EBP: Bedside Shift Report

Alyssa, Ashley, Caitlin, Hailey, Jacky,

James, Kelly, Milena, & Wendy
Intro
Issue: bedside report is a policy at many hospitals but it is not
implemented by the nurses
Affects patient care
Increased medication errors
Patient feels less involved in care
Increased falls
Lack of communication
Nursing significance
Provide best care possible starting at shift report
Follow hospital policies
Legal concerns

(Maxson, Derby, Weobleski, & Foss, 2013), (Groves, Manges, & Scott-Cawiezell, 2016), (Sand-Jecklin & Sherman, 2013)
 PICOT:
What is the best practice to prevent nursing errors when
acute care nurses perform SBAR handoff at shift change?
Current Practice
Research demonstrates a variance in nursing handoff reports across the country including bedside,
verbal outside the room, audio-taped, or group reports (Sherman, Sand-Jecklin, Johnson, 2013).

Local hospitals utilizing SBAR bedside National hospitals utilizing SBAR bedside
handoff: handoff:

St. Josephs Hospital Ronald Reagan UCLA Medical Center (M.

Tucson Medical Center Sullivan, personal communication, October 20, 2016)

Banner University Medical Center

National Hospitals utilizing verbal handoff
Northwest Medical Center
outside the patients room:
VA Hospital
McLane Childrens Center (K. Bell, personal
communication, October 20, 2016)
Synopsis
Nursing problems that bedside report improves according to research
Lack of patient involvement/personal connection
Patient falls (Sand-Jecklin & Sherman, 2013)
Medication Errors (American Nurses Association, 2012)
Skin assessment
Nursing staff unsatisfied with accountability between fellow nurses and
physicians (Cairns, Dudjak, Hoffman, & Lorenz, 2013)
Communication breakdowns (Sand-Jecklin & Sherman, 2013)
Malpractice suits (Lang, 2012)
Summary of Research Articles Strengths and Limitations
Strengths:
Credibility peer reviewed
Included both nurses and patients
opinions
Interview guide consistent method of
interviewing
Similar trends and themes identified
Dependability multiple quotes
supported themes
Findings were congruent with other
studies
Limitations:
Lack of generalizability
Small sample sizes
under-representation
Convenience sampling selection bias
Only one unit in one hospital
Too many variables
Self reporting errors from nursing staff
Evidence Based Nursing recommendations that
Support Best practice
Nurses were better able to prioritize care because they were able to
visuals their patients
Patients reported an increase in involvement in the plan of care for the
day and felt more individualized care
Improvement in patient satisfaction scores based on HCAHPS scores
By completing report at the bedside, there is a more complete report
on the patient with a decrease in interruptions
Maintain privacy with bedside report
Nursing staff reported increased nurse-to-nurse accountability
(Maxson, Derby, Wrobleski, & Foss, 2012) (Groves, Manges, & Scott- Cawiezell, 2012) (Jeffs et al., 2014)
Application/ Implementation into Nursing
1. The unfreezing phase - confront/challenge staff attitudes toward bedside report
a. Month one
b. Nurse educators/charge nurses will ask for nurses opinions on bedside report and educate them on the
benefits it can bring to them and the patient
c. Performed during the monthly staff meetings,
2. Moving phase - achieving staff acceptance
a. Month 2
b. Start implementation of EBP bedside report recommendations
c. Address any important factors in the bedside report process and reiterate importance of bedside report
3. Refreezing phase
a. Month 3
b. Bedside handoff audits and disciplinary action
c. Continued reinforcement/education and addressing concerns
4. Review at one year - Nurses annual performance review

(Vine, Dupler, & Van son, 2014)

