Evidence Based Practice- Bedside

ReportingPresented by: Marissa Braun, Dillon Busher, Megan Callahan, and Karli Focht

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What is Reporting? (Riesenberg, Leitzsch, & Cunningham, 2010)

Reporting/Handoffs/Shift report/Sign-out can all be used interchangeably.

Reporting is a form of communication regarding patient status/plan of care between nurses.

They occur most commonly between shift change when one nurse is handing off care to another.

Various formats including bedside reporting, handoffs at the nurse’s station, handoffs outside of the patient’s room, taped reports, and electronic reports.

The Joint Commission has defined handoffs as “a process in which information about patient/client/resident care is communicated in a consistent manner from one healthcare provider to another” (The Joint Commission, 2008).

Bedside Reporting (Sand-Jecklin and Sherman, 2014)

Report given to the oncoming nurse in the patient’s room by the bedside.

Promotes patient interaction and informs the patient about the plan of care for the upcoming shift with the oncoming nurse.

Allows the patient to learn about his or her status, upcoming tests and/or procedures, as well as promotes patient-to-nurse communication.

Provides an opportunity for the patient to ask questions.

Allows the current nurse to directly show the oncoming nurse abnormal physical assessments.

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PICO Question

What is the effect on patient’s health when nurses perform standardized bedside shift reports as compared to nurse-to-nurse communication and/or recorded shift reports?

Learning Objectives

The reader will be able to list the various formats of shift reporting or nursing handoffs five minutes after reading the self-learning module.

The reader will be able to identify barriers to performing effective nursing handoffs within ten minutes of reviewing the content.

Determine if bedside nurse-to-nurse handoff has an effect on nurse and patient satisfaction and patient health.

Recognize the benefits of bedside shift report in regards to patient safety.

Identify the benefits of a standardized shift report or handoff protocol.

What is nurse-to-nurse communication and recorded shift reports?

Nurse-to-nurse communication is considered an informal transfer of medical information from one nurse to another which can occur at any time or location within the clinical setting.

Recorded shift reports are pathways of communication for nurses to utilize when they cannot be face to face with one another and need to translate the important patient information.

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Clinical ObservationsThis topic was chosen because it has been witnessed throughout various clinical experiences the differences in change of shift report, some of which have negatively affected patient care. Some of the observations include....

- Errors in communication

- Disorganization

- Near miss incidents

- Confusions with patient discharge and plan of care

- Codes on the unit

- Dissatisfaction with patients not knowing the oncoming nursing staff

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Clinical Observations

At Reading Hospital on R3S, primary locations of shift reports included...

At the nurses station

Outside the patient’s rooms

In the computer den

On occasions report was given….On voice recorder

At the bedside

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Current Practice (Riesenberg, Leitzsch, & Cunningham, 2010)

There are currently no standard guidelines for how to perform a handoff or shift report

There are also no standardized formats or checklists for relying pertinent patient information to another healthcare professional.

This may be because it is difficult to create a standardized format that relates to each hospital unit (i.e. labor and delivery focuses on different patient information than an intensive care unit).

Many studies have shown that nurses perform shift report wherever they choose (bedside, nurses station, electronic, taped, hallway, etc.)

SignificanceA significant percentage of a nurse’s communication each day

occurs during patient handoffs and the safety of the patient can be compromised at this time (Riesenberg, Leitzsch, & Cunningham, 2010).

A survey of over half a million hospital staff found that respondents rated the safety of patient handoffs second lowest among 12 areas of patient safety (Sorra et al. 2012).

In a study concerning near miss incidents, nurses again identified patient handoffs as a factor (Sand-Jecklin and Sherman, 2014).

SignificanceIn recent years, bedside nursing handoffs have been

presented positively in the literature, with benefits such as improved patient satisfaction, improved nurse communication and shorter shift reports being identified

(Riesenberg, Leitzsch, & Cunningham, 2010).Patients claim to have more involvement in their care and they are better

informed about their current health status and treatment plan (Maxson et al., 2012).

Patients also report that discharge planning is occurring continuously throughout their care (Dearmon et al., 2013).

Nurses have also benefited from bedside nursing handoffs claiming that there is more team-work, increased nurse accountability, and increased report accuracy (Sand-Jecklin and Sherman, 2014).

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Common Benefits Among Research(Cairns et. al, 2013) (Caruso, 2007) (Riesenberg, Leitzsch & Cunningham, 2010) (Sand-Jecklin and Sherman, 2014) (Sherman, Sand-Jecklin & Johnson, 2013)

When bedside shift report occurred the following benefits were concluded:Improved nurse–patient relationshipIncreased mentoring opportunitiesIncreased nurse ability to answer physicians’ questions at the beginning of the shiftGeneral improvement in nurse satisfaction with reportReduction in patient discharge times due to improvement in patient educationBetter task prioritizing at the beginning of shiftDecrease in total number of fallsImprovements in nurse friendliness and attitude and more prompt response to patient

callsA decrease in patient call light useDecrease averaged length of time required to give hand-off reportDecrease in amount of overtime for nursing staffNoise level on the unit decreased

Stigmas Related to Bedside Shift Report

If there are so many researched benefits of performing shift report at the bedside then why is it not being utilized in all hospitals?

