Bedside Shift Report

 

Nicole Leftenant

College of Central Florida

NUR4165- Nursing Research

Dr. Rolland

09/05/2021

 

 

 

 

 

 

 

 

 

 

 

 

 

Bedside Shift Report

Part I

Topic

            Effective communication among healthcare professionals is imperative for providing safe, high-quality, patient-centered care (Merlino, 2017).  A study released by The Joint Commission in 2016 estimated that miscommunication in U.S. hospitals and medical practices were responsible at least in part for 30% of all malpractice claims resulting in 1,744 deaths and $1.7 billion in malpractice costs over five years (The Joint Commission, 2012). Research conducted by the Institute for Healthcare Communication during a 10-year period demonstrated that ineffective team communication is the root cause for nearly 66% of all medical errors during that period ("Impact of communication in Healthcare,” 2011).

 

             

Significance

1. Medical Errors: Joint Commission (2017) conducted a study in which nine medical centers over the course of 10,740 patient admissions reduced preventable adverse events by 30 percent and medical errors by 23 percent during the intervention period.
2. Patient Falls: After implementing bedside shift report for four months, patient falls decreased by 24% compared to pre-implementation rates (McAllen et al., 2018).
3. Hospital Acquired Infections: By incorporating patient safety assessments into bedside shift reports there was a 26.5% reduction in hospital-acquired infections in 2018 compared to 2017 (Rudisill et al., 2019).

 

Problem

The clinical problem is that shift report was not given at the patient’s bedside due to COVID-19 isolation rooms. During this period a patient had a critical change in status and nursing detection was delayed. That gap in communication lead to a patient having a code requiring the patient to be placed on mechanical ventilation. This was a sentinel event for the hospital. With medical errors being the third leading cause of death in the United States (Ofori-Atta et al., 2015), implementation of bedside shift report by nursing staff will improve communication and patient safety.

Purpose

            The purpose of this project is to explore the effectiveness of bedside shift report on improving patient safety.

PICO

            In the acute care setting (p) how effective is bedside shift report (I) on improving patient safety (O)?

 

Part II

Method

A literature search was conducted using the databases Ovid and CINAHL, google scholar, and PubMed. Keywords were safety, bedside report, adverse events, patient handoff, patient falls, medication errors, and errors. Inclusion criteria were full-text peer-reviewed articles, English, and adult patients. Articles were excluded if they were lower levels of evidence, inappropriate settings, non-experimental, and non-peer reviewed. The search date had to be expanded due to limited literature within five years. Four articles were reviewed. One was an observational data collection using work sampling (Sun et al., 2020), one was a gap analysis (McAllen et al., 2018), and two were quasi-experimental studies (Sand-Jecklin & Sherman, 2014; Hada et al., 2021).

 

Part III

 

Synthesis of Findings

Three themes were found when reviewing the literature. The first theme was presented together in all four articles and discussed a decrease in fall rates with the implementation of bedside shift report. According to McAllen et al. (2018), the study showed a decrease in patient falls by 24% in the four months with the greatest reduction of falls of 55.6% in the orthopedic unit, followed by a decrease of 16.9% of falls in the neuroscience unit post bedside shift report implementation. Sun et al. (2020), reported that their data indicated that falls most often occur on Mondays (w2 = 17.26, P < .01), and for every one-unit increase in falls they expected a 0.564 increase in the number of observations with the patient (OR, 1.76; CI, 1.148-2.690). Sand-Jecklin & Sherman (2014), reported that the number of patients falls during shift change for all units decreased from 20 pre-implementation to 13 at three months postimplementation, and four at 13 months postimplementation. Hada et al. (2021), revealed that before the intervention, the mean falls rate per month was 4.84 (SD = 2.65) compared to 3.66 (SD = 1.66) after intervention. After adjustment for wards, a reduction was observed for all adverse patient outcomes with an incident rate ratio (IRR) of 0.762 (95% CI: 0.599, 0.969; p = 0.027) for falls.