Detailed cost analysis
Time - No additional cost because education will take place during monthly staff meeting
Educator - No additional cost because part of their job description
Room- No additional cost because it will take place during meeting and huddle
Approval and gathering information - No additional cost as it is already a policy for the hospital
Educational Component- no additional cost as this will be implemented with charge nurse
education
No new equipment would be needed, no extra training, and there has been no cost to
implement in previous hospitals
The printing of the surveys for 60 surveys (2 surveys per day for a month) would be about 10
dollars (considering it is 10 cents per page)
Minimal cost to implement, it is beneficial to the hospital.
Total cost = $30 for printing
Risk vs. Benefit: The Hospital
Decrease in malpractice litigation, falls, medication errors, Change in culture- increased attrition due to
pressure ulcers, and other adverse events (Sand-Jecklin & dissatisfaction with more rules (Freitag, et al., 2011)
Sherman, 2014) (Maxson, Derby, Wrobleski, & Foss, 2012)

No increase in overtime pay (Cairns, Dudjak, Hoffman, & Lorenz,

2013) (Sherman, Sand-Jecklin, & Johnson, 2013) (Wakefield,
Ragan, Brandt, Tregnago, 2012)

Decrease in overtime pay (Wu, Lee, Tsai, Lin, Huang, & Mills,
2013)

Meets JCo National Patient Safety Goal of improve staff

communication (American Nurses Association, 2012)

HCAHPS increased patient satisfaction ratings = increased levels

of reimbursement (1.5% presently and 2% in 2017) from
Medicare/Medicaid and insurance entities (Reinbeck &
Fitzsimmons, 2013)
 Risk vs. Benefit: The Nurse
Reduced incidences of malpractice suits and medication errors
(Lang, 2012)
Promoted accountability, teamwork, respect among staff
(Sand-Jecklin & Sherman, 2013)
Visualizing patient allows for prioritization of care
(Spooner, Corley, Chaboyer, Hammond, & Fraser, 2014)
Providing a greater sense of confidence in themselves
while providing care before and after shift change
(Cairns, Dudjak, Hoffman, & Lorenz, 2013)
Reduction of call lights for the hour before and after
bedside report
Increases care coordination (Kerr, Lu, & McKinlay,
2013).

Bedside handoff increased nursing staff satisfaction by: HIPAA-protected behavior (Office for Civil Rights, 2002)
Increasing conciseness, decreased amount of time spent on
report
(Cairns, Dudjak, Hoffman, & Lorenz, 2013)

Generating more staff accountability and fewer distractions

(Spooner, Corley, Chaboyer, Hammond, & Fraser, 2014)
Risk vs. Benefit: The Nurse
Desire to respect client confidentiality (family members, semi-private rooms, infectious disease) (Burke, McLaughlin,
2013)

Perception of increased time for handoff (actual time not statistically significant) (Burke, McLaughlin, 2013)

Stress of waking up/disturbing a patient (psychosocial stressor) (Burke, McLaughlin, 2013)

 Risk vs. Benefit: The Patient
Rise in patient satisfaction in nurse communication on
HCAHPS survey in three areas:
-nurses kept me informed
Staff worked well together to provide care
Staff included me in decisions regarding my treatment
(Vines, Dupler, Van Son, & Guido, 2014)
80% of patients indicated preference for bedside handoff
(Lu, Kerr, & McKinlay, 2014)
Patients report an increase in feeling informed and involved
in their care (Lu, Kerr, & McKinlay, 2014)
Risks:
Patient care information may be heard by others in a
semiprivate room (Wakefield, Ragan, Brandt, Tregnago, 2012)
Increased stress in having sensitive information stated in
semi-private rooms (Lu, Kerr, & McKinlay, 2014)
Increased stress to patients family with the use of medical
jargon (Lu, Kerr, & McKinlay, 2014)
Increased anxiety about repeatedly hearing about their
condition (Lu, Kerr, & McKinlay, 2014)

Warm handoff results in increased satisfaction by

transferring trust from one nurse to another (Lang, 2012)

Increased patient safety outcomes (Wakefield et al., 2012)

