Purpose for the Program
Patient handoff has been identified as a time when the risk of ineffective communication contributes to errors and miscommunication. Accrediting organizations in the United States and Canada have identified the importance of an effective transfer of accountability process. Legislation and professional standards address privacy and the need to identify, assess, plan, implement, and evaluate care on an ongoing basis. Transfer of accountability episodes throughout the continuum of a woman's inpatient experience provides opportunities for providers to exchange important and relevant information about the woman and include her in the interaction. Bedside report in the perinatal setting places the woman and her family in the center of the process and has been demonstrated to improve provider-to-provider and patient-to-provider communication, improve nurse efficiency at shift change, improve patient satisfaction with care, and improve nurse satisfaction. On our unit, chart audits uncovered concerns and when seeking the root cause of the issues identified, the shift handover report was identified as one system issue contributing to near misses and adverse events.
Shift report traditionally took place in the nurse's station. There was no standard format for report and the quality and value of information exchanged varied widely. The proposed change moved the shift report and all transfers of accountability to the bedside.
Implementation, Outcomes, and Evaluation
Utilizing recommendations from evidence-based literature and the shared experiences of a peer hospital, our unit implemented the bedside transfer of accountability initiative using role-play, a report prompt tool, and addressing questions and concerns. When the off-going and on-coming nurses exchange information about the woman at the bedside it provides an opportunity to use visual cues, including verification of the patient's identification, intake and output, the status of dressings and drainage devices, and pain management. It also enables the on-coming nurse to gather information from the off-going nurse. Each patient and her family are provided with the opportunity to be partners in her care and contribute information or clarification. Patient rounds data, risk audits, and nurse feedbacks have revealed positive outcomes, including improved quality of communication, documentation, and both patient and staff satisfaction.
Implications for Nursing Practice
Implementing change can be challenging in any unit culture. In this presentation, we will share our strategies and experiences as a learning opportunity for others considering implementation of bedside report.