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Steps Required to Implement the Bedside Shift Reporting Project

Literature Review

The bedside shift reporting has included the comprehensive review of the history of a patient; the description of their previous events during shifts and the accounts of the tasks that were accomplished by caregivers during the previous shift (Law & Amato, 2010). Most of the time these shifts result in focused discussions between the caregivers in which the patients are not included in the conversation. The bedside shift reports provide an important occasion for the out-going and the in-coming nurse to interact about the pertinent information concerning the care of the patient and also in the reviewing of the treatment plans and goals.

However, patients should not be excluded from the planning of their care. The bedside shift reporting avails this opportunity to the patient and this helps to improve their understanding of their health issues on a matter such as their diagnosis as well as the plan for their care. Therefore, each and every report should be tailored to meet the needs of the individual patient (Bulleit, 2006).

More importantly, the Situation, Background, Assessment, Recommendation (SBAR) format should be employed for the purpose of achieving consistency during the process of bedside shift reporting. The information that is contained in the report (the treatment course and goals) is reviewed by the in-coming and out-going nurses; during this process, the nurses can provoke the patient to share their experience by asking them questions. The comments of the patients are invaluable as they are then included in the development of the individualized care plan (Baker, 2010).

The bedside shift reporting is advantageous to both the patient and the nurses. For one the nurses are able to involve the patient in the formulation and implementation of their own care plan. Secondly, the nurses are able to take baseline notes and this makes the task of identifying changes through shifts less tasking. Thirdly, the reporting encourages safer patient handoffs by making it possible for two nurses to be at the bedside: the in-coming and the out-going. On the other hand, bedside shift reporting is helpful to the patient especially in their understanding of their diagnosis and care plan. It also helps patients to keep track of their treatment; for instance, they can tell whether the nurses are conveying proper information when they hand over their shifts. Thirdly, bed shift reporting helps the patient to make a correction on information about their medical history and well-being, if at all it is misrepresented in the report. Finally, it also helps the patient to interact with nurses and participate in the development of their individual care (Anderson & Mangino, 2006).

Project Management Concepts

For effective management of this project, various concepts were adopted by the implementation team. These included communications which helped in coordinating all the processes that were involved in implementing the project. Baker and McGowan (2010) contend that the importance of communication in project implementation cannot be gainsaid. He further adds that the managers of a project need to facilitate communication by coordinating all the stakeholders involved in a project. The success of this project is largely attributed to sound communication employed even before the implementation process began.

The other management concept that was observed during the implementation of the bedside shift reporting was teamwork. The coordination enjoyed between caregivers resulted from each person taking responsibility for the duties assigned to them in accordance with the project. As Baker (2010) advices, each caregiver was assigned responsibilities and was even provided with avenues to resolve any arising dispute.

The third concept of management that was instrumental in the implementation of this project was conflict resolution. The implementation of the project brought with it the possibility of friction between the nurses especially through the loosing of crucial information as they were changing shifts. Whenever conflict arose, we adopted the procedures proposed by Bulleit (2006), which included the identification of the problem, the gathering of all available information in regards to the problem; this was then followed by the analysis of that information and choosing the interventions to be taken. More importantly, the implementation of the intervention was as crucial just as learning the problem.

The fourth concept of management that was applied was motivation. Law and Amato (2010) observe that motivation is management too that is crucial inspiring people to work within their teams and also as individuals. This in turn produces the efficiency and the desired results after the execution of a project. Motivation played a significant part in enforcing teamwork during the implementation of the project; it also helped in striking a rapport between the nurses and the patients.

The fifth concept of management that was applied was ethical management. The exchange of information between nurses and their patients involved the respect of the confidentiality of the patient, without which the rights of the patients would otherwise be infringed. Ethical consideration cannot only be sanctioned by the law. According to Baker (2010) moral considerations need to be taken into account when observing ethical standards. This is one of the precepts that guided the nursing staff as they upheld the legal and moral rights of their colleagues and also their patients.

Detailed Discussion

Summary of the Project

The purpose of this project is to propose the implementation of Bedside Shift Reporting. This report will discuss the various stages that are required in implementing the exercise. It will then look at the constraints that may come up in the process of implementation and will discuss the best way to overcome them. It will also address the various means through which the process can be monitored and evaluated. The education of the stakeholders involved is crucial for the desired results to be achieved; the essay will therefore discuss the ways in which both patients and caregivers can be trained. Finally, the report will look at some of the lessons that can be learnt from this exercise.

Project Implementation

The successful implementation of this project will begin by establishing a hardwired leader rounding on the nursing staff and also a leader rounding on the patience. This is important as it ensures that the hospital staff is engaged in the project and that there is a process in place that can generate feedback from the patients. This then is followed by a discussion with the nursing staff on the importance of implementing the bedside shift report. The discussion is aimed at reviewing the process and gaining consensus on the importance of the bedside shift report (Baker, 2010). Law and Amato (2010) concur that the planning process to begin the implementation of the project should begin with the discussion on the shared vision and the specific focus. This is crucial in the identification of the rationale for the proposed changes and is achieved through the consolidation of all the information about bedside shift reporting.

The next critical stage in the implementation of bedside shift reporting is the building of a robust team to help in carrying out the exercise. For this team to be realized there should be collaboration from the administration of the hospital. In addition, to obtain efficient bedside shift reporting guidelines, a developed nurse unit should be put in place. The guidelines can be drawn from the recommendation of various literature reviews that touch on the subject. But these units should be given the prerogative to determine what guidelines will be adopted for their situation at the hospital. The nursing staff can also be tasked to develop the reporting sheet, which will meet the goals of their exercise (Law & Amato, 2010).

The operation stage will then follow. There will be a chart provided for each patient in their room. The in-coming nurse will be required to study this chart to acquaint themselves with the medical history of the patient and their treatment. Then the in-coming nurse will fetch for the guidance of the out-going nurse and together they will visit the bedside of the patient. The out-going patient introduces the in-coming nurse to the patient and brings the in-coming nurse up to speed on the condition of the patient, normally in a positive light. During this stage, the in-coming nurse will be tasked with introducing themselves and asking the patient questions such as their name, their date of birth, and checking the patient’s armband for safety. They will also be checking pumps and intravenous medications to ensure the general safety of the patients. The in-coming nurse will then update the whiteboard in the patient’s room (Baker & McGowan, 2010).

For effective implementation of the bedside shift report, the responsibilities of the caregivers should be defined clearly; the communication processes should be standardized and the process should create room for interactive communication between the patients and the caregivers (Baker & McGowan, 2010).

Constraints Encountered and How they are Handled

One of the constraints that are expected to arise during the implementation of the Beside Shift Report is the breakdown of communication or the loosing of information between shifts. Communication failure, especially during shift reports has been pinpointed as the major contributing factors to sentinel events (Joint Commission on Accreditation of Health Care Organization, 2000). Therefore, the communication breakdown can be checked by putting in place standardized hand-off communication. This boosts the effectiveness of communication between the caregivers by providing them with the opportunity to inquire and give responses to questions during hands-off, which includes change-of-shift reporting. The provision of sufficient information during the reporting of the change of shift is crucial in the promotion of the safety of patients (Laws & Amato, 2010). According to Schroeder (2006), effective hand-off communication involves the availing of current information regarding the patient in terms of the care given, the treatment provided, the current condition of the patient and any changes that are bound to occur to the patient.

Monitoring Progress

The Bedside Staff report can best be monitored by the use of the Situation- Background-Assessment-Recommendation (SBAR) communication technique. This technique provides a comprehensive framework for communication between the caregivers’ team. Apart from that, the SBAR is an easy-to-remember mechanism that is instrumental in framing conversations, including the ones that are conducted in the presence of the patient. Additionally, the SBAR technique lays out an easy and focused framework through which expectations are set and important information is relayed (Baker &McGowan, 2010).

Lessons Learnt

Some of the lessons learnt would be that bedside shift reporting provides the caregivers with a chance to boost the safety of their patients and also improve on the collaboration of the patients in the plan of care (Strople & Ottani, 2006). Secondly, the implementation of bedside shift reporting will boost the satisfaction of the caregivers as they will feel more at gripes with the information about their patients and therefore are in a better position to plan and set priorities for any interventions that they intend to put in place (Laws & Amato, 2010). Additionally, the communication process that results after the implementation of the bedside shift reporting meets the information needs of both the patient and the caregivers (Strople & Ottani, 2006).

Education Plan

As proposed by Laws and Amato (2010), the education of the patients and the nursing staff should be conducted a week before the bedside shift reporting exercise commences. This training can be attained using various means: one of the ways through which it can be achieved is through in-service education. The nurses are given materials that lay out the basics of the exercise; they use these handouts during the change of shift to implement the process. Apart from the guidelines of the exercise, the handout includes the purpose of the exercise, the contributing factors and the general benefits expected. Additionally, the nurses should be exposed to fresh standardized reporting tools prior to the actual bedside shift reporting. This is to make the caregivers familiar with report sheets. Furthermore, there is a need to design a manual for bedside reporting that will be used as a reference by the caregivers. Some of the issues that may be covered in such a manual are in-service education, bedside reporting, content from, the patient letter, and the Nursing Partnership Model.

On the other hand, the patients are educated about bedside shift reporting through the provision of a welcome letter that serves as a brief presentation of the process in an informal manner. The caregivers are then required to enforce the reporting process and encourage the patients to fully participate during the change-of-shift reporting (Laws &Amato, 2010). The education of the patient is imperative in the whole process of caregiving: this is because the patient would also want to be involved or in the least instance, informed about the alternatives that are available for treating their ailments (Anderson & Mangino, 2006).

Evaluation Plan

The hospital will need to make formal the training of the caregivers in regards to the application of the bedside shift report. More importantly, evaluators will be needed to come up with a competency assessment, which will help in ensuring the compliance and standards in the implementation of the reports. The results of the assessment will reflect the challenges, wins and opportunities that are presented with the implementation. These challenges, wins and opportunities should be communicated to the caregivers for the purposes of brainstorming to come up with solutions where needed and to resolve to keep the trends that are productive to the process (Baker & McGowan, 2010). The best way to conduct the assessment of the bedside shift reporting exercise is conducting a post-implementation survey about four months after its implementation has taken effect in the hospital (Laws &Amato, 2010).

Conclusion

The implementation of Bedside Shift Reporting has become an indispensable tool in the operation of the hospital, particularly in boosting communication and the sharing of information between patients and caregivers. This fact is best captured in the report by the Joint Commission which pointed out that the implementation of a standardized approach in regards to hands-off communication at hospitals is one of the major components of the 2007 National Patient Safety Goals for Hospitals (Joint Commission on Accreditation of Health Care Organization, 2006). We therefore highly recommend the implementation of this project.

References

Anderson, C. D., & Mangino, R. R. (2006). Nurse Shift Report: Who Says You Can’t Talk in Front of the Patient? Nursing Administration Quarterly, 30(2), 112–122.

Baker, S.J., & McGowan, N. (2010). Bedside Shift Report Improves Patient Safety and Nurse Accountability. Journal of Emergency Nursing, 36 (4), 255-358.

Baker S. J. (2010). Rounding for Outcomes: An Evidence-based Tool to Improve Nurse Retention, Patient Safety, and Quality of Care. Journal of Emergency Nursing, 35, 162-4.

Haig, K. M, & Sutton S. W. (2006). A Shared Mental model for Improving Communication between Clinicians. Joint Commission Journal of Quality Patient, 32, 167–175.

Joint Commission on Accreditation of Health Care Organization (JCAHO). (2000). Sentinel Event Alert: Fatal Falls. Web.

Joint Commission on Accreditation of Health Care Organization (JCAHO). (2006). Improving America’s Hospitals: A Report of Quality and Safety. Web.

Laws, D., & Amato, S. (2010). Incorporating Bedside Reporting into Change-of-Shift Report. Rehabilitation Nursing, 35, 2, 70-74.

Schroeder, S. J. (2006). Picking up the PACE: A New Template for Shift Report. Nursing, 36(10), 22–23.

Strople, B., & Ottani, P. (2006). Can Technology Improve Inter-shift Report? What the Research Reveals. Journal of Professional Nursing, 22(3), 197–204.