Bedside Report - A process Change

Report
BEDSIDE
REPORT
Deena Clevenger BSN, RN
and
Sheila Connelly MSN, RN
TOP REASONS FOR BEDSIDE REPORT
Patient safety
 Patient satisfaction
 Builds teamwork, ownership, and accountability
 Allows mentoring for new nurses

(Baker & McGowan, 2010)
Jean Watson Nursing Theory
o Carative #3 Cultivation of sensitivity to
one’s self and to others
• The nurses promote health and higher level
functioning only when they form person to person
relationships.
o Carative #4 Establishing a helpingtrust relationship
• Communication includes verbal, nonverbal,
and listening in a manner which connotes
empathetic understanding.
•http://currentnursing.com/nursing_theory/Watson.com
Jean Watson Nursing Theory cont.
o Carative #7 Promotion of Interpersonal
teaching-learning
• Understanding the person’s perception of the situation assist
the nurse to prepare a cognitive plan.
o Carative #8 Provision for a supportive,
protective, and /or corrective mental, physical,
socio-cultural and spiritual environment
• Nurse must provide comfort privacy, and safety for the
patient.
•http://currentnursing.com/nursing_theory/Watson.com
PATIENT SAFETY

According to Baker & McGowan,

“Bedside shift report decreases the potential for near
misses through a transfer of responsibility and trust
by using standardized communication” (2010, p 357).

Improves “patient safety by incorporated safety
checks into report, such as ensuring there is a suction
machine at the bedside and noting allergy alerts”
(Trossman, 2009, p 7).
PATIENT SATISFACTION

“Reassures patients that the nursing staff works
as a team, and patients witness a safe,
professional transfer of responsibilities” (Laws &
Amato, 2010, p 71).

Patients feel more empowered.

Patients are more involved.

Patient becomes an additional resource in
diagnosis and treatment (Caruso, 2007).
3 OF THE JOINT COMMISSION’S NATIONAL
PATIENT SAFETY GOALS ARE UPHELD
1. “Improve the accuracy of patient identification.”
-Checking armbands during report and asking for
two patient identifiers.
2. “Improve the effectiveness of communication among
caregivers: managing hand-off communications.”
3. “Encourage patients’ active involvement in their own
care as a patient safety strategy.”
(Joint Commission Perspectives, 2008)
BENEFITS FOR THE NURSING STAFF

Oncoming nurse can visualize patients
immediately and prioritize care for the shift.

Prepares RN to answer MD questions.

Accountability between shifts is promoted.

Improves the relationships of staff between shifts
and builds a “teamwork” environment.
( Anderson & Mangino, 2006)
CHALLENGES
Letting go and
allowing
change
Fear that
report will
take longer
Confidentiality
and privacy
Cynicism and
pessimism
Lack of a
shared vision
TIPS FOR SUCCESS




“Be sensitive to privacy and information shared
in front of patient. Discuss sensitive information
away from patients bedside.”
Educate the incoming nurses about how to give
report.
Exclude opinions and stories, report is a time for
facts.
Avoid putting a nurse on the spot in front of
patient and/or family.
(Baker & McGowan, 2010, p 358)
Informative
More
individualized
Bedside
report
Involves the
Patient
Shorter
CHARGE NURSE ON THE PREVIOUS SHIFT
oProvides for the on coming shift a one page
report sheet showing:
Palliative care
patients
• DNR’s
• Isolation patients:
MRSA, VRE,
pseudomonas, etc
• Possible discharges
•
•
•
•
•
•
Close observation
One to one patients
24 hour urine
Wound vac’s
Anything else that
constitutes extra
time for care
PICO QUESTION



Does the use of a standardized bedside report
versus taped report help increase patient
satisfaction and decrease nursing overtime usage
at the Veterans Healthcare Systems of the
Ozarks (VHSO)?
Approval from management as well as U of A
professors to begin pilot study. Discussion at both
Evidenced Based Practice Committee and Shared
Governance Committee
April 1st, 2012 Bedside Report began at VHSO!
DESIGN

Before-after experimental design used.

Independent variable is the method of communication

(taped report versus verbal at bedside)
2 Dependent Variables
1. Patient Satisfaction
2. RN Overtime Usage
DESIGN

Patient Satisfaction
Measured by Survey of
Healthcare
Experiences of
Patients (SHEP) data.
 Data gathered pre and
post initiation of
bedside report.


