Report or handoff of patients at change of shift is a common practice in healthcare settings, and recent research has identified the value of bedside nursing report and its impact on nurse and patient satisfaction.1,2 Change-of-shift report can be designed to prevent errors or adverse patient events, but best practices have yet to be identified for reporting between administrative supervisors—the hospital nurse leaders on the evening, night, and weekend shifts.
In a nationwide study, administrative supervisors identified that their change-of-shift report consists of a verbal and written report.3 A verbal report is given to another nurse leader at change of shift regarding the census, staffing, patient and facility issues, and significant issues that occurred during the shift. Additionally, administrative supervisors have a written report that includes information such as the census, patients who died, codes and rapid responses, serious reportable events, or other major issues.3,4 The supervisors explained that the report was either sent electronically to the nurse leaders or available on a secure website.3
At a recent administrative supervisor conference, four supervisors participated in a panel presentation during which they detailed their change-of-shift report. All supervisors provide a verbal, face-to-face report at the change of shift, which reinforces the written report and provides additional information. The variations in their written reports sparked discussion about best practices. In this article, we explore best practices for the administrative supervisor report by examining documented report elements at four healthcare systems in the mid-Atlantic region of the US.
Report at four hospitals
At a 311-bed teaching hospital, the administrative supervisors utilize an electronic report that was developed by a manager about 10 years ago. The nursing administrative shift report sheet allows for documentation of staffing issues, 1:1 observations, and “anything out of the ordinary” that happened on the more than 15 nursing units. (See Figure 1.) Because this hospital has many electronic systems and databases, the report sheet doesn't include data, such as patient census, transfers, or deaths, because this information can be obtained anytime from other systems. The supervisors document in the electronic report throughout their shift. And although the report is available on a shared drive, which the nurse managers and leaders can access, a night supervisor explained, “This report sheet is also sent each morning via email to the nurse managers, so we know they're looking at it.” The supervisors find this report to be an extremely valuable communication tool. When issues are documented in the report, follow-up can occur. Information from previous reports is also easily retrievable.
At a three-hospital system, the administrative supervisors document in an extensive daily administrative supervisor report, which is completed continuously throughout the shift. (See Figure 2.) This report is sent to the nurse directors, department heads, and executive team at 7 a.m. each day and stored on an accessible shared drive. Documentation consists of the census and hours per patient day (HPPD) for each unit, inpatient holds/no beds, ED status bypass, codes/rapid responses, patient falls, campus issues, emergency procedures, patient transfers, 1:1 observations, restraints, patient deaths, against medical advice (AMA), blocked beds, and isolation patients. Although this report takes time for the administrative supervisors to complete, they find the report useful because it provides a good overall description of the shift and the 24-hour period.
At a regional medical center with two facilities, the administrative supervisor report is an internally developed electronic web document. The administrative supervisors document in this electronic report throughout their shift and then email it to all administrators, managers, and supervisors to provide the details of what occurred during the previous shift. This report includes documentation on tabs, with drop-down boxes for the supervisors to provide additional information. (See Figure 3.) Key documentation tabs include surge (including divert and critical care divert), transfers in and out of the facilities, alerts/codes, patient deaths, equipment issues/failures, accidents (including falls and needle-stick injuries), and medical and behavioral restraint usage. The administrative supervisors like the user-friendliness of this report, particularly that it allows narrative documentation of important issues or events. Additional advantages of this electronic report include the ability to review past reports and create spreadsheets to track data trends.
At a community medical center, the administrative supervisors developed a standardized report named IPASS (issues, patient census, actions, situational awareness, and synthesis). (See Figure 4.) The IPASS report is stored as a word processing template, sent via email to the oncoming supervisor or nurse leader, then emailed to the nursing leadership team at 7 a.m. and 7 p.m. Issues include patient deaths, patient/family concerns, clinical issues (falls and restraints), and staffing. Patients who are on 1:1 observation are also listed so the nurse managers can assess the continued need for observation in the morning. The administrative supervisors complete a spreadsheet with imbedded formulas that provides the census and staffing/budget variances as part of the IPASS report. The action list includes available beds and plans for the next shift/weekend. Situational awareness includes issues expected for the next shift or the weekend, staffing changes, plans for high/low volume, nurses scheduled to come in midshift, and high patient populations of isolations or 1:1 observations. Synthesis indicates the receiver, or the nurse leader who received report. At this medical center, the IPASS report is a favorite of managers and administrative supervisors because of all the information it provides. The managers state that it's the first thing they read when they wake up, which prevents surprises and tells them what they can expect when they arrive at work.
Gathering best practices
With no information in the literature on administrative supervisor change-of-shift report and to determine best practice, The Joint Commission recommendations were reviewed. According to The Joint Commission, handoff communication of patient care responsibility between caregivers should include standard critical content, using standardized tools, in both a written and verbal, face-to-face format.5 The administrative supervisors at these four healthcare systems all utilize a standardized written report format and communicate a verbal, face-to-face report. Although the written reports vary, patient census, deaths, codes and rapid responses, 1:1 observations, and major issues are the most common items documented in the report. These four administrative supervisor reports are individualized and designed to meet the needs of the organization and its nurse leaders. Additional research and sharing of best practices are needed.
Along with administrative supervisor change-of-shift report, charge nurse end-of-shift reporting also typically occurs in hospitals. Researchers at one hospital developed a new charge nurse end-of-shift report tool and found that, in addition to communicating what happened during the shift, this new tool was a good mechanism to trend data and problems and drive performance improvement projects.6 One of the aforementioned reports was specifically created to track trends and generate reports on the data entered by the administrative supervisors. With data and trends from the evening, night, and weekend shifts, administrative supervisors are empowered to make action plans for improvement and change.
Because hospitals function 24/7, communication of what happened during the evening, night, and weekend shifts is essential. Administrative supervisor report is a critical handoff; nurse leaders must assess and enhance their organization's change-of-shift report to foster nurse and patient safety.