Our Progress as of the end of Fiscal Year 2014 We have decreased our incidental overtime (from 80 hrs. to 28 hrs) More staff are now able to get out on time,(from 40% in Feb. to 72% last pay period in June 2014 Safer, evidence based practice that encourages patient involvement.
Medicine Specialties All Staff OT Hours Per Pay Period
80 66 50.5 56 60.25 78 75.75 57.25 41 61.25 54.75 47.8 28 -10 10 30 50 70 90 110 130 H o u r s
Pay Period Medicine Specialties Comparison of FY13 and FY14 Incidental OT
Pay Period FY13 Incidental OT FY14 Incidental OT Continuing Issues Persistent barriers to timely bedside report. 1. Not knowing who to give/get report to/from ahead of time 2. Privacy concerns 3. Cannot write inside the room, as patient is on Contact Precautions. 4. Patient is confused and is not going to understand what we are saying anyway. 5. Patient is sleeping and if awaken will ask for more pain medicines, toilet needs, etc. 6. Patient is rude and mean. 7. Patient will ask a lot of questions and report will take forever. 8. ? 9. ? 10.? Inconvenience, cannot let go of old culture? 1. Its easier to give report sitting down face to face with the other nurse.
( Your feedback is highly appreciated so we can continually address the barriers.)
Solutions to barriers Charges and relief charge need to consistently write down the names of nurses you are getting/giving report to. The need to educate the patient about bedside report and when it is going to happen and discuss any privacy concerns ahead of time with the patient. Nurses to have read patient history before starting report. Reporting by exception is the key. Listen to report and write after. The more that we need to see the patient when they are confused for safety and baseline assessment. The reason for patient education about bedside handoff is for patients to know what to expect and that if they have any needs before then, like pain meds, toileting, etc., it could be addressed before shift report. (when giving 0600/1800 meds would be the best time to talk to patient about BHR). If patient clearly stated he/she does not want to be bothered by BHR, respect patient wishes, but still go inside the room quietly and do your safety scan and whiteboard updates.
Solutions Contd If patient asks a lot of questions, acknowledge their concerns and you may use the scripting below.
I understand you have concerns and questions about your care and condition. I will be back and I will make sure I set enough time to sit with you and address those concerns. We have a bedside handoff nurse checklist for your use. We are hoping to have the patient brochure finally printed and handed to patient.
Timeline: We have seen remarkable improvement in areas of overtime and staff getting out on time. For the new Fiscal Year we should continue to improve and maintain this new culture of reporting at the bedside with the available resources that we have. Resources Consistent Bedside Reporting Patients Relief RNs Charge Nurses Nurse Assistants Clinical Nurse Summary of Reported Advantages and Disadvantages of Nursing Bedside Report Patient Advantages Patients more informed Patients more involved in their care Improved nurse/patient relationship Improved general patient satisfaction Improvements in safety Decrease in patient falls Faster discharge times
Nurse Advantages Improved report efficiency Improved staff teamwork Better nursing accountability Increased mentoring opportunities Better prioritization at start of shift Improved reporting accuracy More informed about patients sooner in shift Advantages and disadvantages contd Patient Disadvantages Medical jargon, difficult to understand Tiring repetition of information Anxiety from incorrect information Anxiety from so much information Lack of privacy Anxiety in hearing about their illness
Nurse Disadvantages Shift report may take longer References: AHRQ www.ahrq.gov
Baker, S. (2010). Bedside Shift Report Improves Patient Safety and Nurse Accountability. Joumal of Emergency Nursing, 36(4),p 355-358 Hagman,J., Oman, K., Kleiner, C., Johnson, E., Nordhagen, J., Lessons Learned From the Implementation of a Bedside Handoff Model JONA Volume 43, Number 6, pp 315-317 Lippincott Williams & Wilkins.