The second theme discussed by two of the articles (Sand-Jecklin & Sherman, 2014; Hada et al., 2021) was a decrease in errors by nursing staff. The study conducted by Sand-Jecklin & Sherman (2014), revealed that although not statistically significant, documented medication errors decreased from 20 pre-implementation to 10 at three months postimplementation. Hada et al. (2021), found that mean medication error rates post intervention were 4.78 (SD=2.84), a reduction from 6.26 (SD=2.66) pre intervention. Additionally, a reduction was observed for all adverse patient outcomes with an incident rate ratio of 0.782 for medication errors (95% Cl: 0.633, 0.966; p=0.023). Furthermore, the odds of medications being reviewed in the medication management, anesthesia, and research support (MARS) component of the IeMR (Q11) were 5.59 (95% CI: 2.76, 11.31; p < 0.001) greater after the intervention, with an increase of 34.8% in compliance with this recommendation.

The third theme discussed by three of the articles (McAllen et al., 2018; Sand-Jecklin & Sherman, 2014; Hada et al., 2021) was nursing compliance with bedside shift report. The study conducted by McAllen et al. (2018) revealed a combined nursing compliance rate of 94% (n= 157) post intervention. Sand-Jecklin & Sherman (2014), revealed that 10 and 18% of total responses to their surveys by patients indicated that bedside shift report was not used, was used inconsistently, or consisted of only an introduction of the oncoming nurse. Hada et al. (2021) discussed a 42.7% increase in compliance with implementation of bedside shift report leading to encouragement of patient participation during nurse handover increasing to 6.46 (95% CI: 2.80, 14.92; p < 0.001) greater after the intervention.

 

Strengths and Threats to Validity

While the use of nursing bedside shift report was associated with an increase in overall patient safety, it must be noted that three of the studies took place in single institutions (McAllen et al., 2018; Sand-Jecklin & Sherman 2014; Hada et al., 2021. Two of the studies were conducted in a large healthcare system (McAllen et al., 2018; Sand-Jecklin & Sherman, 2014). One study involved two large urban hospitals within one healthcare system (Sun et al., 2020). Two of the four studies presented with a higher level of evidence (Sand-Jecklin & Sherman 2014; Hada et al., 2021), and two studies presented with a moderate level of evidence (Sun et al., 2020; McAllen et al., 2018). Three of the four of the studies were within a five-year period (McAllen et al., 2018; Sun et al., 2020; Hada et al., 2021), and research for one of the four articles had to be expanded due to limited literature within a five-year period (Sand-Jecklin & Sherman, 2014).

Summary

            In summary, this project investigated strategies for increasing patient safety with the implementation of nursing bedside shift report. Medication errors, falls, and injuries increase hospital stay, cost to the patient, risk of injury and risk of death. The Joint Commission (2017) has issued a sentinel event alert emphasizing the importance of bedside shift report for adequate patient safety.  The use of nursing bedside shift report has slowly been increasing in the hospital setting with different platforms and guidelines per hospital policy. This generated the PIO, among patients in the acute care setting (P), how effective is bedside shift report (I) on improving patient safety (O)? A literature search was conducted, and four peer-reviewed research articles were selected related to bedside shift report and patient safety. Three common themes were identified including falls, errors, and nursing compliance. After analyzing the four articles, strengths and threats to validity were identified.

Conclusion and Future Research

            In conclusion, evidence supports that the use of nursing bedside shift report was effective on improving patient safety. Recommendations for practice include implementing the use of bedside shift report at every shift change on all units, education to nursing staff on proper bedside reporting, and the use of a standardized nursing shift report tool. Future research would include a pilot study to evaluate the effectiveness of nursing shift report and patient safety.

Proposed Pilot Study Outline

Purpose: Evaluate the effectiveness of nursing bedside shift report on improving patient safety.

Research Type and Design: A quantitative research study will be conducted because it allows for evidence to be gathered in a systematic approach, with statistical results that are analyzed objectively. A non-experimental cohort design will be utilized because it evaluates the relationship between an intervention and an outcome of an assigned population (use of bedside shift report with hospitalized patients).

Variables:

• Independent Variable: The use of bedside shift report
• Dependent Variable: Patient safety

Research Question: Does the use of nursing bedside shift report improve patient safety?

Setting: 350-bed hospital in rural Ocala, Florida, on two medical surgical units.

Target Population: Adult patients who will be in the acute care setting for at least one shift change.

Participants: 340 participants to include inpatient adults of any gender. With 170 participants receiving nursing bedside shift report at shift change, and 170 participants not receiving bedside shift report. Excluding factors consist of patients under 18 years old, outpatient setting, and patients who will be in the acute care setting for less than one shift change.

