Ohio hospital keeps TABS on patients
Riverside Methodist Hospital develops a bedside tool to help with patient reports
After reading this article, you will be able to:
- Describe the new bedside reporting method used at Riverside Methodist Hospital
- Identify why Riverside Methodist Hospital’s old patient reporting process was unsuccessful
In October 2008, staff members at Riverside Methodist Hospital (RMH) in Columbus, OH, approached Sheryl Tripp, MSN, RN-BC, nurse manager for the gynecology/gynecology-oncology (gyn/gyn-onc) surgical unit, in hopes of changing the way nurses were issuing patient reports.
Tripp reviewed the current process on the gyn/gyn-onc surgical unit for patient reports, along with the unit’s Press Ganey patient satisfaction scores, and decided it was time to implement a new process for patient reports and end-of-shift reports.
Tripp led an effort to implement a new reporting process, Transferring Accountability at the Bed Side (TABS), that includes an interaction between the nurse whose shift is ending and the nurse whose shift is beginning. Under the new process, both nurses visit the patient’s bedside together, as opposed to each nurse reporting separately.
The new process has improved the unit’s Press Ganey scores dramatically, Tripp says.
Time for a change
For as long as Tripp could remember, nurses on her unit used tape recorders to create patient reports. At the end of each shift, the nurse would go into the designated recording room to record patient reports. The nurse coming in for the next shift would listen to that report and attend to patients and daily tasks.
“This process is all right, but most of the time nurses would end up doing verbal reports because the tape recorder would fail, or they had problems understanding what the nurse was saying on the recording,” explains Tripp.
The unit’s Press Ganey scores were hovering around 50% for nurse-to-patient communication and safety during the patient’s stay. Tripp knew it was time to honor her nursing staff members’ requests to help improve patient safety and nurse communication.
Research and trial and error
To start, Tripp ran a series of two-week trial methods on her unit that involved preparing a few types of reports: tape-recorded, written, verbal, and a bedside report. “We told the staff members each week the style of reporting we would do, and then asked them to report back to us with any feedback,” says Tripp.
During the trial period, Tripp would visit patients’ rooms and talk with them about each of the reports, specifically the bedside reporting.
On RMH’s gyn/gyn-onc surgical unit, semiprivate and private rooms are available, and there are patients who share rooms. Tripp wanted to make sure patients did not have any problems concerning their privacy during bedside reporting.
“During this trial period, a majority of the patients I talked with liked the bedside process, so I decided this was the right process,” Tripp says.
Education and implementation
Tripp, her clinical nurse manager, the women’s health clinical nurse specialist, and a research nurse at RMH formed an evidence-based practice team to research information on bedside reporting.
While researching, the team chose three articles that highlighted the pros and cons of bedside reporting. Nursing staff members received these articles for education in preparation for the upcoming change in reporting process.
As part of the TABS process, when the two nurses enter a patient’s room, the nurse coming off shift introduces the nurse coming on shift to the patient. Then, the new nurse checks the patient’s armband and asks the patient’s name and date of birth.
The nurse coming on shift then writes his or her own name, along with the patient’s name on the whiteboard located in each patient room.
In addition to having the two nurses work together and converse with the patient more, a report sheet is kept outside the patient’s room.
“The report sheet is used as a guideline for the nurses to communicate with one another, especially if a float nurse comes to the unit,” says Tripp. (See the “Nurse-to-nurse report sheet” on p. 5.)
After using the new TABS process for a month, Tripp and her team sent out surveys to the nursing staff members. Overall, the new process of reporting was well received, and many nurses liked the process better than they had expected.
“Nurses reported that they were now clocking out on time, as opposed to leaving a half an hour after their shift has ended,” says Tripp.
In addition to receiving great reviews from the nursing staff members and the patients on the gyn/gyn-onc surgical unit, the TABS process vastly improved the Press Ganey scores. The three areas on which RMH focuses are:
- How well nurses keep patients informed
- How well staff worked together to care for patients
- Whether staff members include patients in the decision-making process
Prior to implementation, Tripp’s unit scores were hovering around 26%, 50%, and 60% satisfaction for each of the three foci respectively. Just three weeks after implementing reporting at the bedside, each focus area reached 99% satisfaction.
“It is great to know that even now, a year after implementation, that our Press Ganey score has not dropped,” says Tripp.
Adapted from Patient Safety Monitor (Briefings on Patient Safety), February 2010, HCPro, Inc.
Transferring Accountability at the Bed Side: An evidence-based practice project
Purpose: To improve patient safety and nurse-to-nurse communication by using an evidence-based practice (EBP) model to implement Transferring Accountability at the Bed Side (TABS) in a shift-to-shift report.
Clinical issue: The current method of shift-to-shift reporting was not standardized or consistent. Patients were not actively involved in their daily plan of care. Reports did not follow SBAR format and had the potential to omit essential patient care information.
- Team assembled
- Literature reviewed
- Staff and patients surveyed
- Pilot designed
- SBAR worksheet created
- Staff and patient education provided
- Outcomes measured
1. Customer Service: Press Ganey data
- “How well the nurses kept you informed”: Prior to improvement project, 26%; post, 99%
- “How well staff worked together to care for you”: Prior to improvement project, 51%; post, 99%
- “Staff effort to include you in decisions about your treatment”: Prior to improvement project, 64%; post, 99%
2. Quality of care/safety: This process enhances numerous bedside safety checks:
- ID bands
- IV and dressing change dates
3. Quality of work life:
- Monitor Nursing Database of Nursing Quality Indicator scores
- Efficient transfer of information
- Increased awareness of patients’ needs
- Decreased overtime at shift change
Conclusion: The 2009 National Patient Safety Goals support a culture of safety for developing a process for effective handoffs. The EBP TABS improves patient safety and enhances RN and patient satisfaction.