Some nurses believe they would be bothering the patient.

Nurses fear waking up the patient if they are sleeping.

Hospital tradition and habits.

Fear of lack of time.

Dislike for the patient.

Apprehension to discuss medical information in front of patient and/or family.

Fear of upsetting the patient and/or family.

Barriers to Effective Handoffs (Riesenberg, Leitzsch, & Cunningham, 2010)

Communication barriers

Omissions of information

Errors or inaccurate recall of information

Misunderstood information

Problems associated with standardization

Lack of policies and procedures

System in use is not defined

Staff resistance or stigmas

Environmental issues

Interruptions and distractions

Too much noise and poor lighting

Lack of privacy

Human factors

Too few nurses on a shift or unit

Stressful or overlong shifts

Reports may be rushed

Time management

Time constraints

Too time consuming

Report is too long

Summary of EvidenceCall light bell usage decreased during shift change by 33% (Cairns and Dudjak, 2013).

Average length of time to complete shift report decreased from 45 minutes to 29 minutes (Evans et al., 2012).

Staff satisfaction with report increased from 37% to 78% (Evans et al., 2012).

The number of patient falls during shift change for all units decreased from 20 preimplementation to 13 at three months postimplementation and 4 at 13 months postimplementation (Sand-Jecklin and Sherman, 2014).

Globally positive comments in patient narrative responses related to bedside report increased from 42% at 3 months postimplementation to 48% at 13 months postimplementation (Sand-Jecklin and Sherman, 2014).

An increased percentage of nurses also reported that information received in the report was more consistent with the actual patient condition. It started with 72.4% and after implementation increased increased to 83.4% (Cairns and Dudjak, 2013).

Nurses expressed increased confidence when assuming care of the patient (Cairns and Dudjak, 2013).

RecommendationsVery little research has been done on nursing handoffs or shift reports and therefore

articles and studies from years beyond a five year limit were used to conduct this evidence based learning project.

What research has been done included small sample sizes, or was performed on a single unit and therefore cannot be generalizable to other units (Sherman, Sand-Jecklin & Johnson, 2013).

Further research is necessary to make evidence based practice changes in nursing practice.

The development of a standardized tool for performing shift report may be helpful for future use. The tool should be unit specific, easy to follow, and contain pertinent patient information regarding status/unit of hospital.

More research needs to be completed in regards to the long-term impact on patient’s health such as morbidity and mortality (Evans et al., 2012).

With advancements in patient care including access to online charting notes, lab results and upcoming appointments, patients prefer being kept up to date on their health status; by incorporating bedside report we would be enhancing patient involvement and providing them the opportunities to better their health outcomes.

Literature Review

Search terms included a combination of the following: handoff, handoffs, signout, sign-out, shift report, nursing communication, bedside report, reporting, change of shift, nurse, nurses, nursing, patient, patients

Inclusion criteria: English-language, scholarly articles, peer-reviewed, published between 2010-2016 (time frame was extended due to limited research/availability of articles)

Databases used during research: EBSCOhost, CINAHL, Cochrane, Joanna Briggs Institute

Articles: 8 articles used in research including systematic reviews, quasi-experimental, cohort studies, and qualitative studies

Nurses Make A Difference!!!

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References Cairns, L. L., Dudjak, L. A., Hoffman, R. L., & Lorenz, H. L. (2013). Utilizing Bedside Shift Report to Improve the Effectiveness of

Shift Handoff. Journal Of Nursing Administration, 43(3), 160-165 6p. doi:10.1097/NNA.0b013e318283dc02.

Caruso, E. (2007). The evolution of nurse-to-nurse bedside report on a medical-surgical cardiology unit. MEDSURG Nursing, 16(1),

17-22 6p.

Dearmon, V., Roussel, L., Buckner, E. B., Mulekar, M., Pomrenke, B., Salas, S., & ... Brown, A. (2013). Transforming Care at the

Bedside (TCAB): Enhancing Direct Care and Value-added Care. Journal Of Nursing Management, 21(4), 668-678 11p.

doi:10.1111/j.1365-2834.2012.01412.x.

Evans, D., Grunawait, J., McClish, D., Wood, W., & Friese, C. R. (2012). Bedside Shift-to-Shift Nursing Report: Implementation and

Outcomes. MEDSURG Nursing, 21(5), 281-292 12p.

ReferencesMaxson, P. M., Derby, K. M., Wrobleski, D. M., & Foss, D. M. (2012). Bedside Nurse-to-Nurse Handoff Promotes Patient Safety.

MEDSURG Nursing, 21(3), 140-145 6p.

Riesenberg, L. A., Leitzsch, J., & Cunningham, J. M. (2010). Nursing Handoffs: A Systematic Review of the Literature. American

Journal Of Nursing, 110(4), 24-34.

Sand-Jecklin, K., & Sherman, J. (2014). A quantitative assessment of patient and nurse outcomes of bedside nursing report

implementation. Journal Of Clinical Nursing, 23(19/20), 2854-2863. doi:10.1111/jocn.12575.

Sherman, J., Sand-Jecklin, K., & Johnson, J. (2013). Investigating Bedside Nursing Report: A Synthesis of the Literature. Med-Surg

Matters, 22(5), 308-318 11p.