TWO YEARS AGO, the nurses on a 28-bed medical-oncology unit began using bedside shift report as an evidence-based process improvement activity. Moving shift report to the bedside has increased patient satisfaction, staff communication, and nurse-patient interactions.
The literature abounds with the positive effects that bedside shift report has on safety, communication, teamwork, accountability, and patients' involvement in their own care.1-7 This article describes how a medical-oncology unit implemented bedside shift report for unlicensed assistive personnel (UAP) and the positive results of this step.
A change of scene for a change of shift
The Agency for Healthcare Research and Quality promotes the importance of a multidisciplinary approach to bedside shift report.8 A brief literature search revealed various articles that discuss the team approach to bedside shift report and how it improves communication among care providers and patients when staff perform bedside shift report together with patients.2,8-13 The articles describe teams of nurses and UAP or multidisciplinary teams conducting shift report at the bedside. No research studies were found that specifically address the bedside shift report process among UAP.
One informative article discussed the effects of a “walking shift report” by UAP. According to Spanke and Thomas, when walking shift report was performed by UAP, patient satisfaction increased, falls and patient calls to the desk decreased, and staff response time to call lights improved.14
Using the evidence
The medical-oncology unit began to implement a structured UAP bedside shift report as a unit-based evidence-based practice process improvement project to improve UAP professionalism, the perception of the importance of rounding, teamwork, and interaction with the patient. Before moving UAP shift report to the bedside, the UAP report had been an unstructured exchange of information that was conducted in the hallway or at the nursing station.
According to The Joint Commission, sentinel events are often the result of deficiencies in the shift report process.2 The Joint Commission has identified specific National Patient Safety Goals and best practices that are pertinent to the process of bedside shift report.15 Patient safety goals have tasked organizations with implementing a standard approach to handoff communication. Patients have also been encouraged to become more actively involved in their own care.
When UAP perform shift report at the bedside, the staff can spend more time in the patient's room to interact with and care for the patient's personal and safety needs. The bedside interactions let the patient conclude the shift with the current caregiver and meet the oncoming one. During this time, patients can participate in planning their own care and activities for the shift. UAP can also plan for their own shifts.
Implementing the new process
UAP were trained using a modified SBART (situation, background, assessment, recommendations, and thank you) tool developed specifically for them. (See Implementing aSBART tool for UAP.) The information focused on the patient's individual personal care needs and didn't contain any exchange of medical information. The report let the UAP provide a picture of patient-care needs, functional status, safety concerns, and shift tasks. This also provided a forum for oncoming and offgoing UAP to establish accountability to one another while visually surveying the room.
Hour-long educational sessions were scheduled to train the UAP, address concerns, and answer any questions. The SBART tool was given to each UAP for a reference while explanation and example scenarios were provided. UAP performed supervised role-playing during the educational session to increase their comfort levels. Role-playing also allowed for self-reflection and feedback from the instructor and peers.
The UAP bedside shift reporting process was monitored for adherence and technique. Monitoring UAP during bedside shift report revealed excellent adherence; shift report was performed at the bedside and not in the hallways or at the nurses' station. Opportunities for improvement in delivery technique were identified. Feedback was given to UAP directly after their report was concluded and appropriate coaching support was provided. On one occasion, for example, they were reminded not to engage in any exchange of medical information but instead to focus on UAP tasks and patient personal care routines. Most frequently, UAP were redirected to follow the SBART format to include all necessary information and include the patient when appropriate.
UAP didn't have difficulty acclimating to performing shift report at the patients' bedside and didn't express any issues or discomfort about bedside shift reporting. However, UAP working in the medical-oncology unit said that they felt uncomfortable about holding each other accountable for tasks that still needed to be completed at the time of shift change. Incomplete tasks included dedicated equipment that needed to be removed from isolation rooms, empty isolation carts or glove boxes that needed to be restocked, and patient water pitchers that needed to be refilled. This provided a good opportunity to discuss organization, peer-to-peer feedback, and task delegation with the UAP.
