Bedside Shift Report In the Emergency Department
The ED is a high-risk environment in which additional safety factors must be considered: • Multiple individuals involved in the care of a single patient; • Patients with high acuity illness or injury; • Rapid healthcare decisions under severe time constraints; • High volume of patients and unpredictable patient flow; • Barriers to communication with patients, families, and other healthcare professionals, and; • Interactions with multiple types of diagnostic and/or treatment technology.
Why is this important? • More than 37% of hand-offs of patients between caregivers “were defective and didn’t allow the receiver to safely care for the patient”. • Estimated 4 out of 5 serious medical errors- including “sentinal events” such as death or serious physical or psychological injury- occur due to miscommunication between caregivers during hand-offs. • **released by the Joint Commission Center for Transforming healthcare
Alarming Fact…. • There are 4,000 hand-offs a day in a typical teaching hospital. If 90 percent go flawlessly, that’s still 400 failures per day” remarked The Joint Commission President Mark R. Chassin, M.D., during a conference call with journalists, according to The Wall Street Journal.
Joint Commission National Patient Safety Goals support Bedside Report • Goal 1 “Improve the accuracy of patient identification” because we check the patient armband and ask the patient his name and birth date as identifiers during bedside report.
Goal 2 • Goal 2 “Improve the effectiveness of communication among caregivers; managing hand-off communications: with particular attention to assuring the opportunity for asking and responding to questions”.
Goal 13 • Goal 13 “Encourage patients’ active involvement in their own care as a patient safety strategy”
Benefits for the Patient: • The patient’s perspective is valued as being most important. It isn’t about us, or our schedule, or our comfort zone. Our priority must be the patient, as they are the reason we are here. • Patients will see—and hear—from the team of professionals who are providing their care! • Patients will be reassured that everyone is getting all the necessary report about what is going on with them. • Patients will feel more informed about their care, thereby making them less anxious about their care and treatments. They feel more involved. • Patient will know who their nurse is on every shift.
Benefits for the patient…. • The process will reduce the “2-3 hour ‘alone time’ during shift change. Many patients perceive the 2-3 hours around the change of shift to be a time when no one is around. Bedside Report could help eliminate this. • The process will aid in increasing communication. Communication issues are the root cause of about 30% of patient safety events and improved communication between caregivers generally improves patient care outcomes.
What are the Benefits to you? • Improves the sharing of information between health care providers by utilizing a standardized method of communicating. • If asked questions, you won’t have to say ”I haven’t seen my patients yet” and therefore will be more prepared. • The off-going nurse can use “hands on” to show the oncoming nurse how to operate special equipment or how special orders are being handled.
Benefits to you… • Accountability will increase since each nurse will know his or her patients’ condition at the end of the shift. • Keeps report items related to patient condition. • Improves the nurses understanding of patient condition as you are able to visualize the patient • Gives you an orderly room and patient at the beginning of each shift. • Overcomes differing communication styles.
Bedside Shift Report might look something like this: Introduce the on-coming nurse. Before entering the room,become familiar with the patient’s condition, tests, procedures. If a new diagnosis (i.e. cancer) or test results occurs, give the information that the patient is aware of only during report. You can give additional information to the next shift after the Bedside Report.
The oncoming nurse accompanies you into the room. You introduce the oncoming nurse. “Hi Mr. Jones, I’m getting ready to go home. This is Sally, and she is going to be your nurse now that I’m leaving. (Sally says hello, and checks the pt’s armband and D.O.B) while you continue: “Mr. Jones is here for chest pain that started at ….etc. He had a full cardiac workup and we are still waiting on his CBC. Once that is back, Dr. Ellis is going to consult with his primary doctor, to see if we need to keep him over night”, etc. Sally now checks the IV site, checks the room and makes sure it is neat and tidy. Now is the time for Sally to make sure the offgoing nurse empties the bedside commode before she leaves, etc. • Before leaving the room, ask Mr. Jones if he has any questions before you leave, and thank him for letting you be a part of his care today/tonight.
Tips: • If the patient is asleep or off the unit, don’t wake the patient up. Give report in the usual fashion, and when pt. awakes or returns, the on-coming nurse will introduce self using AIDET. • If there is a code or crisis at the change of shift, the on-coming nurse will go room to room and introduce themselves and check patients. • If visitors are in the room, explain that you are doing bedside report and ask patient if they want to have visitors step out. • Exclude opinions. Report is a time for facts. If a nurse is unhappy with the patient (or provider caring for the patient), the bedside report is not time to vent. Criticism makes the nurse appear less credible.
Tips continued: • Prior to leaving the room, the off-going nurse thanks the patient for allowing you to provide care to them. • Educate the on-coming nursing team if they are float nurses. • Communicate with your patients before Bedside Report starts. You could say “We will be doing Bedside Report very soon so is there anything you need at this time?” • If the on-coming nurse has a question or needs clarification about a sensitive issue, wait until after Bedside Report and then ask the off-going nurse. Avoid putting a nurse “on the spot” in front of the patient and/or family.