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Addressing Perceptions of Bedside Reporting for Successful Adoption

Addressing Perceptions of Bedside Reporting for Successful Adoption - Clinical Hub, Nursing Hub, Nursing Practice Tools and Resources, Bedside Shift Report, Creating Awareness and Interest, Resources


Addressing Perceptions of
Bedside Reporting for
Successful Adoption
April 201470 Nurse Leader
JoAnn A. Frazier, BSN, RN, CPHQ, and Wes Garrison, MSN, MBA, RN, NE-BC
W
ith the changing healthcare cli-
mate, healthcare organizations are
increasing their focus on delivering high-quality
care and improving patient safety.
1
One nursing
practice that is getting heightened attention is the
practice of bedside reporting (BSR) as the pre-
ferred means of end-of-shift handoff communica-
tion. Extensive literature supports the practice of
bedside reporting as a means of improving quality
care, patient satisfaction, and patient–family par-
ticipation in the plan of care.
2,3
Additionally, BSR
can increase communication and accountability
between nurses, improve communication between
the nurse and patient, improve coordination of
patient care, and increase patient–family adher-
ence with the plan of care.
4

THE NEED FOR CHANGE
St. Vincent Infirmary Medical Center (SVI) is part of St.
Vincent Health System in Little Rock, Arkansas, which com-
prises 3 hospitals and 8 clinics. The health system is a member
of Catholic Health Initiatives, a national nonprofit healthcare
organization. In January 2013, the American Nurses
Credentialing Center (ANCC) recognized St. Vincent
Infirmary as a Magnet
®
organization.
In the spring of 2011, managers of 4 nursing units at SVI
identified similar challenges on their units: patients/families not
involved in the plan of care, lengthy shift report resulting in
unnecessary overtime, and a general lack of communication
among the nursing staff. Each of the managers had prior expe-
rience with BSR at other organizations, and each thought that
implementing the practice on their units could address those
challenges successfully. A senior nurse leader assisted in collabo-
rating with the managers, and an idea to pilot a BSR initiative
to improve communication was developed. However, to move
forward with the project, it was necessary to understand a vital
piece of historical fact: SVI previously implemented BSR in
2009, but failed to sustain the practice long term.
To understand the previous failure and to successfully
adopt BSR, the team needed to understand staff perceptions
and the barriers to changing those perceptions. Feedback
from direct care staff was elicited, and common themes
emerged as to why this practice was unsuccessful in previous
attempts:
• No clear communication for why the practice change
was necessary
• No education about how to perform the practice
• Lack of communication to staff about how the practice
change was improving patient care
• No staff accountability to implement the practice
• Lack of practice validation post-implementation
A PILOT INITIATIVE WAS DEVELOPED
The pilot team members utilized the feedback about past
failures to establish a plan to pilot BSR on the 4 nursing units:
3 surgical and 1 medical. Upon receiving support from the
senior nursing leadership, the 3-month pilot plan was formal-
ized and rolled out. The pilot was structured around the obvi-
ous theme in the failure of past attempts: communication.
The pilot team used a tool: survey registered nurse (RN)
staff to obtain baseline data about common perceptions and
misconceptions about bedside reporting. After the survey was
complete, informal education in the form of articles from
literature review was provided to staff, supporting BSR as a
practice change. A formal education module was developed,
communicating not only the reasons for implementing the
pilot, but also a summary of the evidence-based literature
supporting the practice. Explanation of the steps involved in
performing the BSR practice was clearly communicated to
the pilot units. The team also took into account that visual
aids could be a helpful learning tool in adult learning, and
the team produced a video that would be used in conjunc-
tion with the formal training component. Because 1 of the
misconceptions of BSR was that it would take longer than
traditional report formats, the pilot training video included a
timer in the bottom of the screen demonstrating to the view-
er that a comprehensive, real-time end-of-shift report could
be given in approximately 5 minutes per patient. Once edu-
cation was complete, each staff RN received competency
assessment verification via a formal check-off tool.
SUPPORTING/MONITORING A CHANGE IN
PRACTICE
From the inception of the idea to change practice, the unit
managers made a clear case for the need for change and the
expectations for the outcomes. All managers had previous
experience with the BSR practice in other organizations and
had seen the benefits of the practice on the patients and on
the organizations. Those experiences helped them to effec-
tively lead their units through the transition process.
Once the pilot began, daily patient rounding by the nurse
manager elicited individual patient feedback that the managers
could (in real time) take back to the staff in order to bolster
staff support, as well as coach staff who were not following the
BSR process as instructed. Additionally, results from periodic
rounding by the off-shift supervisors and “mystery shopper”
audits were given to the managers, allowing validation that staff
were adhering to the BSR process in order to hold staff
accountable to implementing the practice. Weekly review of
patient satisfaction metrics were shared with the unit staff, as
well as a pilot dashboard of specific metrics that were most
impacted by the BSR practice change.
OUTCOMES
The staff perceptions regarding the practice of BSR were
resurveyed 3 months post-implementation of the pilot. Using
a 5-point Likert scale, results showed improvement in 5 of
the 6 metrics (Figure 1). Staff responses regarding the BSR
practice were mostly positive, including many nurses verbaliz-
ing an improvement in their ability to prioritize their work-
load at the beginning of their shift and a clearer
understanding of the patient condition, as they could imme-
diately confirm accuracy of the verbal report with the clinical
picture. “Bedside reporting gives me a great start to my day,”
reported one nurse. The RN staff of the pilot units also
provided feedback that allowed the team to understand
ongoing concerns that needed to be addressed in order to
successfully sustain the practice change. These concerns and
potential barriers to adoption included:
• Violating patient privacy when visitors were present
• The nurse who resists the BSR practice
• Patient/family requests to not perform report at bedside
• The sleeping patient
• The sleeping patient with various pain issues during the
previous shift
The team determined appropriate responses to the special
situations that the staff identified and re-produced the training
video to incorporate staff feedback. Although there were many
nurses who readily adopted the practice change, there was push-
back noted from others who were not as ready to change their
practice or were not as proficient in the reporting format. The
www.nurseleader.com Nurse Leader 71