UAP bedside shift report has been a successful process improvement activity on the medical-oncology unit. Reporting at the bedside demonstrates the providers' commitment to efficiency, timeliness, and caring. The Institute for Patient- and Family-Centered Care identifies four major concepts of patient- and family-centered care, including:
- dignity and respect
- information sharing
Patients often feel they have no control when they're in the hospital. Forming partnerships with patients and families is an essential aspect of patient-centered care. When patients participate in shift report with nursing-care staff, they can be involved in the planning of their own care for the day. Through continued staff communication and collaboration, patients can enhance their knowledge and participate in healthcare decisions that may affect their well-being and outcomes.
The new process of UAP bedside shift report adds to the existing process improvement project of nursing bedside shift report. No significant increase in patient satisfaction scores was noted after implementing the UAP bedside shift report; however, anecdotal patient responses were very positive.
UAP bedside shift report has also encouraged teamwork among staff members. The UAP have been diligent about communicating with the nursing staff to ensure they have timely information to exchange when they enter a patient's room. As a result, the UAP have reported an improved sense of confidence and professionalism. A postimplementation survey revealed that 100% of the UAP believe bedside shift report has improved their job process work duties, and it's reportedly improved job satisfaction.
The positive effects of bedside shift report on the unit were realized by the staff and the patients. To sustain the change, the nursing staff responsible for implementation in the unit will continue monthly monitoring of each shift for adherence and technique. The leadership staff is also committed to successfully moving shift report to the bedside.
The initiative and education has been shared with other nursing units and has been adopted as a facility-wide practice. Adherence to and techniques of bedside shift report are reported and discussed at the nursing policy and clinical practice council and the hospital process improvement committee meetings monthly.
By routinely communicating shift report at the bedside, UAP and other healthcare providers can consistently reinforce patients' plan of care, promote patient-centered care, and improve overall quality of care.
1. Baker SJ. Bedside shift report improves patient safety and nurse accountability. J Emerg Nurs
2. Laws D, Amato S. Incorporating bedside reporting into change-of-shift report. Rehabil Nurs
3. Ofori-Atta J, Binienda M, Chalupka S. Bedside shift report: implications for patient safety and quality of care. Nursing
. 2015;45(8). http://journals.lww.com/nursing/Fulltext/2015/08000/Bedside_shift_report__Implications_for_patient.20.aspx
4. Riesenberg LA, Leitzsch J, Cunningham JM. Nursing handoffs: a systematic review of the literature. Am J Nurs
5. Rush SK. Bedside reporting: dynamic dialogue. Nurs Manage
6. Sand-Jecklin K, Sherman J. A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation. J Clin Nurs
7. Vines MM, Dupler AE, Van Son CR, Guido GW. Improving client and nurse satisfaction through the utilization of bedside report. J Nurses Prof Dev
9. Anderson CD, Mangino RR. Nurse shift report: who says you can't talk in front of the patient. Nurs Adm Q
10. Chaboyer W, McMurray A, Johnson J, Hardy L, Wallis M, Chu SFY. Bedside handover: quality improvement strategy to “transform care at the bedside.” J Nurs Care Qual
11. Chaboyer W, McMurray A, Wallis M. Bedside nursing handover: a case study. Int J Nurs Pract
12. Grant B, Colello SH. Culture change through patient engagement. Nurs Manage
13. Kelly M. Change from an office-based to a walk-around handover system. Nurs Times
14. Spanke MT, Thomas T. Nursing assistant walking report at change of shift. J Nurs Care Qual
15. The Joint Commission. Improving patient and worker safety: opportunities for synergy, collaboration and innovation. 2012. www.jointcommission.org/improving_patient_worker_safety/
16. Johnson A, Abraham M, Conway J, et al. Partnering with Patients and Families to Design a Patient- and Family-Centered Health System
. Bethesda, MD: Institute for Patient- and Family-Centered Care; 2008.