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Bedside Reporting Change Implementation Research Paper

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Updated: Aug 3rd, 2020

Abstract

The Capstone project sought to move the facility from the current recorded reports to bedside reporting. It was observed that staff nurses completed their shift reports at the nursing station, not at the bedside, raising the potential for communication lapses. Miscommunication in clinical settings is a critical factor influencing patient safety and satisfaction and nurse outcomes. The project involved an evidence-based practice change to bedside handoffs for duty nurses. Scholarly evidence reviewed indicated that a standardized bedside reporting protocol could promote clinical communication, care continuity, and patient safety outcomes. To move the facility to bedside reporting, the project included a 12-week educational offering to create staff capacity for the change and promote compliance. Its implementation was based on the premise that the practice change would improve patient safety. An interdisciplinary team led by the DON, Unit Managers, and champions oversaw the unit-level implementation of bedside reports, staff re-education, and project evaluation.

Implementation

Capstone Project Steps

Before the adoption of bedside reporting, the shift-to-shift handover occurred at a central nurses’ station, active involvement of patients in the reporting process was lacking, and nurses were unclear on what to put in the report. My practice change project specifically focused on a clinical educational offering to foster a cultural change founded on Lewin’s change model. I presented the concept to the clinical leadership (DON and Unit Managers), addressed their concerns, and initiated a dialogue among the nursing staff through meetings in week 1-2. The presentations highlighted the benefits of bedside reporting over the current recorded reports and adduced evidence i.e., low medical error risk and improved patient/nurse outcomes, to advance a case for a practice change (Tidwell et al., 2011).

Further, I worked collaboratively with the educational team to develop a customized SBAR tool (reporting template) and educational materials for nurses and patients in week 3-4. Through this collaborative effort, we also recruited the nurse champions (RNs) who were trained in the essentials of bedside reporting (week 5-7) to provide change leadership and train the staff nurses. The nurses attended a four-week interactive workshop (week 8-11) to prepare them for bedside reporting. I was able to influence change by integrating bedside reporting into the educational curriculum and daily nursing practice. The uncertainties surrounding what constitutes a bedside report, how to engage patients/families, and how to exchange of confidential patient data were addressed through education, removing the barriers to change.

Changes to the original implementation plan

Several changes were made to the tentative implementation plan to accommodate budget and timeline constraints. The workshop was initially planned to last for two weeks (week 8-11); however, because the educational hours varied between nurses, the course was offered twice to accommodate all nurses based on their availability. Further, the number of RNs (champions) trained was reduced from the initial 12 to five (one per unit) due to budgetary constraints.

Barriers associated with implementation

The initial implementation barrier I encountered was the lack of staff support, acceptance, and compliance with the bedside handover due to the perception that the process was time-consuming and tedious. Thus, they could not direct their full efforts into its implementation. The second barrier experienced was the limited staff capacity to drive the change. Staff nurses were unclear about the bedside handover process and its benefits. Another implementation barrier was related to temporal components, i.e., time delays or changes in timelines. Holding the educational sessions in December is a busy month, was a challenge. The training was constrained by limited educational hours or nursing availability leading to delays. Further, the unit champions were not trained in bedside nursing. There was insufficient time to train the champions to lead the change process. Obtaining sufficient funds to book lecture rooms for the workshops and procure the training materials was the other challenge experienced.

Overcoming barriers

To bolster compliance and acceptance of bedside reporting, I worked with the Unit Managers and champions to monitor the process and ensure adherence to the new practice. The action I took to change their perceptions involved holding an open dialogue on the pros and cons of bedside reporting to nursing practice. The challenge of limited staff capacity was addressed through the training of champions and staff nurses on the bedside reporting process. I worked with the Unit Managers to register all staff nurses for the training, develop timelines for the workshop, and realign the nurses’ workflows with the educational sessions to avoid delays and ensure implementation proceeds as planned. Further, I collaborated with the clinical leadership (DON and the Unit Managers) to determine the duration of the workshop and training resources fall within the allotted budget and staffing dynamics of the champions and staff nurses.

