent, and 15 completed surveys
before and after practice change
were used in the data analysis. Most
respondents (93%) were females
with an average of 2 years nursing
experience.
Scores on the pre-practice change
survey included means of 2-4, with
nurse-to-nurse accountability, med-
ication reconciliation, and ability to
communicate immediately with
physicians regarding patient care
after shift handoff receiving the
lower rankings (see Figure 5). The
post-practice change survey resulted
in all questions receiving a mean
score of 1 (best). Every question in
the survey had statistical significance
(p<0.05) with the exception of one:
nurse-to-nurse shift report helps me
prioritize my workload (p=0.06).
Discussion
Findings of this study indicated
bedside nurse-to-nurse shift handoff
had a positive impact on patients
and nursing staff. Patients noted a
significant increase (p=0.02) in their
perception of being informed of the
plan of care for the day. Nurses’ per-
ception improved significantly re -
garding nurse-to-nurse accountabili-
ty (p=0.0005), medication reconcilia-
tion (p=0.0003), and ability to com-
municate immediately with physi-
cians regarding patient care after
shift handoff (p=0.008). These find-
FIGURE 1.
Patient Survey
1. I was informed of my plan of care for the day.
1 Strongly
agree
2Agree 3 Neither agree
nor disagree
4 Disagree 5 Strongly
disagree
2. There was open communication between members of the health care
team about my plan of care.
1 Strongly
agree
2Agree 3 Neither agree
nor disagree
4 Disagree 5 Strongly
disagree
3. I was satisfied with the amount of input I was able to give about my plan
of care.
1 Strongly
agree
2Agree 3 Neither agree
nor disagree
4 Disagree 5 Strongly
disagree
4. My care providers worked together as a team.
1 Strongly
agree
2Agree 3 Neither agree
nor disagree
4 Disagree 5 Strongly
disagree
5. The report given between care providers was given in a professional and
confidential manner.
1 Strongly
agree
2Agree 3 Neither agree
nor disagree
4 Disagree 5 Strongly
disagree
Comments:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Sex: �� Male �� Female
Years of registered nursing experience: _____________
1. Nurse-to-nurse shift report makes people accountable.
1 Strongly
agree
2Agree 3 Neither agree
nor disagree
4 Disagree 5 Strongly
disagree
2. Nurse-to-nurse shift report provides adequate communication between
nursing staff at the change of shift.
1 Strongly
agree
2Agree 3 Neither agree
nor disagree
4 Disagree 5 Strongly
disagree
3. Nurse-to-nurse shift report helps me prioritize my workload.
1 Strongly
agree
2Agree 3 Neither agree
nor disagree
4 Disagree 5 Strongly
disagree
4. Nurse-to-nurse shift report allows me to perform shift change medica-
tion reconciliation.
1 Strongly
agree
2Agree 3 Neither agree
nor disagree
4 Disagree 5 Strongly
disagree
5. Immediately after nurse-to-nurse shift report, I am able to communicate
with physicians regarding patient care.
1 Strongly
agree
2Agree 3 Neither agree
nor disagree
4 Disagree 5 Strongly
disagree
Comments:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
FIGURE 2.
Staff Nurse Survey

May-June 2012 Vol. 21/No. 3 143
ings are consistent with the literature
(Anderson & Mangino, 2006;
Caruso, 2007; Trossman, 2009).
According to Anderson and
Mangino (2006), staff nurses found
bedside handoff a better way for
them to prioritize their shift work
because they could visualize all their
patients. Researchers also found staff
nurses had increased satisfaction in
accountability, interpersonal rela-
tionships, and receipt of informa-
tion. This study showed nurses
found satisfaction in bedside report
through improved awareness of
immediate patient needs and con-
cerns. Results also indicated nurses
felt more prepared immediately after
the change-of-shift handoff to dis-
cuss patient care issues with physi-
cians.
Patients added comments to their
surveys that articulated the impor-
tance of this practice change. “I
would strongly encourage you to
continue the practice of coordinat-
ing the shift change in front of the
patient. It gave me a sense of
involvement in the process and con-
fidence that the incoming staff knew
of the concerns that I had.”
“Excellent procedure – it was nice to
witness the handoff and it mini-
mized confusions and/or conflicting
messages that may otherwise have
come my way.” Comments such as
these reinforced the importance of
bedside handoffs in which patients
are viewed as partners and active
participants with the health care
team to enhance patient safety.
