Change of Shift Report in Nursing

Change in Practice Assignment: Shift Report

• Elizabeth Campins

Nurses communicate information about their assigned client at the end of each shift to the nurse working on the next shift. Shift report provides updated patient’s status for continuity of care. The purpose of this assignment is to analyze the effectiveness of the change-of-shift-report at bedside and the implementation of evidence-based practice for an accurate and relevant report.

The Problem

There are different change-of-shift-report according to the institution rules and regulations. The different ways to give the end-of-shift report vary among institutions, and especially among different units in the same hospital. It constitutes a problem for nurses, particularly when they float from unit to unit (Dufault et al., 2012). Some common types of reports are orally in person, by audiotape, and walking- planning rounds. Oral reports are given in conference rooms, with staff members from both shifts participating. It has the advantage that they allow staff members to ask questions or make clarifications face to face. By audiotape recording question and clarifications have to be made after listening to the tape report.

The problem is that orally and audiotapes reports are made without visualizing the client actual condition. The status of a patient, changes in vital signs, unusual response to treatments, and changes in client’s emotional condition can happen very quickly. These quick changes in a client’s condition can cause a gap of information between what is written or recorded in a report and what the client is experiencing at the moment. Inaccurate information can lead to treatment using outdated or even incorrect information that puts the patient and the nurse at risk.

Nurse’s consent on taking the client with no direct observation are in danger of being responsible for any critical situation aroused at the last minute that it was not in the report, including death of the patient. Nurses accepting the assignment are responsible and accountable to the care of that patient they have not seen yet (Nelson & Massey, 2010). Because nurse-patient relationship begins when the nurse accepts responsibility for nursing care, it does not matter the modality of the shift report, nurses are still accountable. Change in the way of giving an end-of-shift report is an implementation needed in every health care institution. Considering one format with the same protocol in every unit can be the most efficient strategy for bedside shift report. This implementation will reduce the possibilities of communication errors that is the most reported cause of sentinel events in U.S hospitals (Guido, 2013), and also has the advantage of involving the family in client care.

Practice Change

The evidence-based change to practice propose in this assignment is a standardized protocol for bedside-shift-report. Evidence supports that breakdown in communication and medical errors occur during end-of- shift-report (Gregory, Tan, Tilrico, Edwardson, & Gamm, 2014).

The proposed standardized protocol for the report will use the SBARP format: Situation will review admitting information, problem list, and diagnosis. Background will include a review of past medical history, social history, resuscitation status if any, current orders and medication list. Assessment will be together with the oncoming nurse including validating progress notes and verification of the most recent vital signs. This step will be with nurses already in the patient room. Recommendation will be in front of the patient to discuss what the care plan for the shift is. Patient participation will consider patient concerns and questions.

Gathering relevant information from medical notes and nursing documentation is the first step to initiate the report. It is necessary to validate all information with the actual status of the patient to facilitate the transfer to the recipient of the report. The oncoming nurse will review assignment sheet and read information on the computerized reports. At the time of meeting with the off-going nurse, it is necessary to review the information and to add what is not on the computerized report. This time outside of the patient room may be an appropriate time to discuss any sensitive information that may be considered an HIPAA violation if family members are present or when the patient is in semi-private rooms. Some staff members are skeptic in being able to discuss a sensitive topic as infectious diagnosis, HIV, drug abuse or psychiatric issues in front of and with the patient. In this case, both nurses could go to a private setting before entering the patient room. The study recommendation is to adjust models as appropriate to attain and sustain the outcomes. Each off-going nurse will provide a verbal report at the bedside of the patient using the SBARP format (Dufault et al., 2012). Would be necessary highlight every critical area considering situation that include admitting information and diagnosis problem list. Nurse need to review past medical history, current orders, resuscitation status, med list, among others. At the time of the assessment oncoming nurse will verify the most recent patient assessment, review labs, vital signs and read progress notes. Any observation shared with the patient is useful for meeting their needs and also to find out what is not in need at that time. Both nurses need to discuss the proposed plan of care to move to the next level. Reporting in front of the patient reassures the patients that they are the priority and nurses are aware of the details in the client condition. Off going nurse will introduce to the patient the oncoming nurse, and assess the patient concerns and the care plan for the day. This strategy will give to the patient a sense of security and wiliness to participate in their care with the recommended options. Finally, the off-going nurse turns over patient to the oncoming nurse (Dufault et al., 2012).

Evidence Supporting the Proposed Change

The first research study that supports the evidence for bedside shift report is Translating an Evidence-Based Protocol for Nurse-to-Nurse Shift Report (Dufault et al., 2012). The purpose of this study was standardizing communication practices to reduce the risk of patients in an acute care environment as a result of a gap in communication at the time of the shift report. It focuses on how to translate research into practice model to generate the best-practice-protocol for nurse-to-nurse shift handoffs in a Magnet designated community hospital in U.S.

