EBP: Bedside

Shift Report
Alyssa, Ashley, Caitlin, Hailey, Jacky,
James, Kelly, Milena, & Wendy
Intro
Issue: bedside report is a policy at many hospitals but it is not
implemented by the nurses

Affects patient care

Increased medication errors

Patient feels less involved in care

Increased falls

Lack of communication

Nursing significance
Provide best care possible starting at shift report
PICOT:
What is the best practice to prevent
nursing errors when acute care
nurses perform SBAR handoff at
shift change?
Current Practice
Research demonstrates a variance in nursing handoff reports across the country including bedside,
verbal outside the room, audio-taped, or group reports (Sherman, Sand-Jecklin, Johnson, 2013).

Local hospitals utilizing SBAR bedside National hospitals utilizing SBAR bedside
handoff: handoff:

St. Josephs Hospital Ronald Reagan UCLA Medical Center (M.

Sullivan, personal communication, October 20, 2016)

Tucson Medical Center

National Hospitals utilizing verbal handoff
Banner University Medical Center outside the patients room:

Northwest Medical Center McLane Childrens Center (K. Bell, personal

communication, October 20, 2016)

VA Hospital
Synopsis
Nursing problems that bedside report improves according to research

Lack of patient involvement/personal connection

Patient falls (Sand-Jecklin & Sherman, 2013)

Medication Errors (American Nurses Association, 2012)

Skin assessment

Nursing staff unsatisfied with accountability between fellow nurses and

physicians (Cairns, Dudjak, Hoffman, & Lorenz, 2013)

Communication breakdowns (Sand-Jecklin & Sherman, 2013)

Malpractice suits (Lang, 2012)

Summary of Research Articles
Strengths
Strengths: and Limitations
Limitations:

Credibility peer reviewed Lack of generalizability

Included both nurses and patients Small sample sizes under-representation

opinions
Convenience sampling selection bias
Interview guide consistent method of
interviewing Only one unit in one hospital

Similar trends and themes identified Too many variables

Dependability multiple quotes supported Self reporting errors from nursing staff
themes

Findings were congruent with other

studies
Evidence Based Nursing
recommendations that Support
Best practice
Nurses were better able to prioritize care because they were able to
visuals their patients
Patients reported an increase in involvement in the plan of care for the
day and felt more individualized care
Improvement in patient satisfaction scores based on HCAHPS scores
By completing report at the bedside, there is a more complete report
on the patient with a decrease in interruptions
Maintain privacy with bedside report
Nursing staff reported increased nurse-to-nurse accountability
(Maxson, Derby, Wrobleski, & Foss, 2012) (Groves, Manges, & Scott- Cawiezell, 2012) (Jeffs et al., 2014)
Application/ Implementation
into Nursing
1. The unfreezing phase - confront/challenge staff attitudes toward bedside report

a. Month one

b. Nurse educators/charge nurses will ask for nurses opinions on bedside report and educate them on the
benefits it can bring to them and the patient

c. Performed during the monthly staff meetings,

2. Moving phase - achieving staff acceptance

a. Month 2

b. Start implementation of EBP bedside report recommendations

c. Address any important factors in the bedside report process and reiterate importance of bedside report

3. Refreezing phase
Detailed cost analysis
Time - No additional cost because education will take place during monthly staff meeting

Educator - No additional cost because part of their job description

Room- No additional cost because it will take place during meeting and huddle

Approval and gathering information - No additional cost as it is already a policy for the hospital

Educational Component- no additional cost as this will be implemented with charge nurse
education

No new equipment would be needed, no extra training, and there has been no cost to implement
in previous hospitals

The printing of the surveys for 60 surveys (2 surveys per day for a month) would be about 10
dollars (considering it is 10 cents per page)

Minimal cost to implement, it is beneficial to the hospital.

Risk vs. Benefit: The Hospital
Decrease in malpractice litigation, falls, medication errors, Change in culture- increased attrition due to
pressure ulcers, and other adverse events (Sand-Jecklin & dissatisfaction with more rules (Freitag, et al., 2011)
Sherman, 2014) (Maxson, Derby, Wrobleski, & Foss, 2012)

No increase in overtime pay (Cairns, Dudjak, Hoffman, & Lorenz,

2013) (Sherman, Sand-Jecklin, & Johnson, 2013) (Wakefield,
Ragan, Brandt, Tregnago, 2012)

Decrease in overtime pay (Wu, Lee, Tsai, Lin, Huang, & Mills,
2013)