formal training component was updated to address common
misconceptions and excuses that nurses might encounter from
other nurses who did not want to perform the practice, and the
rationale for rising above those excuses in order to improve RN
support of the new practice to facilitate nurse buy-in.
During the pilot, specific patient satisfaction questions
that the team felt would be the most impacted by BSR
were tracked:
• “During this stay, how often did nurses listen carefully to
you?”
• “How often did the staff meet your expectations regard-
ing your family’s involvement in your care?”
• “During this hospital stay, how often did the staff treat
you as a whole person, not just a medical condition?”
• “During this hospital stay, how often was your pain well
controlled?”
• “During this hospital stay, how often did the hospital
staff do everything they could to help you with your
pain?”
An added outcome of the improved communication
process on the pilot units was that patient satisfaction scores
for the selected metrics improved. Although improvement in
scores for the selected metrics occurred in most units during
the pilot, the most significant and sustained change occurred
on the neurosurgical/spine unit (Figures 2 and 3). Patient
satisfaction for all 5 of the selected metrics improved during
the pilot phase and demonstrated sustained improvement
through the following seven quarters.
CHANGING PRACTICE SYSTEM-WIDE
The results from the pilot were presented to the senior
nursing leadership of the organization that approved a
April 201472 Nurse Leader
Figure 1. RN Survey Response on Pilot Units
Figure 2. Pilot Unit Patient Satisfaction-A

