Lehigh Valley Health NetworkLVHN Scholarly Works

Patient Care Services / Nursing

Bedside Shift HandoffAmelia Bard BSN, RNLehigh Valley Health Network

Tyler McLean BSN, RNLehigh Valley Health Network

Mollie Rohrbach BSN, RNLehigh Valley Health Network

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Published In/Presented AtBard, A., McLean, T., Rohrbach, M. (2014, June 5). Bedside Shift Handoff. Poster presented at LVHN UHC/AACN Nurse ResidencyProgram Graduation, Lehigh Valley Health Network, Allentown, PA.

Bedside Shift Handoff

Amelia Bard, BSN, RN Mollie Rohrbach, BSN, RN Tyler McLean, BSN, RN

Background/Significance

To implement a change in practice in shift report at ED-CC that will result in improved patient outcomes and nurse satisfaction, while decreasing adverse patient safety incidents.

PICO QUESTION

(P) In adult emergency department patients, (I) will standardizing bedside shift handover

(C) as compared to report at the nursing station (O) be effective in decreasing

negative patient outomes (i.e. IV infiltrations, medication rate errors,

biohazard exposures) and increasing nurse accountability?

▪ PICO Question – written as a question and show the elements (PICO)

TRIGGER?

▪ Knowledge v. Problem

• Trigger:

• Knowledge deficit at change of shift

• At change of shift there was an informal

handoff that took place only at the nurses’

station

• For example: orders not being completed,

medications not being given, disorderly rooms,

and infiltrated IVs

EVIDENCE

▪ Negative Patient Outcomes • Nurses able to visual patient at very beginning of shift and end

(Reinbeck & Fitzsimons, 2013)

• Sentinel events occur from communication breakdowns during shift reports (Weigand, 2013)

• Allows for glance at patient status, IV patency, fall precautions, etc) (Baker, 2010)

▪ Nurse Accountability/Satisfaction • Bedside reporting promotes accountability and teamwork (Weigand,

2013)

• More accurate hand off (Evans, D., Grunawalt, J., McClish, D., Wood, W., & Friese, C. R., 2012)

• Bedside reporting encourages a successful transition to practice environment for nurses (Joshi, Currier, & O’Brien, 2011)

• It is a way to transfer trust between nurses (Baker, 2010)

EVIDENCE

▪ Resistance to Change • Staff reported bedside handoff took little to no additional time from

completing tasks (Cairns, Dujak, Hoffman, & Lorenz, 2013) • HIPAA concerns addressed by specifying appropriate in-room

comments between nurses (Reinbeck & Fitzsimons, 2013) • Initially, staff members were concerned with an increase in length

(Reinbeck & Fitzsimons, 2013) • Nurses oppose due to report taking too long (Weigand, 2013) • Bedside shift report is meant to be fast (Baker, 2010)

▪ Patient Satisfaction • HCAHPS scores increased (Reinbeck & Fitzsimons, 2013) • Patients were more involved in their care and able to identify with

their caregivers (Evans et al. 2012) • Bedside report integrates patient into healthcare team (Joshi et al.,

2011) • Patients are more comfortable about the direction of their care and

satisfied with the healthcare team (Baker, 2010)

Current Practice at LVHN

▪ At LVHN the current standard of practice is

to complete bedside shift handoff at every

shift change, however it was not always

implemented in the past on specific units

IMPLEMENTATION

Implementation and staff compliance of Bedside Shift Handoff will:

• Increase nurse-to-nurse accountability

• Integrate patients into their own healthcare team

• Recognize change in patient status

• Increase nurse satisfaction

• Catch and/or prevent medical errors

Practice Change

▪ Nurses completed pre-survey to include their concerns

▪ Staff was educated with a TLC learning module to demonstrate the conduction of a bedside shift handoff, as well as its importance

▪ Bedside shift handoff was also demonstrated to the staff by the nurse residents prior to the to “Go Live” date

▪ Nurses will be validated during “Go Live” time on bedside shift handoff by the residents

RESULTS

▪ Nurse residents are currently awaiting the

“Go Live” date in June of 2014 to validate

staff and await results of the post-surveys

Implications for LVHN

▪ Implications for LVHN include:

• Increased patient satisfaction

• RN to RN reliance, respect, and satisfaction

• Safe practices

• Improved patient outcomes and care

Strategic Dissemination of Results

■ Poster presentation at nurse residency

graduation

■ Staff made aware of progress of the

EBP project through frequent e-mails

from Deb Greenwood, group facilitator

Lessons Learned

▪ Nurse residences learned the process of applying the research of evidence-based practice project to a unit

▪ Hopefully, post-”Go Live” results will show that:

• RNs of floor learned the importance of bedside shift handoff in their care and how to effectively and efficiently perform bedside shift handoff

References

▪ Baker, S. J. (2010). Bedside shift report improves patient safety and nurse accountability. Journal of Emergency Nursing, 36(4), 355-358.

▪ Cairns, L., Dujak, L., Hoffman, R., & Lorenz, H. (2013). Utilizing bedside shift report to improve the effectiveness of shift handoff. Journal of Nursing Administration, 43(3), 160-165.

▪ Evans, D., Grunawalt, J., McClish, D., Wood, W., & Friese, C. R. (2012). Bedside shift-to-shift nursing report: Implementation and outcomes. Medsurg Nursing, 21(5), 281-292.

▪ Joshi, M. S., Currier, A., & O’Brien, K. (2011). Bedside change-of-shift reporting: A strategy to increase patient safety. National Patient Safety Foundation.

▪ Reinbeck, D. M., & Fitzsimons, V. (2013). Improving the patient experience through bedside shift report. Nursing Management, 44(2), 16-17.

▪ Wakefield, D., Ragan, R., Brandt, J., & Tregnago, M. (2012). Making the transition to nursing bedside shift reports. The Joint Commission Journal on Quality and Patient Safety, 38(6), 243-253.

▪ Weigand, L. (2013). Customer service: The nursing bundle. Journal of Emergency Nursing, 39(5), 454-455.

Make It Happen

▪ Questions/Comments:

Contact Information: