According to a report published in Scientific American, it’s estimated that every year more than 400,000 patients who are cared for in United States hospitals may suffer some kind of preventable harm that contributes to their death. That estimate makes medical errors the third leading cause of death trailing behind cancer and heart disease.
The Joint Commission identified change-of-shift times as a high-risk period for sentinel events contributing to patient harm. Why? Traditionally, nurses conducted change of shift reports at the nurses’ station, away from patients. During this hour or more of report time patients were virtually left alone; sentinel events were more likely to occur during this so-called alone time.
With an increased focus on improving patient safety and healthcare quality, many facilities have begun transitioning away from the traditional shift report to a bedside, patient-centered, shift report or patient information hand-off. With a bedside shift report, the patient and family are also involved in the information hand-off. The patient identifies which family members are permitted to participate.
The answer is an overwhelming, yes! Transitions in care, from one care-giver to another, create a risk for patient care errors. Bedside reports reduce the risk by providing a two-person verification process that permits the oncoming nurse to verify with the outgoing nurse IV infusions, IV pump settings, monitor settings, tubing and catheter connections, and possible adverse medication reactions. The nurse can also assess the patient’s condition to gain insight into his baseline status, inspect for pressure ulcers, assess surgical wounds, and evaluate room safety.
At the start of the bedside shift report, the patient and his family (if present) are introduced to the oncoming nurse and invited to participate. The electronic health record is opened so that it can be referred to during the information hand-off. The outgoing nurse provides a verbal report using a standardized format, such as SBAR (situation, background, assessment, and recommendation); using a standardized format, in words that the patient and family can understand, streamlines the report, and provides a consistent message for the patient and family. During the bedside shift report, the patient and family have the opportunity to ask questions about the patient’s condition and treatment plan and express their needs and concerns. Moreover, the patient can set short- and long-term goals with the nurse.
Involving the patient and family in the bedside report acknowledges that they’re an integral part of the health care team. It improves patient satisfaction by demonstrating to the patient and family that the nurse caring for him is receiving the information needed to adequately facilitate care.
In addition to improving patient satisfaction, bedside shift reporting has other benefits. It improves hand-off communication efficiency, saves nursing time, improves teamwork, and ensures accountability. Using a standardized communication format reduces the risk for miscommunications that can occur with different communication styles. As a result, institutions that adopt bedside shift reports experience fewer medication errors, fewer patient falls, fewer sentinel events, and less overtime than facilities who haven’t adopted them.
So, if you haven’t already, why not join the movement from the nurses’ station to the bedside; your patients and staff will benefit.
Have you joined the movement? What is your experience with bedside shift reports?