Strategy 3: Bedside Shift Report (Tool 3)

Report
The Essentials of
Bedside Shift Report
in Acute Care
Adapted from AHRQ and the Studer Group
1
Overview & Objectives
• It’s critical that you understand the concepts behind Bedside
Shift Report and how you are expected to incorporate them into
your practice here at GHS
• This learning event is one part of the training plan you will
participate in to ensure your knowledge and success
• At the conclusion of this presentation you should be able to do
the following:
– Define patient and family centered care and engagement and
identified benefits
– Define Bedside Shift Report and purpose
– List the critical elements of bedside shift report
– Discuss the benefits and challenges of bedside shift report
– Identify what HIPAA says about bedside shift report
2
Patient- and Family-Centered Care
At GHS we are committed to providing patient and family
centered care
What are the Core Concepts of patient- and family-centered care?
Dignity and Respect - listening to and honoring patient and family ideas/choices and using
patient and family knowledge/values/beliefs and cultural backgrounds to improve care
planning and delivery
Information Sharing – communicating and sharing complete, unbiased information with
patients and families in useful ways. Patients and families receive timely and accurate details
so they can take part in care and decision making
Involvement – encouraging and supporting patients and families in care and decision making at
the level they choose
Collaboration – inviting patients and family members to work together with health care staff to
develop and evaluate policies/programs and care processes
Patient and family engagement is an important part
of providing patient- and family-centered care
3
What is Patient and Family
Engagement?
Actively and Purposefully involving patients and family
members as:
• members of the health care team
• advisors working with clinicians and leaders to improve policies
and procedures
Our goal at GHS is to create a set of conditions where
patients, family members, clinicians and hospital staff are all
working together as partners to improve the quality and
safety of care
Bedside Shift Report supports this goal!
4
What is Bedside Shift Report?
• Nursing staff conducts change of shift/hand-off of care
reports at the patient’s bedside
• Patients can identify a family member or close friend to
participate
• Patients and family actively participate in report
• Report should take about 3-5 minutes per patient
• Purpose:
– To engage the patient and family in hospital care
– To share accurate and useful information between nurses,
patients, and families
– To ensure safe hand-offs
– To improve quality care and optimal patient outcomes
5
Why Focus on Bedside Shift Report?
• Transitions in care have potential for medical errors
• More than 70 percent of adverse events are caused by breakdowns in
communication among caregivers and between caregivers and
patients1
• Research shows bedside shift report can improve:
– Patient safety and quality
• Improved communication
• Decrease in hospital-acquired complications
– Patient experiences of care
– Time management and accountability between nurses
• Decrease in time needed for shift report
• Decrease in overshift time
Ask your manager about your unit’s patient satisfaction
scores and the goals for implementation
of Bedside Shift Report
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What are the Critical Elements of
Bedside Shift Report?
On Admission:
• All patients/families must receive BSSR brochure and education on
what to expect (These will be available from print-shop for inclusion in admission packets by May 1, 2014. In the interim, your Manager will
share copies with you and direct you on where to get them for patient education)
• Ask patients/families if they want to be awakened to participate
should they be sleeping
• Ask patients if they want family to participate in BSSR or if they
want them to be asked to step outside of the room for privacy
Prior to end of Each Shift:
• Notify pt/family during last round that bedside report will occur
soon
• Verify pt permission for family to be present during report (HIPAA)
• Check Pain Score/Adm. meds if needed
7
Critical Elements of Bedside Shift Report
continued…
For EVERY Change of Shift/Caregiver:
• Bedside Shift Report is required as part of handoff communication
• Bedside Shift Report must be done inside room (exceptions: sharing of
sensitive information such as psychosocial family dynamics, new diagnosis or lab results
that the patient is not aware of yet. Your Manager/CNS/CNE will discuss unit specific
examples with you during your unit specific training)
• Bedside Shift Report should focus on sharing priority clinical and
care information with collaborative, focused assessments of highrisk findings and equipment
• Bedside Shift Report should only take about 5 minutes per patient
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Critical Elements of Bedside Shift Report
continued… What information must be shared?
Minimum Information Required to be Shared During BSSR:
•
Patient name, diagnosis and procedures since admission
•
Changes in patient’s condition or episodic events
•
Current condition
•
Current orders and goals reviewed, anything requiring follow-up
•
IV site check, verification of fluids and rates
•
Visual check and tracing of all lines, tubes, drains to patient
•
Visual check of all dressings
•
Equipment check
•
Scan of environment for safety/hazards
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Critical Elements of Bedside Shift Report
continued… What are the KEY
Components?
• Active Patient ID (Wrist Band/DOB)
• Manage up oncoming RN
• Use of AIDET *may do abbreviated with full AIDET
done during second encounter
• Use of SBAR to organize report
• Include Patient and Family
• Use whiteboard
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Critical Elements of Bedside Shift Report
continued… Setup
for Success
Your Unit:
•
•
•
off-going Charge RN makes patient assignments to support BSSR
shift change huddles occur where off-going charge RN gives overview to all on-coming nurses before
dismissing for BSSR
use of standardized report form customized for your specific unit/patient population
Off-going RN :
•
•
•
•
•
•
during rounds toward end of shift tell patient/family when BSSR (Bedside Shift Report) will take place
remind patient/family that BSSR is to ensure a safe hand-off of care
ask patient/family if they need anything prior to BSSR so focus can be on hand-off of information
prepare for BSSR by having essential information/labs/etc. ready
take WOW in room during BSSR to check meds and pertinent information with on-coming RN
do a brief teach back with patient on a medication or other patient education you’ve covered during your
shift
On-coming RN :
•
•
•
•
•
•
carry report form for documenting information shared during report
use whiteboard
ask patient their goal for the shift
ask patient if they have questions
discuss plan of care for shift and anticipated discharge date
inform patient/family when you will be back and what they can expect next
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Video of Bedside Shift Report –
What does RIGHT look like?
•
Acute Care BSSR- Right Way
https://www.youtube.com/watch?v=H8eEo1Kfzfo&
feature=youtu.be
• ER BSSR - Right way
https://www.youtube.com/watch?v=q1OJ61jHnsc
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Video of Bedside Shift Report –
What does RIGHT look like?
• Use the Bedside Shift Report Video Form
you printed at the beginning of this training
to answer questions about the video you
just watched
• Remember to turn in the completed form to
your Manager/Supervisor or CNS/CNE
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Critical Elements of Bedside Shift Report –
SPECIAL SITUATIONS
• Sometimes there will be special situations where accommodations to
Bedside Shift Report (BSSR) must be made
• Your Manager will define how these situations are to be handled on
your unit
• BSSR must still occur but accommodations will be made
– Unstable Suicidal/Homicidal/Violent patients
– Patient Unresponsive and no family present
– Patient Confused and Disoriented
– Patient is non-compliant
– Sensitive information that should not be included in BSSR
– Family member always tries to take over BSSR and prevents you from having effective
communication
– Oncoming RN will be late
– Code or other emergency is occurring on unit during shift change
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Critical Elements of Bedside Shift Report -
What does Non-Compliance look like?
• Giving report at the nurse’s station, in the break room, or away from
the patient’s room
• Talking about personal or unit issues when you’re in the patient’s
room (i.e. staffing is short today)
• Using the excuse that the patient was “sleeping”
• Not educating patient/family on BSSR
• Not following BSSR expectations and outlined process
• Not involving the patient and family
• Not using whiteboard
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Video of Bedside Shift Report –
What does WRONG look like?
• Acute Care BSSR-Wrong Way
https://www.youtube.com/watch?v=xj0rK0uSbA&feature=youtu.be
• ER BSSR - Wrong Way
https://www.youtube.com/watch?v=45PAIffJf3o
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Video of Bedside Shift Report –
What does WRONG look like?
• Use the Bedside Shift Report Video Form
you printed at the beginning of this training
to answer questions about the video you
just watched
• Remember to turn in the completed form to
your Manager/Supervisor or CNS/CNE
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What About Support Staff…What are
they doing during Bedside Shift Report?