Meets JCo National Patient Safety Goal of improve staff

communication (American Nurses Association, 2012)

HCAHPS increased patient satisfaction ratings = increased levels

of reimbursement (1.5% presently and 2% in 2017) from
Medicare/Medicaid and insurance entities (
Reinbeck & Fitzsimmons, 2013)
 Risk vs. Benefit: The Nurse
Reduced incidences of malpractice suits and medication errors
(Lang, 2012)
Promoted accountability, teamwork, respect among staff
(Sand-Jecklin & Sherman, 2013)
Visualizing patient allows for prioritization of care
(Spooner, Corley, Chaboyer, Hammond, & Fraser, 2014)
Bedside handoff increased nursing staff satisfaction by:
Increasing conciseness, decreased amount of time spent on
report
(Cairns, Dudjak, Hoffman, & Lorenz, 2013)
Generating more staff accountability and fewer distractions
(Spooner, Corley, Chaboyer, Hammond, & Fraser, 2014)
Providing a greater sense of confidence in themselves
while providing care before and after shift change
(Cairns, Dudjak, Hoffman, & Lorenz, 2013)
Reduction of call lights for the hour before and after
bedside report
Increases care coordination (Kerr, Lu, & McKinlay,
2013).
HIPAA-protected behavior (Office for Civil Rights,
2002)
Risk vs. Benefit: The Nurse
Desire to respect client confidentiality (family members, semi-private rooms, infectious disease) (Burke, McLaughlin,
2013)

Perception of increased time for handoff (actual time not statistically significant) (Burke, McLaughlin, 2013)

Stress of waking up/disturbing a patient (psychosocial stressor) (Burke, McLaughlin, 2013)

 Risk vs. Benefit: The Patient
Rise in patient satisfaction in nurse communication on Risks:
HCAHPS survey in three areas:
-nurses kept me informed Patient care information may be heard by others in a
Staff worked well together to provide care semiprivate room (Wakefield, Ragan, Brandt, Tregnago, 2012)
Staff included me in decisions regarding my treatment
Increased stress in having sensitive information stated in
(Vines, Dupler, Van Son, & Guido, 2014)
semi-private rooms (Lu, Kerr, & McKinlay, 2014)

80% of patients indicated preference for bedside handoff Increased stress to patients family with the use of medical
(Lu, Kerr, & McKinlay, 2014) jargon (Lu, Kerr, & McKinlay, 2014)

Patients report an increase in feeling informed and involved Increased anxiety about repeatedly hearing about their
in their care (Lu, Kerr, & McKinlay, 2014) condition (Lu, Kerr, & McKinlay, 2014)

Warm handoff results in increased satisfaction by

transferring trust from one nurse to another (Lang, 2012)

Increased patient safety outcomes (Wakefield et al., 2012)

SMART Outcomes
The HCAHPS score in areas of communication will increase to 90% one year
after bedside reporting re-education has been implemented.

Patient satisfaction will increase by 25% on the survey sent out by the
hospital within three months after the re-education plan has been
implemented.

There will be at least 50% fewer medications errors two hours before and
after handoff within three months after the re-education plan has been
implemented.

There will be no falls the hour before and the hour after shift change within
three months after the re-education plan has been implemented.
Summary
The issue: bedside report is a policy at many hospitals, but is not enforced or
implemented

Significance to the field of nursing because it has the potential to prevent

errors and improve patient satisfaction

The question: what is the best practice to prevent nursing errors when acute
care nurses perform SBAR at shift change?

Current practice: locally hospitals including BUMC, TMC, and St. Joes all utilize
SBAR bedside nursing handoff, and UCLA does as well
McLane Childrens hospital still does verbal report outside the room

Through our research, we found that although many may have policies for
Summary
Completing report at the bedside could provide a solution to nursing
problems including medication errors, patient falls, pressure ulcers,
interruptions during report, and lack of patient involvement

Strengths: credibility, dependability and congruent findings across studies

Limitations : small sample sizes, too many variables, and convenience

sampling

Completing report at bedside is best practice because it allows nurses to

better prioritize, patients feel more involved, errors are reduced and
HCAHPS scores are increased
Summary
Implementing this practice will take three months:
Month one: education

Month two: implementation

Month three: audits and beginning of disciplinary actions

Minimal costs to implement this practice

Risks: perception of increased time for hand-offs and increased patient

anxiety

Benefits: decrease in falls, decrease in errors, and increased patient

involvement

Outcomes include increased HCAHPS scores in areas of communication by

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