RN Overtime Usage

Overtime use included
the time during
change of shift
overlap. May include
up to 1-2 hours over.
Does not include the
extra 4- 8 hour shifts
that nurses agree to
work.
DESIGN



Two acute care nursing units were included in the
study (2A and 2B). Both units were performing
taped report prior to the study. Starting April 1st,
both units transitioned to bedside report.
A standardized communication tool was developed
and distributed prior to the initiation of bedside
report.
Education was given to all RN/LPN staff members
prior to initiation of study via staff meetings and
poster presentations.
OUTCOME MEASUREMENT COLLECTION

Sample population
Veteran patients hospitalized at VHSO (inpatient setting),
Fayetteville, AR.

Inclusion criteria
Veterans who respond to the SHEP survey post discharge.
DATA COLLECTION PLAN

SHEP surveys are mailed to patients post discharge.

Questionnaire includes a total of 53 questions.

It takes an estimated 15 minutes to complete the survey.


We selected 6 total questions directly related to nursing
care to include in this study.
In addition to SHEP survey results, we will discuss RN
overtime usage results…..
DAY SHIFT RN OVERTIME USAGE
25
20
H 15
O
U
R
10
S
2A
2B
5
0
January
February
March
EVENING SHIFT RN OVERTIME USAGE
6
5
H 4
O
U
3
R
S
2
2A
2B
1
0
January
February
March
NIGHT SHIFT RN OVERTIME USAGE
4
3.5
3
H
2.5
O
U
2
R
S 1.5
2A
2B
1
0.5
0
January
February
March
SHEP DATA
DURING YOUR HOSPITAL STAY, HOW OFTEN DID
NURSES TREAT YOU WITH COURTESY AND
RESPECT?
100
90
80
70
60
50
N
40
Weighted %
30
20
10
0
Always
Usually
Sometimes
Never
SHEP DATA
DURING THIS HOSPITAL STAY, HOW OFTEN DID
NURSES LISTEN CAREFULLY TO YOU?
70
60
50
40
N
30
Weighted %
20
10
0
Always
Usually
Sometimes
Never
SHEP DATA
DURING THIS HOSPITAL STAY, HOW OFTEN DID NURSES EXPLAIN
THINGS IN A WAY YOU COULD UNDERSTAND?
80
70
60
50
N
40
Weighted %
30
20
10
0
Always
Usually
Sometimes
Never
SHEP DATA
DURING THIS HOSPITAL STAY, HOW OFTEN WAS PERSONAL
INFORMATION ABOUT YOU TREATED IN A CONFIDENTIAL
MANNER?
90
80
70
60
50
N
40
Weighted %
30
20
10
0
Always
Usually
Sometimes
Never
SHEP DATA
DURING THIS HOSPITAL STAY, HOW OFTEN DID
NURSES SHOW RESPECT FOR WHAT YOU HAD TO SAY?
80
70
60
50
N
40
Weighted %
30
20
10
0
Always
Usually
Sometimes
Never
SHEP DATA
DURING THIS HOSPITAL STAY, HOW OFTEN DID YOU
FEEL NURSES REALLY CARED ABOUT YOU AS A
PERSON?
80
70
60
50
N
40
Weighted %
30
20
10
0
Always
Usually
Sometimes
Never
CONCLUSION



RN Overtime Usage will continue to be collected
over the next 3 months
SHEP data will be reviewed and collected on the
next SHEP report, which will include 3 months of
data.
Input from the nursing staff on 2A/2B wards will
be unofficially collected at staff meetings
regarding their satisfaction with the process.
REFERENCES







Anderson, C., & Mangino, R. (2006). Nurse shift report: Who says you
can't talk in front of the patient? Nursing Administration Quarterly, 30(2),
112-122.
Baker, S. J., & McGowan, N. (2010). Bedside shift report improves patient
safety and nurse accountability. Evidence-Based Practice, 36(4), 355-358).
Caruso, E. M. (2007). The Evolution of Nurse-to-Nurse Bedside Report on
a Medical-Surgical Cardiology Unit. MEDSURG Nursing, 16(1), 17-22.
Laws, D., & Amato, S. (2010). Incorporating bedside reporting into
change-of-shift report. Rehabilitation Nursing, 36(2), 70-74.
The Joint Commission. (2008). Joint Commission 2009 National Patient
Safety Goals. Joint Commission Perspectives, 28(7), 12-14
Tressman, S. (2009). Shifting to the bedside for report. The American
Nurse, 41(2), 7.
http://currentnursing.com/nursing_theory/Watson.com

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