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CE Article: Shift reporting: Move it to the bedside*


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After reading this article, you will be able to:

  • Describe steps to implement bedside shift reporting
  • Identify techniques to improve shift reporting
  • Recall benefits that can result from bedside shift reporting

Many nurses on the progressive care unit (PCU) at Sharp Grossmont Hospital in San Diego were frustrated with the lack of communication during shift reporting. Outgoing nurses were working overtime as it took an average of 40 minutes to review patient information with the oncoming nurse. And nurses weren't the only ones dissatisfied with the process—patients were frustrated too.

"Some staff nurses were missing vital patient information during the shift report, and this led to nurses calling the previous nurse at home to gather the essential data," says Pam Athwal, RN, MSN, nurse manager. "And because shift reporting was not done at the bedside, patients complained that they were never introduced to the oncoming nurse and that their nurse was not available when needed, which led to an increase in patient call lights."

Athwal and her colleague Esther Wagnall, RN, BSN, nurse manager on the unit, wanted to implement a standardized shift report to keep nurses at the bedside and improve the quality of information reported. To help create this structure, they went directly to the bedside nurses.

"We wanted to see our staff nurses happier when they came in to work, so we asked them for their input for the information they needed in order to do their job effectively," says Athwal.

Because staff nurses had a voice in creating a new standardized shift report, communication during shift reporting took place at the bedside and was reduced to about 10 minutes, allowing nurses to leave work on time.

Set the foundation for change

Once staff nurses provided their input to Athwal and Wagnall on what pertinent information they wanted to see and hear during shift reporting, the issue was brought to the PCU's practice council. The practice council, which consists of staff nurses, nurse managers, and unit directors, then took the initiative to review:

  • The current shift report
  • Staff comments
  • Sharp Grossmont's policies and guidelines for possible gaps in nursing practice
  • Literature to identify how other hospitals conducted shift reporting and what practice would work best for the department

"We wanted to change the mindset of staff that just because we have done it one way in the past doesn't mean we have to continue to do it that way," Athwal says. "We could do something better."

Read about a model a 28-bed gynecological unit used to manage staffs' resistance to change in the implementation of bedside shift reporting.

Reveal the new process

After reviewing staff comments on what they wanted to see and hear during shift reporting, as well as reading best practices in literature, the unit practice council streamlined the shift reporting process. The new system combines a one-page written update, followed by a private bedside report.

With this new process, the oncoming nurse reviews the written update and meets with the current nurse to ask questions and clarify information. The two nurses conclude the shift report at the patient's bedside, which includes an introduction of the oncoming nurse to the patient.

"It's a great communication tool because you can look at the written update ahead of time to examine the patient's diagnosis, history, etc., before even speaking with the current nurse," says Rose Valdez, RN, staff nurse on the PCU. "And patients like it that we introduce the oncoming nurse."

Bedside shift reporting can also improve communication because it allows patients to confirm the details nurses discuss.

Read more about the benefits of bedside shift reporting and other tools that can enhance communication.

See the results

Leadership conducted audits to confirm whether staff members incorporated the new standardized reporting structure into their daily practice. The results of the audits were positive, and progress with the new shift reporting structure was quickly seen. The unit experienced:

  • Decreased call light usage, from an average of six calls to one call during shift change
  • Reduced patient falls, from two per month to fewer than one during shift reporting
  • Increased staff nurse satisfaction because they are able to leave work on time
  • Savings of $8,000 in two months from reduction in nurse overtime
  • Reduced patient disclosure information from 40 minutes to 10-15 minutes

"This improvement project is a tribute to the bedside nurse to make sure we provide excellent care to our patients," says Athwal.

Read techniques that can help staff make continued improvements in shift reporting at your facility.

References:

  1. BNET Business Network. (2004). "Get an A+ on end-of-shift report." Available at http://findarticles.com/p/articles/mi_qa3689/is_200406/ai_n9425820
  2. Medscape Today. (2006). "Improving clinical information through structured conversation." Available at http://www.medscape.com/viewarticle/550701_3
  3. PubMed Central. (2005). "Managing change in the nursing handover from traditional to bedside handover." Available at http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=548693

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