Greaves (1999) also found patients
wanted to be involved in the hand-
off and desired access to their health
care information.
Nursing staff comments included,
“Call lights have decreased during
shift change” and “It allows them
(patients) to feel they have an active
voice in their care and recovery and
reinforces nurses’ commitment to
patient safety.” Although changes in
nursing practice can be viewed nega-
tively, the implementation of bed-
side handoffs has had a positive
impact on both patients and nurses
in the study institution.
FIGURE 3.
Patient Demographics (N=60)
Variable
Pre-Practice
Change (n=30)
Post-Practice
Change (n=30) p Value*
Sex = 1 (female) 15 (50%) 16 (53%) 1.0
Diagnosis 0.59
Benign 20 (67%) 18 (60%)
Malignant 10 (33%) 12 (40%)
Operations 1.0
Colorectal 26 (87%) 27 (90%)
Hepatobiliary 4 (13%) 3 (10%)
Length of stay (days) 5.5 (4-6.75) 5.5 (4-8.75) 0.48
Numbers represent frequency (proportion) or median (interquartile range).
* Chi-squared analysis
FIGURE 4.
Patient Survey
(1 = best, 5 = worst)
# Item Pre Post p Value*
1 I was informed of my plan of care for the day. 2 (1-2.25) 1 (1-2) 0.02
2 There was open communication between
members of the health care team about my
plan of care.
2 (1-2) 1 (1-2) 0.06
3 I was satisfied with the amount of input I was
able to give about my plan of care.
2 (1-2) 1 (1-2) 0.37
4 My care providers worked together as a team. 1.5 (1-2) 1 (1-2) 0.14
5 The report given between care providers
was given in a professional and confidential
manner.
2 (1 – 2) 1 (1-2) 0.1
* Wilcoxon rank-sum test
FIGURE 5.
Staff Survey
# Item Pre Post p Value*
1 Nurse-to-nurse shift report makes people
accountable.
3 (2-4) 1 (1-2) 0.0005
2 Nurse-to-nurse shift report provides
adequate communication between nursing
staff at the change of shift.
2 (2-3.5) 1 (1-2) 0.02
3 Nurse-to-nurse shift report helps me
prioritize my workload.
2 (2-3) 1 (1-2) 0.06
4 Nurse-to-nurse shift report allows me to
perform shift change medication
reconciliation.
4 (2-4.5) 1 (1-1) 0.0003
5 Immediately after nurse-to-nurse shift report,
I am able to communicate with physicians
regarding patient care.
3 (2-4) 2 (1-2) 0.008
* Paired t-test
Bedside Nurse-to-Nurse Handoff Promotes Patient Safety

May-June 2012 Vol. 21/No. 3144
Implications for Nursing
Patients value being active partic-
ipants in their plans of care. The
Joint Commission determined
patient safety and communication
need to be nursing priorities (Joint
Commission, 2012). Bedside hand-
off is one avenue to promote patient
safety by allowing patients and fam-
ilies to be active participants in the
nursing shift handoff procedure.
Patients and family members have
the opportunity to clarify and cor-
rect inaccuracies. Performing the
shift change handoff at the bedside
encourages and supports patients
and families to participate in their
desired level of care decision making,
building on their strengths to
enhance control and independence
(Anderson & Mangino, 2006).
Limitations and
Recommendations for
Future Research
Limitations of this study include
the use of a convenience sample of
patients on one surgical unit. This
11-bed unit may not represent the
average size of a hospital unit.
Because many of the surgical
patients included in the study had
past surgeries, patients in the post-
practice change group may have
experienced nursing handoffs previ-
ously that impacted the way they
completed the survey.
Findings from this study will be
instrumental in sparking further
interest in bedside handoff within
this institution. Further research
may be needed to improve the abili-
ty to generalize these research find-
ings. Studies on other adult surgical
and medical units would be benefi-
cial to determining the impact of
this practice change in other hospi-
tal settings.
Conclusion
Bedside nurse-to-nurse change-of-
shift handoff increases nurses’ aware-
ness of the impact of communication
on patient safety and satisfaction
(Chaboyer et al., 2009). With the pub-
lic expecting more transparency
regarding patient safety in health
care, it is only logical patients partici-
pate in their plans of care. Including
them in change-of-shift discussions
between nurses has the potential to
decrease medication errors, as well as
enhance communication among
nurses, physicians, patient/family,
and other members of the health care
team to promote and encourage an
environment that emphasizes patient
safety and quality.