• Depending on the structure of your unit, on-coming support staff will
round on their assigned patients with the off-going support staff
• Their Bedside Shift Report looks like this:
–
–
–
–
–
–
–
Off going introduces on-coming and manages them up
Patient ID is verified
Environment is scanned for safety
Ensure patient is clean and comfortable
Ask patient if they need anything “We have time now…)
Write name on whiteboard
Inform patient when they will be back
• When you have completed BSSR on all of your patients, you must
meet with any support staff assigned to your patient group and
conduct report and delegation of assigned tasks and patient needs for
the shift
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Benefits of Bedside Shift Report –
WINS for the Patient
• Our patients will feel involved in their care
• Our patients will feel informed which increases trust and compliance
with their plan of care
• Our patients will be more satisfied because they know what things will
be done and monitored during the next shift
• Our patients will not feel “alone” during change of shift. Many
patients perceive the 2 – 3 hours around the change of shift to be a
time when no one is around. Sentinel events also occur more often
during this time
•
Our patients will know who their nurse and other caregivers are at the
beginning of the shift
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Benefits of Bedside Shift Report –
WINS for the YOU!
• More time! Bedside shift report is proven to reduce time in report as
you have to keep report focused on the patient and what is reported
follows a standard approach
• Real-time shared assessments with another RN for critical patient care
elements such as wounds, drains, central lines
• Accountability! Bedside shift report means you don’t walk into a
patient room after report and find an infiltrated IV site or a urine
soaked bed
• Your patients are safer!
• If you have questions the off-going care provider is right there with
you
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Bedside Shift Report & HIPAA
• As healthcare providers, you may be concerned about violating
HIPAA, especially when family members are present at shift report
• It is important to know that because bedside shift report is part of
treatment and normal operations, it does not violate HIPAA
• Health information can be disclosed for:
– Treatment
– Health care operations
– Payment
• HIPAA acknowledges incidental disclosures may occur
• It’s not a HIPAA violation as long as:
– reasonable safeguards are done to protect privacy
– you only disclose or use the minimum necessary information
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Bedside Shift Report & HIPAA
FAQs:
• Is a covered entity (in this case an RN or support tech) required to
prevent any incidental use or disclosure of protected health
information?
Answer: No. Your responsibility is to ensure that you are making
reasonable efforts to safeguard patient privacy
• Can physicians and nurses engage in confidential conversations with
other providers or with patients,
even if there is a possibility that they could be overheard?
Answer: Yes. HIPAA does not prohibit providers from talking to each other
and to their patients. Providers’ primary consideration is the appropriate
treatment oftheir patients. Reasonable precautions could include using
lowered voices or talking apart from others when sharing protected
health information
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Bedside Shift Report & HIPAA
FAQs:
• How does all of this relate to doing Bedside Shift Report?
Answer: The HIPAA Privacy Rule recognizes that oral communications
often must occur freely and quickly in treatment settings. Thus, covered
entities are free to engage in communications as required for quick,
effective, and high-quality health care
Examples –
• Health care staff may orally coordinate services at hospital nursing
stations
• A physician may discuss a patient’s condition or treatment
regimen in the patient’s semiprivate room
• Health care professionals may discuss a patient’s condition during
training rounds in an academic or training institution
Your main responsibility with Bedside Shift Report is to take
reasonable precautions such as using lowered voices or talking
apart from others when sharing protected health information
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Putting It All Together…
• Our Hospital is committed to patient and family engagement
and YOU play a critical part
• Patients and families won’t engage if they believe that you
don’t want them to so you have to show them through things
like Bedside Shift Report and Rounding
• Your job is to make it safe for them to be involved in their care,
not just as patients but as partners
Bedside Shift Report is an evidence-based method of
improving patient satisfaction, safety and outcomes
when used along with other tools and initiatives on
your unit!
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Putting It All Together…
• For more information or questions, please see your Manager,
Supervisor or CNS/CNE
• Don’t forget to complete the Bedside Shift Report Video Form
and turn it in as directed for credit
• So what’s next? You will be receiving, or already have
received, information from your unit leadership about next
steps. These include additional training using simulated bedside
shift report , competency validations and on-going monitoring
and support to make sure we keep Bedside Shift Report going
and working for you and our patients
Thank You!
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