SMART Outcomes
The HCAHPS score in areas of communication will increase to 90% one
year after bedside reporting re-education has been implemented.
Patient satisfaction will increase by 25% on the survey sent out by the
hospital within three months after the re-education plan has been
implemented.
There will be at least 50% fewer medications errors two hours before and
after handoff within three months after the re-education plan has been
implemented.
There will be no falls the hour before and the hour after shift change
within three months after the re-education plan has been implemented.
Summary
The issue: bedside report is a policy at many hospitals, but is not enforced
or implemented
Significance to the field of nursing because it has the potential to prevent
errors and improve patient satisfaction
The question: what is the best practice to prevent nursing errors when
acute care nurses perform SBAR at shift change?
Current practice: locally hospitals including BUMC, TMC, and St. Joes all
utilize SBAR bedside nursing handoff, and UCLA does as well
McLane Childrens hospital still does verbal report outside the room
Through our research, we found that although many may have policies for
bedside report, this is not enforced or used by nurses at shift change
Summary
Completing report at the bedside could provide a solution to nursing
problems including medication errors, patient falls, pressure ulcers,
interruptions during report, and lack of patient involvement
Strengths: credibility, dependability and congruent findings across studies
Limitations : small sample sizes, too many variables, and convenience
sampling
Completing report at bedside is best practice because it allows nurses to
better prioritize, patients feel more involved, errors are reduced and
HCAHPS scores are increased
Summary
Implementing this practice will take three months:
Month one: education
Month two: implementation
Month three: audits and beginning of disciplinary actions
Minimal costs to implement this practice
Risks: perception of increased time for hand-offs and increased patient
anxiety
Benefits: decrease in falls, decrease in errors, and increased patient
involvement
Outcomes include increased HCAHPS scores in areas of communication by
one year and 50% fewer medication errors in the hours directly before and
after handoff
 References
American Nurses Association. (2012). Tackling miscommunication among caregivers. Retrieved from

www.theamericannurse.org/index.php/2012/10/05/tackling-miscommunication-among-caregivers

Barry, M. E. (2013). Handoff communication: Assuring the transfer of accurate patient information. American Nurse Today, 9(1), 30-34. Retrieved

from

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/AmericanNurseToday/Archive/2014-ANT/Jan14-ANT/Issues-up

-close-Jan14.pdf

Brem, H., Maggi, J., Nierman, D., Rolnitzky, L., Bell, D., Rennert, R., Golinko, Vladeck, B. (2010). High cost of stage IV pressure ulcers. American

Journal of Surgeries, 200(4), 473-477. doi:10.1016/j.amsurg.2009.12.021

Burke, W., & McLaughlin, D., (2013). Partnering for change. American Journal of Nursing, 113(2), 47-51.

Cairns L., Dudjak L., Hoffman R., Lorenz H. (2013). Utilizing bedside shift report to improve the effectiveness of shift handoff. Journal of Nursing

Administration, 43(3), 160165.

Centers for Medicare & Medicaid Services. (2014). Standard HCAHPS survey. Retrieved from www.hcahpsonline.org/surveyinstrument.aspx.

Freitag M.,, Carroll V. (2011). Handoff communication: Using failure modes and effects analysis to improve the transition in care process. Quality

Management in Health Care, 20(2), 103109. doi: 10.1097/QMH.0b013e3182136f58

Groves, P. S., Manges, K. A., & Scott-Cawiezell, J. (2016). Handing off safety at the bedside. Clinical Nursing Research, 25(5), 473-493.

doi:10.1177/1054773816630535

Holly, C., & Poletick, E. B. (2013). A systematic review on the transfer of information during nurse transitions in care. Journal of Clinical Nursing,

23(17), 2387-2396. doi: 10.1111/jocn.1236

Jeffs, L., Beswick, S., Acott, A., Simpson, E., Cardoso, R., Campbell, H., & Irwin, T. (2014). Patients' views on bedside nursing handover. Journal Of

Nursing Care Quality, 29(2), 149-154. doi:10.1097/NCQ.0000000000000035

Joint Commission. (2013). National patient safety goals. Retrieved from

http://www.jointcommission.org/assets/1/18/NPSG_Chapter_Jan2013_HAP.pdf (accessed 20 Oct 2016).