REFERENCES
Anderson, C.D., & Mangino, R.R. (2006).
Nurse shift report: Who says you can’t
talk in front of the patient? Nursing
Administration Quarterly, 30(2), 112-122.
Athwal, P., Fields, W., & Wagnell, E. (2009).
Standardization of change-of-shift report.
Journal of Nursing Care Quality, 24(2),
143-147.
Cahill, J. (1998). Patient’s perceptions of bed-
side handovers. Journal of Clinical
Nursing, 7(4), 351-359.
Caruso, E.M. (2007). The evolution of nurse-
to-nurse bedside report on a medical-
surgical cardiology unit. MEDSURG
Nursing, 16(1), 17-22.
Chaboyer, W., McMurray, A., Johnson, J.,
Hardy, L., Wallis, M., & Chu, F.Y. (2009).
Bedside handover: Quality improvement
strategy to “transform care at the bed-
side.” Journal of Nursing Care Quality,
24(2), 136-142.
Greaves, C. (1999). Patients’ perceptions of
bedside handover. Nursing Standard,
14(12), 32-35.
Joint Commission. (2012). National public
safety goals. Retrieved from http://www.
jointcommission.org/standards_informa
tion/npsgs.aspx
Timonen, L., & Sihvonen, M. (2000). Patient
participation in bedside reporting on sur-
gical wards. Journal of Clinical Nursing,
9(4), 542-548.
Trossman, S. (2009). Shifting to the bedside
for report. American Nurse, 41(2), 7.

May-June 2012 Vol. 21/No. 3 145
ANSWER FORM
1. If you applied what you have learned from this activity into your practice, what would be different?
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Answer/Evaluation Form:
Bedside Nurse-to-Nurse Handoff Promotes Patient Safety
Deadline for Submission: June 30, 2014
Strongly Strongly
Evaluation disagree agree
2. By completing this activity, I was able to meet the following objectives:
a. Explain the importance of bedside handoff and patient safety. 1 2 3 4 5
b. Describe a study to determine if beside nurse-to-nurse handoff increases patient satisfaction
with the plan of care, and staff satisfaction with communication. 1 2 3 4 5
c. Discuss the nursing implications of the study results. 1 2 3 4 5
3. The content was current and relevant. 12 345
4. The objectives could be achieved using the content provided. 12 345
5. This was an effective method to learn this content. 12 345
6. I am more confident in my abilities since completing this material. 12 345
7. The material was (check one) ___new ___review for me
8. Time required to complete the reading assignment: _____minutes
I verify that I have completed this activity: _______________________________________
Comments_______________________________________________________________________________________________________
_______________________________________________________________________________________________________________
OBJECTIVES
This continuing nursing educational (CNE) activity is designed for
nurses and other health care professionals who care for and educat-
ed patients and their families regarding bedside nurse-to-nurse
handoff and patient safety. For those wishing to obtain CNE credit, an
evaluation follows. After studying the information presented in this
article, the nurse will be able to:
1. Explain the importance of bedside handoff and patient safety.
2. Describe a study to determine if beside nurse-to-nurse handoff
increases patient satisfaction with the plan of care, and staff sat-
isfaction with communication.
3. Discuss the nursing implications of the study results.
CNE Instructions
Persons wishing to obtain CNE credit must read the article and
complete the answer/evaluation form. Upon completion, a certificate
for 1.3 contact hours will be awarded. Evaluations can be submitted
two ways:
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and print your CNE certificate immediately. Simply go to
www.amsn.org/library, and select MEDSURG Nursing Journal
from “My Library.”
Fee: AMSN Member: Free Regular: $15.00
2. Persons without access to the Internet may photocopy and send
the answer/evaluation form along with a check or credit card
order payable to AMSN to MEDSURG Nursing, CNE Series,
East Holly Avenue Box 56, Pitman, NJ 08071-0056. Test returns
must be post-marked by June 30, 2014. A CNE certificate will
be provided by mail.
Fee: AMSN Member: $10.00 Regular: $15.00
This independent study activity is co-provided by AMSN and Anthony J.
Jannetti, Inc. (AJJ).
Accreditation status does not imply endorsement by the provider or
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of CA must retain this certificate for four years after the CNE activity is
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This article was reviewed and formatted for contact hour credit by
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®
, CNE,
MEDSURG Nursing Editor; and Rosemarie Marmion, MSN, RN-BC,
NE-BC, AMSN Education Director.
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