Improving the Quality of Bedside Shift Report Behavior on the Medical-Surgical Unit at Woodland Healthcare Amanda Waggoner, RN, MSN Purpose Ineffective nursing handoff communication at shift change Delay in or inappropriate treatment Extended LOS Increased preventable costs Decreased patient and staff satisfaction Patient harm Leading cause of sentinel events Importance of addressing patient safety risks as a priority https://www.google.com/search?
q=communication+errors+between+nursese&tbm=isch&tbs=rimg:CfjHKqO1bX_1FIjh_1xReqCT1ILjX4Tdmgvg2tjBtocqK6RZ1plxlwjX- Microsystem Assessment 5Ps Assessment Assess quality report at bedside Began on time, introduction, information exchange (SBAR), patient involvement, Safety San. Lack of BSR altogether 0 50% of night shift felt report time is adequate 2 with shift report 4
Only 40% of day shift Nurses felt satisfied 6 Nursing Satisfaction Survey 2 0 1 8 1 6 1 4 1 2 1 0 8 Process Identification Observation of BSR Communication BSR performance of twenty 12 hour night shift RNs 10
10 6 Microsystem Assessment Press Ganey Scores At shift change, do patients feel included in the plan of care? Yes; Total Mean= 89.3 July 03, 2017 Reportable Events Kinked Foley Patient Fall Hypoglycemic Episode Sex 59% Females, 41 % Males Language- 89% English, 11% Spanish
https://myhealth.alberta.ca/alberta/pages/When-you-have-an-indwelling-catheter-after-your-visit.aspx Kinked Foley= $4,500 Cost Analysis Lab Testing Extended LOS x1 day Patient Fall= $5,200 $0 to implement BSR $23,000 Total of absorbed costs by the organization as a result of poor handoff communication related errors
X-ray of hip PT evaluation Pain medication Extended LOS x1 Hypoglycemic Episode= $13,300 Lab Testing Hypoglycemic management/ medications Extended LOS x3 days https://health.clevelandclinic.org/2012/11/healthcare-costs-and-you/ Qualitative Costs Staff perceptions Emotional Pain/ Suffering Daily living Physical Pain Financial Responsibilities Teamwork/ Communication/ Unit
Patient/Staff Satisfaction Relationship Strain morale Scores https://archive.ahrq.gov/news/newsletters/research-activities/14jan/0114RA9.html Literature Review PICO Strategy P: Medical-surgical nursing I: Bedside report tool C: Non-bedside shift report O: Effective communication at shift change as evidenced by improved patient outcomes, prevention of events, and
improved patient and staff satisfaction. Benefits of BSR tool Clarification of significant information Physical examination of patient and environment/ safety checks Improved nursing accountability/ teamwork Improved patient and staff satisfaction Reduction of hand-off related errors (Ferguson & Howell, 2015)(Zou &
Preparation Oncoming RN arrives on time to prepare for report. This means before 0700 or 1900 Report begins at 0700 or 1900. Introduction Off going nurse uses AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank You) to introduce oncoming nurse to patient and family Update Whiteboards with correct information o Other team members may be present (CNAs, RT, Lab, etc). Information Exchange
Use of SBAR (Situation, Background, Assessment, and Recommendation) Use of simple terms and language that patient and family will understand (including use of interpreter services as needed), avoid using medical terms that patient is unfamiliar with (i.e. NPO). WOW (Workstation on Wheels) present during bedside report utilized to clarify any information. Patient Involvement Give patient and/or family the opportunity to ask questions related to care, clarify exchanged information, review plan of care/ goals for the day including expected hourly rounding. Safety Scan Review the patient, environment, AND EHR (Electronic Health Record) bedside. o Patient Assessment: Visually inspect any and all incisions, wounds, .dressings, drains, catheters, IV lines. o Environment Assessment: Visually inspect IV pumps, oxygen, bed alarms, suction equipment, fall mats, call light and personal belongings within reach. Make sure bed is low and locked in position. o EHR: Review of medication administration record to verify all medications have been given and documented correctly, vital signs, I&Os, etc.
Specific Aim Statement Through implementation of a standardized bedside report tool, 95% of twelve-hour night shift nurses on the medical surgical unit at Woodland Healthcare will demonstrate proper quality bedside report at shift change by August 15, 2017. Methodology Lewins Theory of Planned Change Unfreezing: Presented evidence-based research during huddles, gained stakeholder interests, addressed staff barriers, provided education to staff. Moving: Monitored and coached staff during BSR. Act as resource for support/ mentoring. Refreezing: evaluate BSR utilizing competency checklist, postimplementation survey results of staff and patients. Enact sustainability plan. Identification of Barriers Pre-Implementation
Survey Nursing Survey Results Time constraints Nursing attitude/compliance HIPPA violations Language barrier Patient compliance Timeline Gantt Chart Summary Report Evaluation of Outcomes What I learned In the process of collecting post- The importance of flexibility and
implementation data and evaluating outcomes: Nursing Competency Checklist Press Ganey Survey Nursing post-implementation survey Review of reportable events networking Setting realistic goals and objectives Utilizing effective communication strategies Application of the PDSA cycle Sustainability Plan
PDSA PDSA PDSS Aligning with WHC Mission and Vision -Dignity, collaboration, stewardship, justice, and excellence Having a unit champion - Key player and influencer Continued perceived benefits for staff and patients - Post results of improvement, storytelling Maintaining stakeholder support -Running reports and audits, benchmarking http://www.opendoorhr.com/Quality-Improvement-Process/ References Ferguson, T.D. & Howell, T.L. (2015). Bedside reporting protocols for improving patient care. Nursing Clinics of North America, 50(4), 735-747. Image one. (2017). Retrieved from https://www.google.com/search?
q=communication+errors+between+nursese&tbm=isch&tbs=rimg:CfjHKqO1bX_1FIjh_1xReqCT1ILjX4Tdmgvg2tjBtocqK6RZ1plxlwjXImage two. (2017). Retrieved from https://myhealth.alberta.ca/alberta/pages/When-you-have-an-indwelling-catheter-after-your-visit.aspx Image three. (2017) Retrieved from https://health.clevelandclinic.org/2012/11/healthcare-costs-and-you/ Image four. (2017). Retrieved from https://archive.ahrq.gov/news/newsletters/research-activities/14jan/0114RA9.html Image five. (2017). Retrieved from http://www.opendoorhr.com/Quality-Improvement-Process/ Zou, X.J. & Zhang, Y.P. (2016). Rates of nursing errors and handoffs-related errors in a medical unit following implementation of a standardized nursing handoff form. Journal of Nursing Care Quality, 31(1), 61-67.