Data Collection: Methods for data collection include surveys and result analyzation. A bedside handover tool will be completed by nursing staff at each shift change. Data collection for the independent variable will consist of the number of patients receiving bedside shift report, and the number of patients not receiving bedside shift report. Data collection for the dependent variable will include a report of the number of adverse safety events that occur when bedside shift report is used, and when bedside shift report is not used.

Analysis: A t-test would be implemented as it will determine the significance of results. A T-test analysis will help objectively determine if bedside shift report improves patient safety outcomes. This is important because it will determine if bedside shift report is effective at improving patient safety.

Ethical Considerations: To ensure privacy and confidentiality of all patients, HIPAA will be enforced, and patient identifiers will not be used on reports or surveys. Ethical principles and federal regulations for the protection of human rights will be followed with the implementation of an Institutional Review Board.

Dissemination of Findings: This study will be presented to hospital administration and nursing staff. It will also be published in nursing journals and presented at national nursing conferences.

 

 

 

 

 

 

References

Craven, H. (2016, March 10). Is bedside shift report associated with improved patient outcomes? Abstract: Is Bedside Shift Report Associated with Improved Patient Outcomes? (2016 ANA Annual Conference). Retrieved October 10, 2021, from https://ana.confex.com/ana/ndnqi16/webprogram/Paper14737.html. 

Groves, P. S., Manges, K. A., & Scott-Cawiezell, J. (2016). Handing off safety at the bedside. Clinical Nursing Research, 25(5), 473–493. https://doi.org/10.1177/1054773816630535 

Hada, A., Jones, L. V., Jack, L. C., & Coyer, F. (2021). Translating evidence‐based nursing clinical handover practice in an acute care setting: A quasi‐experimental study. Nursing & Health Sciences, 23(2), 466–476. https://doi.org/10.1111/nhs.12836

Lee, S.-H., Phan, P. H., Dorman, T., Weaver, S. J., & Pronovost, P. J. (2016). Handoffs, safety culture, and practices: Evidence from the hospital survey on Patient Safety Culture. BMC Health Services Research, 16(1). https://doi.org/10.1186/s12913-016-1502-7 

Markides, M. (2011). The importance of good communication between patient and health professionals. Journal of Pediatric Hematology/Oncology, 33(Supplement 2). https://doi.org/10.1097/mph.0b013e318230e1e5 

McAllen, E., Stephens, K., Swanson-Biearman, B., Kerr, K., & Whiteman, K. (2018, May). Moving shift report to the bedside: An evidence-based quality improvement project. Ojin.nursingworld.org. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No2-May-2018/Articles-Previous-Topics/Moving-Shift-Report-to-the-Bedside.html

Mitchell, A., Gudeczauskas, K., Therrien, A., & Zauher, A. (2017). Bedside reporting is a key to communication. Journal of Healthcare Communications, 03(01). https://doi.org/10.4172/2472-1654.100124

Ofori-Atta, J., Binienda , M., & Chalupka, S. (2015, August). Bedside shift report: Implications for patient safety and quality of care. Nursing center, 45(8)1-4.  https://www.nursingcenter.com/journalarticle?Article_ID=3146996. 

Rudisill, P., Van Buren , T., & Stefanov , L. (2019, October 11). How reliable is your bedside shift report? American Nurse. Retrieved November 12, 2021, from https://www.myamericannurse.com/how-reliable-is-your-bedside-shift-report/.

Sand-Jecklin, K., & Sherman, J. (2014). A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation. Journal of Clinical Nursing, 23(19-20), 2854–2863. https://doi.org/10.1111/jocn.12575

Sun, C., Fu, C. J., O'Brien, J., Cato, K. D., Stoerger, L., & Levin, A. (2020). Exploring practices of bedside shift report and hourly rounding. is there an impact on patient falls? JONA: The Journal of Nursing Administration, 50(6), 355–362. https://doi.org/10.1097/nna.0000000000000897 

The Joint Commission. (2012, September 12). Sentinel event alert: Inadequate hand-off communication. Joint Commission.  https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/sea_58_hand_off_comms_9_6_17_final_(1).pdf?db=web&hash=5642D63C1A5017BD214701514DA00139