Blending Caring and Excellence: Translating Culture of Caring and Safety in Bedside Handoff


Poster Presentation

Purpose for the Program

To determine whether the blending of culture of caring, bedside handoffs, and safety checks will improve patient satisfaction, increase collaboration among team members, and improve patient safety in the labor and delivery unit.

Proposed Change

A labor and delivery unit in a community hospital developed a new process for shift-to-shift reporting that blends the culture of caring concept with bedside handoffs and safety checks.

Implementation, Outcomes, and Evaluation

Change of shift report is the time when critical information relevant to patient care is communicated and exchanged between staff members. With the initiation of the culture of caring concept and the analysis of the last two quarters’ house-wide Press Ganey patient satisfaction scores, results revealed that improving patient satisfaction and safety must be the primary goals of the unit. A voluntary labor and delivery core team of nurses and physicians named Innovative Practice Team (INPT) was created. Expectations, goals, and evaluations were developed and probable challenges and barriers were recognized and identified. Information regarding the new initiative was communicated through e-mails before implementation. Physician and nurse champions piloted the initiative. This was followed by the go live phase. Structured bedside handoffs were implemented. Critical and private information were discussed in a brief report outside the patients’ rooms. Bedside handoffs took place in the patients’ rooms using the patient care board with patient friendly language. Key information, such as plan of care, was discussed with the patients, including significant events that occurred during the previous shift. Teach-back method was used, including pain medication and plan of care. Safety checks were performed on high-alert medications and equipment.

Staff evaluations provided strong positive feedback in the areas of value of communication methods, increase in collaborative efforts among team members, and efficacy of safety checks. Leadership will continue to play an important role in sustainability through daily shift-to-shift rounding. Additional outcomes will continue to be assessed through house-wide quarterly Press Ganey patient satisfaction scores.

Implications for Nursing Practice

The methods used enhanced the majority of staff acceptance and the participation necessary to improve patient satisfaction and maintain culture of safety and caring while including patients in the plan of care. Patients witnessed collaborative effort among team members. Staff participation has been strong and continuous efforts to bring staff to compliance through unit leadership (daily rounding) has played a considerable role.