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Clinical Hub,Nursing Hub,Nursing Practice Tools and Resources,Bedside Shift Report,Creating Awareness and Interest,Resources

Bedside Shift Report for Leadership Council

Bedside Shift Report for Leadership Council - Clinical Hub, Nursing Hub, Nursing Practice Tools and Resources, Bedside Shift Report, Creating Awareness and Interest, Resources


BEDSIDE SHIFT REPORT IN
PRESENCE OF PATIENT
February 12, 2015
Nursing and Patient Care
Services Leadership Council



There is inconsistent practice and
performance related to bedside shift to shift
report with the patient present.
SITUATION

BACKGROUND
Vision Statement

Service - providing the best possible patient
care experience and outcomes for all those
who need our services and providing
programs that support the health and
wellness of individuals and populations

…Patient and Family Centered Care…


BACKGROUND
Patient and Family
Centered Care

SITUATION
ORGANIZATION’S STRATEGIC PLAN

• Patient and Family Experience (Five-Year
Aim)
– UW Health is clearly distinguished for its culture of
patient- and family-centered care and ensures
excellence during every patient encounter
– Improve the UWHC patient and family experience in
inpatient settings by implementing patient- and
family-centered rounding at the bedside in all
inpatient units as part of the interdisciplinary model
of care








BACKGOUND

Patient and
Family Centered
Care

BACKGROUND
Policy 14.33
• Nurses will conduct a bedside hand-off
report at change of shift. This verbal report
will be in the presence of the patient
and/or family (unless barriers, such as
patient refusal, cannot be overcome) and
includes a bedside safety check.
Documentation is required to capture the
nurse’s shift summary.


BACKGROUND: Current Example
TLC
Safety Bundle includes RN bedside Handoff
with safety check (line reconciliation) and
family presence


“Practice and Progress” article Summer
2013

BACKGROUND: Current Example
TESTIMONIALS

• “I felt included and that I contributed to the discussion about my
brother’s plan of care.”
Patient and Family Centered Care

• “I feel reassured when the nurses discuss my husband’s care inside the
room and invite me to stay. They check things together and introduce
me to the nurse.”
Satisfaction

• “I like the fact that I can show the next nurse important things about the
patient such as lines and drains. That way I won’t forget things before I
leave after my shift.”
Safety

• “Catching med errors: PSN”
Safety


ASSESSMENT: 2014 Survey Results
Surveyed

• Nurse Managers N = 23
• Clinical Nurse Specialists N = 11
• Nurse Clinicians N = 309

ASSESSMENT: Survey Results

Are nurses engaged in bedside report?
Yes No
NC 92.2% 7.8%
CNS 90.9% 9.1%
NM 95.7% 4.3%

ASSESMENT: Survey Results
Bedside report includes bedside verbal
report in SBAR format and bedside safety
check.






% Yes
NC 81.6%
CNS 90%
NM 81.0%

ASSESSMENT: Survey Results
Common themes for Success
• Structure:
– Expectation from nurse manager and peers
– Examples of patient calling out to staff if face to face report
is not done
– Everyone does it, not just some staff
• Process:
– Periodic reminders to get back to the bedside are needed.
– Consistently ask patients if they have anything to add to
report

ASSESSMENT: Survey Results
Themes for Success
– Utilize bedside report super users/champions to
support process
– NAs help answer call lights during report
– Use timelines for implementation
– Admitting RN sets the expectation with the patient
and family
– Utilize unit council and Kotter’s model for change
process
– Highlight all PSNs that captured an error or near miss
during bedside shift to shift report
– Have NMs and CNSs observe process and give
feedback


Assessment: Survey Results
Themes for Success
• Tools
– Clipboard or something to write on
– Standardized report sheets
– Report sheets that pre-populate some of the
patient information

ASSESSMENT: Survey Results
BARRIERS to bedside shift not occurring
(Rank Order: 1 = most significant barrier )
Barrier NC CNS NM
Disrupting sleep & Pt satisfaction 2 4 2
HIPAA concerns 7 8 6
Discussing sensitive issues 1 4 1
Discussing things pt may not know 3 4 3
Pt and Family Interruptions 4 1 4
External Interruptions 7 7 6
Takes too long 6 1 6
Lack of computers 5 1 4
Other 9 9 5

ASSESSMENT: Survey Results
Common Themes regarding inconsistent
practice
1. Lack of consistency in practice of bedside
shift-to-shift report
• Varies by or day of week
• Only works with the float pool
• Depends on who is working
• Some units strict – some units not strict
• Less likely if patient sleeping
• Lack of time


ASSESSMENT: Survey Results
Common Themes continued:

2. Resistance to change

3. When leadership is not present, bedside
shift report falls apart

4. Nurse
• Depends on individual nurse
• Either not happening at all or doing line checks
only

ASSESSMENT: Survey Results
Identified Steps to the Process
• Bedside Safety checks
• Bedside verbal report in SBAR format
• Hallway report / outside room / at the computer
• Review chart prior to report
• Combo of hallway and bedside report
• Sensitive info discussed outside patient room
• Locate nurse for report
• Huddle at beginning of shift


ASSESSMENT: Other Feedback
Practice council and Unit council of chairs:
What specific actions or tools would be
effective in removing or addressing barriers to
bedside shift report?
Inpatient Manager group:
What is an effective, reliable way to measure
compliance with the expectation to conduct bedside shift
report including;
• Face to Face report with patient present
• Verbal SBAR format
• Safety check




ACTIONS BASED ON FEEDBACK
• Developing a tool kit of resources to be
available on the intranet
• Relevant articles
• Links to outside resources
• Policy 14.33
• Video presentation(s)
• Instructions for accessing “RN Shift Handoff Report”
• Monitor compliance through Leadership
Rounding Process:
– “Do nurses do change of shift report in your
room?”


RE-LAUNCH / RENEW
• Target date: February, 2015
• E-mail notification regarding intranet
resources
• Updates to all relevant councils



NEXT STEPS
• Ongoing Monitoring of Metric for success
• Set target
• Identify acceptable exceptions
• Consider change ownership for monitoring
and further process improvement work to
Process owners (Inpatient Manager group
and /or Practice council and Unit council
of Chairs).



Questions