Bedside Handoff Status Report

Nelfa Padovano BSN, RN-BC

Charge Nurse, MDSS
July 19, 2014

Our Progress as of the end of Fiscal Year 2014
We have decreased our incidental overtime (from 80 hrs. to 28
hrs)
More staff are now able to get out on time,(from 40% in Feb. to
72% last pay period in June 2014
Safer, evidence based practice that encourages patient
involvement.




Medicine Specialties All Staff OT Hours Per Pay Period

80
66
50.5
56
60.25
78
75.75
57.25
41
61.25
54.75
47.8
28
-10
10
30
50
70
90
110
130
H
o
u
r
s

Pay Period
Medicine Specialties Comparison of FY13 and FY14
Incidental OT

67
83
65
81
72
71
64
69
75
66
64
67
60 59
74 75
63
80
83
86
89
99
76
93
87
109
101
104
127
107 107
103
73
102
79
80
103
91
98
80
66
51
56
60
78
76
57
41
61
55
48
28
0
20
40
60
80
100
120
140
160
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
H
o
u
r
s

Pay Period
FY13 Incidental OT FY14 Incidental OT
Continuing Issues
Persistent barriers to timely bedside report.
1. Not knowing who to give/get report to/from ahead of time
2. Privacy concerns
3. Cannot write inside the room, as patient is on Contact Precautions.
4. Patient is confused and is not going to understand what we are saying anyway.
5. Patient is sleeping and if awaken will ask for more pain medicines, toilet needs, etc.
6. Patient is rude and mean.
7. Patient will ask a lot of questions and report will take forever.
8. ?
9. ?
10.?
Inconvenience, cannot let go of old culture?
1. Its easier to give report sitting down face to face with the other nurse.

( Your feedback is highly appreciated so we can continually address the barriers.)




Solutions to barriers
Charges and relief charge need to consistently write down the names of nurses you are
getting/giving report to.
The need to educate the patient about bedside report and when it is going to happen and
discuss any privacy concerns ahead of time with the patient.
Nurses to have read patient history before starting report. Reporting by exception is the
key. Listen to report and write after.
The more that we need to see the patient when they are confused for safety and baseline
assessment.
The reason for patient education about bedside handoff is for patients to know what to
expect and that if they have any needs before then, like pain meds, toileting, etc., it could be
addressed before shift report. (when giving 0600/1800 meds would be the best time to talk
to patient about BHR). If patient clearly stated he/she does not want to be bothered by
BHR, respect patient wishes, but still go inside the room quietly and do your safety scan
and whiteboard updates.




Solutions Contd
If patient asks a lot of questions, acknowledge their concerns and you may use the
scripting below.

I understand you have concerns and questions about your care and condition.
I will be back and I will make sure I set enough time to sit with you and
address those concerns.
We have a bedside handoff nurse checklist for your use.
We are hoping to have the patient brochure finally printed and handed to patient.


Timeline:
We have seen remarkable improvement in areas of overtime and staff getting out on time.
For the new Fiscal Year we should continue to improve and maintain this new culture of reporting at the bedside with the available
resources that we have.
Resources
Consistent
Bedside
Reporting
Patients
Relief RNs
Charge
Nurses
Nurse
Assistants
Clinical
Nurse
Summary of Reported Advantages and Disadvantages
of Nursing Bedside Report
Patient Advantages
Patients more informed
Patients more involved in their care
Improved nurse/patient relationship
Improved general patient satisfaction
Improvements in safety
Decrease in patient falls
Faster discharge times

Nurse Advantages
Improved report efficiency
Improved staff teamwork
Better nursing accountability
Increased mentoring opportunities
Better prioritization at start of shift
Improved reporting accuracy
More informed about patients sooner
in shift
Advantages and disadvantages contd
Patient Disadvantages
Medical jargon, difficult to understand
Tiring repetition of information
Anxiety from incorrect information
Anxiety from so much information
Lack of privacy
Anxiety in hearing about their illness

Nurse Disadvantages
Shift report may take longer
References:
AHRQ www.ahrq.gov

Baker, S. (2010). Bedside Shift Report Improves Patient Safety and Nurse Accountability. Joumal of Emergency
Nursing, 36(4),p 355-358
Hagman,J., Oman, K., Kleiner, C., Johnson, E., Nordhagen, J., Lessons Learned From the Implementation of a
Bedside Handoff Model JONA Volume 43, Number 6, pp 315-317 Lippincott Williams & Wilkins.