The project used the Collaborative Research Utilization (CRU) model with a six-step translating-research-into-practice approach. The model use three steps in this order: Identifying clinical problems related to change on shift report. The second is appraising and evaluating the strength of theoretical, empirical and clinical evidence. And the third one is the translation of this evidence into a best practice and standardized protocol for change of shift report. It has its basis in the Roger’s Adoption of Innovation Theory that considers three important factors to improve research translation into practice. The first one is the availability of a validated and predictable knowledge. Second, need of a competent staff using this knowledge with a favorable attitude toward the research. Third, a supportive policy-generating structure that promotes innovation (Dufault et al., 2012). Additionally to CRU model with its groundwork of Roger’s Adoption of Innovations Theory it was included Orlando’s Nursing Theory. It emphasizes in meeting the patient’s need and value the concept of nursing’s role as client-family advocate. The model gives tools to the review for validated literature on nursing shift reports. It provides a guide of research roundtables (experiential, problem-focused learning exercises) to evaluate and translate the empirical knowledge. Additionally, at the time to create the organizational structures within the hospital it provides the test; sustain evidence-based policies, and standards needed to cue clinical actions. While the transition to change, the above-mentioned model, paired in teams of clinicians, nurse researchers, clinical specialists, undergraduate and graduate nurse students. This strategy addresses the clinical issue, in this case, development of a standardized protocol for nurses’ shift report. The before mentioned approaches to change has been tested in other previously apply problems in which the evidence-based is strong.

The second research study was Bedside Shift Reports: What Does the Evidence Say? By (Gregory, Tan, Tilrico, Edwardson, & Gamm, 2014). This study summarizes a systematic literature review of BSRs and serves as a mechanism to relate the support for improving quality of care and patient safety. After strong evidence supporting the benefits of BSR, sustainability is still an issue. As a result, many studies recommend assessing staff attitudes before and after implementation to identify if periodic interventions are needed to sustain desired change in practice. Models of bedside report incorporating the patient into the triad have been shown to increase patient engagement and enhance caregiver support and education. This study analyzed Thirty-three titles divided into six categories: team-based variables, dynamic relationships, individual benefits, confidentiality concerns, accountability and cost efficiency.

Twenty-five studies were reporting team-based variables that discuss positive attitudes and improved patient-centered care, team collaboration, and care coordination after implementation of BSR. In sixty-four percent of these studies (n=16) was noted an increased patient care. Only twelve percent (n=3) of the articles cited increased family-centered care within team-based variable. Enhanced team collaboration was observed in thirty-two percent of the articles. Nurses reported increased communication, timeliness, and consistency of information. Seventeen of the articles cited positive aspects of the nurse-nurse relationships. It included providing emotional support to on another, increased communication, mentoring and coaching and overcoming feelings of discomfort during BSRs. Twenty-nine articles highlighted individual benefits of BSRs for the patient, nurse, and even physician. Fifteen articles expressed confidentiality concerns with BSRs when discussing sensitive information about the patient especially during a family visit or semi-private rooms. Eight articles show advantage and disadvantage regarding accountability and reducing overtime accumulated between shifts changes.

In resume, nurse shift reports are one of the most crucial processes in patient care were patient safety can be improved to reduce medical errors in the U.S.

Evaluating the Change

Press Ganey Patient Satisfaction Survey data (Press Ganey, 2015.) was used to evaluate patient preference and nursing staff competence. It described the patient-centered, evidence-based, best practice protocol developed for the hospital, it made eight recommendations. The study evaluates the information content of the bedside-shift-report in a medium sized magnet-designated community hospital. It serves a high population of tourists, the military and older adults from the surrounding community. This population is similar in the percent of minorities, gender, and socioeconomic status to others community hospitals in the state. Bedside reports have been supported by improving patient safety, patient-centered care, and nurse communication as well as reduce medical errors by the Joint Commission’s National Patient Safety Goals (The Joint Commission, 2015).

The project has a positive and sustained impact as an effective approach to handoffs report, and in other problem-solving in the future (Dufault et al., 2012).

The results of the study indicate that standardized BSRs will increase compliance, increase patient’s and nurses’ satisfaction, and will saves nurses time. But it was found weak or little evidence to support the use of specific structure, protocol, or method for BSRs (Gregory, Tan, Tilrico, Edwardson, & Gamm, 2014). The evidence is clear of the benefits to models of BSRs. The task is to identify the suitable model that fit each organization and patient population to attain and sustain the outcomes.

Summary

Bedside shift reports is a critical process in patient care that can improve patient safety, and reduce errors as a consequence of communication gaps during the transfer of information at the end of each shift. This assignment addressed the problem, and the evidence-based change to practice as with the standardized protocol for bedside-shift-report. We based our conclusion on two studies Translating an Evidence-Based Protocol for Nurse-to-Nurse Shift Report (Dufault et al., 2012), and Bedside Shift Reports: What Does the Evidence Say? By (Gregory, Tan, Tilrico, Edwardson, & Gamm, 2014). After analyzing the data and evaluating the change proposed, we mention the most relevant results concerning to this change.

References

Dufault, M., Duquette, C. E., Ehmann, J., Hehl, R., Lavin, M., Martin, V., … Willey, C. (2012, March 9). Translating an evidence-based protocol for nurse-to-nurse shift handoffs. Wiley Online Library, 7(2), 59-75. http://dx.doi.org/10.1111/j.1741-6787.2010.00189.x

Gregory, S., Tan, D., Tilrico, M., Edwardson, N., & Gamm, L. (2014, October). Bedside shift reports: What does the evidence say? JONA, 44(10), 541-545. http://dx.doi.org/10.1097/NNA.0000000000000115

Guido, G. W. (2013). Legal and ethical issue in nursing (6th ed.). Upper Saddle River, NJ: Prentice Hall.

Nelson, B. A., & Massey, R. (2010). Implementing an electronic change-of-shift report using transforming care at the bedside processes and methods. JONA, 40(4), 162-168. http://dx.doi.org/10.1097/NNA.0b013e3181d40dfc

Press Ganey website. (2015). http://www.pressganey.com/resources/patient-satisfaction-survey

The Joint Commission website. (2015). http://www.jointcommission.org/standards_information/npsgs.aspx