system-wide implementation of BSR to begin in January
2012. The leadership believed that a “phased” approach
would allow better adoption, with more focused attention
provided to the units who were newly implementing the
practice. The phased approach also would allow anticipa-
tion to grow as positive staff feedback disseminated
throughout the organization as new units began the prac-
tice change. A plan for rolling out the practice to groups
of units was devised that took into account RN floating
practices and competing priorities of other evidence-based
practice initiatives that were being implemented within
the system. The formal education module and video train-
ing were disseminated to the other nurse managers to
begin unit-level training as each nursing unit began the
BSR practice.
Several initiatives that began as part of the system rollout
included: formal education to existing staff, communication
regarding BSR as the expected form of end-of shift commu-
nication during the bimonthly new-hire nursing orientation
training, and inclusion of BSR on the competency assessment
tool for all RNs. Additionally, the team utilized staff feedback
about barriers to the BSR practice to reproduce the training
video to include managing scenarios related to:
• Patient privacy concerns when visitors were in the room
• The nurse who preferred not to wake up a sleeping
patient to give report
• The patient who had a difficult prior shift and has finally
gone to sleep just prior to end-of shift report
• Patient or family request not to perform verbal handoff
of BSR in the room
LESSONS LEARNED
In retrospective review of the rollout of the BSR initiative to the
organization, there were several lessons learned that will be
considered when implementing future projects. The most signifi-
cant lesson was the value of training staff and the manager sup-
port of the project. During the pilot phase, the strong unit
manager support and buy-in of the project helped to successfully
launch the expectation of BSR on those units and further rein-
forced staff adherence to the process. The managers of the pilot
units had special interest in ensuring that the staff clearly under-
stood the process. During the rollout phases to the remainder of
the organization, it was noted that there were varied degrees of
buy-in from unit managers, and thus, staff education was not as
solid across all units. Successfully training staff and implementing
BSR in some units was much more difficult, despite the fact that
the training materials and video were provided to the managers.
Had the organization removed the responsibility to train their
staff from the already busy manager’s “to-do” list, those managers
may have been able to focus more on supporting the practice.
Creating classroom style in-services by moderators who could
clearly and effectively communicate the need for change and the
fundamental principles of the bedside report process would have
better managed the learning needs of staff nurses who were
more hesitant to change their practice.
Despite initial struggles, on-going education to newly hired
staff and validation of BSR practice remain priorities for the
organization. St. Vincent Health System has continued to moni-
tor the expected outcomes and has looked for new ways to
continue promoting the positive outcomes of BSR in order to
sustain change. Creating a culture change such as BSR within a
healthcare system is not an easy one and does not occur
overnight, but with careful planning, it has shown positive out-
comes. One of the most important lessons learned through the
project has been the understanding that to create, implement,
and sustain a successful change, an organization first must iden-
tify and fully understand the barriers so that each such chal-
lenge can be addressed before it derails the initiative. NL
References
1. Baker S. Bedside shift report improves patient safety and nurse accountabil-
ity. J Emerg Nurs. 2010;36(4):355-358.
2. Caruso E. The evolution of nurse to nurse bedside report on a medical
surgical cardiology unit. MedSurg Nurs. 2007;16(1):17-22.
3. McMurray A, Chaboyer W, Wallis M, Johnson J, Gehrke T. Patient perspec-
tives of bedside nursing handover. Collegian. 2011;18:19-26.
4. Laws D, Amato S. Incorporating bedside reporting into change of shift report.
Rehabil Nurs. 2010;35(2):70-74.
www.nurseleader.com Nurse Leader 73
Figure 3. Pilot Unit Patient Satisfaction-B

JoAnn A. Frazier, BSN, RN, CPHQ, is a the nursing quality
coordinator at St. Vincent Health System in Little Rock, Arkansas.
She can be reached at jfrazier@stvincenthealth.com. Wes
Garrison, MSN, MBA, RN, NE-BC, is an executive director of
nursing at St. Vincent Infirmary in Little Rock, Arkansas.
1541-4612/2014
Copyright 2014 by Elsevier Inc.
All rights reserved.
http://dx.doi.org/10.1016/j.mnl.2013.09.013
April 201474 Nurse Leader