Joint Commission. (2015). Preventing falls and fall-related injuries in health care facilities. Sentinel Event Alert, 55, 1-5.

Kerr, D., McKay, K., Klim, S., Kelly, A. M., and McCann, T. (2013). Attitudes of emergency department patients about handover at the bedside

Journal of Clinical Nursing, 23(11), 1685-1693. doi:http://dx.doi.org.ezproxy3.library.arizona.edu/10.1111/jocn.12308

Kerr, D., Lu, S., & McKinlay, L. (2013). Bedside handover enhances completion of nursing care and documentation. Journal of Nursing Care and

Quality, 28(3), 217-225.

Kohn, L.T., Corrigan, J.M., & Donaldson, M.S. (2000). TO err is human: building a safer health system. Institute of Medicine, 1-312. Retrieved from

http://www.nap.edu/catalog/9728.html.
Lang E. (2012). A better client experience through better communication. Journal of Radiology Nursing, 31(4), 114119. doi:

10.1016/j.jradnu.2012.08.001

Lu, S., Kerr, D., & McKinlay, L. (2014). Bedside nursing handover: Patients' opinions. International Journal of Nursing Practice, 20(5), 451-459.

doi:10.1111/ijn.12158 [doi]

Maxson, P. M., Derby, K. M., Wrobleski, D. M., & Foss, D. M. (2012). Bedside nurse-to-nurse handoff promotes patient safety. MEDSURG Nursing,

21(3), 140-144. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22866433.

McMurray, A., Chaboywer, W., Wallis, M., Johnson, J., & Gehrke, T. (2011). Patients perspectives of bedside nursing handover. Collegian, 18 (1),

19-26. doi: 10.1016/j.colegn.2010.04.004

Office for Civil Rights. (2002). HIPAA Privacy: Incidental uses and disclosures [45 CFR 164.502(a)(1)(iii)]. U.S. Department of Health and Human

Services. Retrieved from www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/incidentalusesanddisclosures.htm

Reinbeck D., & Fitzsimons V. (2013). Improving the client experience through bedside shift report. Nursing Management, 44(2), 1617.

Sand-Jecklin, K., & Sherman, J. (2013). Incorporating bedside report into nursing handoff: evaluation of change in practice. Journal of nursing care

quality, 28(2), 186-194.

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

of Clinical Nursing 23, 2854-2863.

Sherman, J., Sand-Jecklin, K., & Johnson, J. (2013). Investigating bedside nursing report: A synthesis of the literature. Medsurg Nursing : Official

Journal of the Academy of Medical-Surgical Nurses, 22(5), 308-12, 318.

Spooner, A.J., Corley, A., Chaboyer, W., Hammond, N.E., & Fraser, J.F. (2014). Measurement of the frequency and source of interruptions occurring

during bedside nursing handover in the intensive care unit: an observational study. Australian Critical Care, 28 (19-23).

http://dx.doi.org/10.1016/j.aucc.2014.04.002

Vines, M. M., Dupler, A. E., Van Son, C. R., & Guido, G. W. (2014). Improving client and nurse satisfaction through the utilization of bedside report.

Journal for Nurses in Professional Development, 30(4), 166-73. doi:10.1097/NND.0000000000000057

Wakefield D., Ragan R., Brandt J., Tregnago M. (2012). Making the transition to nursing bedside shift reports. The Joint Commission Journal on

Quality and Client Safety, 38(6), 243253.

Wu, M. W., Lee, T. T., Tsai, T. C., Lin, K. C., Huang, C. Y., & Mills, M. E. (2013). Evaluation of a mobile shift report system on nursing documentation

quality. Computers Informatics Nursing Journal, 31(2), 85-93.