Transprofessional Relationships

Various professionals contributed to the implementation of the change project. The interdisciplinary team members included various stakeholders, ancillary staff, and physicians that provided clinical expertise and leadership support to facilitate the transition to bedside reporting. The team included:

  • Director of Nursing (DON)
  • Unit Managers
  • Physicians
  • Unit champions – RNs
  • Staff nurses – dayshift and nightshift
  • Clinical nursing officer (CNO)
  • Certified nurse assistants (CNAs)
  • Chief financial officer (CFO)
  • Ancillary staff – occupational therapists, radiologists, nutritionists, etc.

How relationships facilitated implementation

The DON mobilized to support and buy-in for the Capstone project at the leadership level (CFO) after my oral presentation. The DON and Unit Managers held meetings with the staff nurses to demonstrate their support for the project, mobilized resources, and approved the educational program and workflow changes. The physicians also embraced bedside reports for a general check-up. Charge nurses (RNs) acted as trained unit champions that educated staff nurses and led the transition process by providing technical expertise in bedside reporting. They clarified/support unit nurses over the implementation period. They also helped assess the progress of the practice change.

The CNO performed day-to-day leadership roles, provided support, and helped in reinforcement by motivating the staff to embrace bedside handover. The trained nurses acted as agents of change. They used bedside reports to promote patient safety across the continuum of care. The CNAs helped inform the patients of an impending bedside reporting before the reporting time to minimize interruptions. They also helped in pain management and health education, informed patients of their expected roles in bedside reporting, and assisted them with bathroom activities in collaboration with the ancillary staff. The CFO approved the financial resources to support the change during the project cycle.

Post-Capstone Project Considerations

Capstone Successes

Successful aspects

Organizational change management is essential in implementing a new practice or project. Wakefield, Ragan, Brandt, and Tregnago, (2012) observe that successful adoption of bedside reporting requires “extensive planning, education of the nursing staff, and stepwise implementation” (p. 245). This project helped identify the need for practice change by highlighting the benefits of bedside reporting over recorded reports. Further, it helped create staff awareness through education and understanding around the bedside reporting process as a means of improving nursing efficiency and patient safety at the facility.

The project also improved clinical communication among stakeholders. The practice change was an evidence-based project to support communication between outgoing and oncoming nurses. Kourkouta and Papathanasiou (2014) state that bedside shift reports aim to promote safe patient care through effective shift-to-shift handoffs. Another dimension of communication impacted by the project was patient/family engagement. Patient involvement in bedside reporting has been shown to improve the safety of care and patient satisfaction due to participation in clinical decision-making (Poh, Parasuram, & Kannusamy, 2013). The project also helped establish leadership/staff commitment to practice change. It prepared the unit champions, Unit Managers, and staff nurses for a transition bedside reporting through training and by addressing their concerns.

Impact on future projects

The lessons learned from implementing this project could be used to inform future practice changes and policies in the facility. According to Clarke and Persaud (2011), bedside reporting calls for clear policy and standards to guide the transition. The facility presently lacks a bedside reporting policy or procedure to reinforce compliance and cultural change. This project serves as a foundation for developing an organizational policy on bedside reporting. Future projects should focus on how having a standardized bedside shift procedure/policy could enhance adherence to evidence-based reporting standards. The reporting protocol should identify effective communication tools, including “white boards and reporting templates”, to support bedside handoffs (Clarke & Persaud, 2011, p. 14). The policy should clearly state the specific information to be communicated through bedside shift reports.

The educational offering laid the foundation for practice change in the organization. Going forward, the leadership should formulate a plan for addressing nursing concerns related to bedside reports to remove the barriers to effective transition. Sand-Jecklin and Sherman (2013) note that leadership should address “inconsistencies and perceived barriers” to a practice change to inform policy development (p. 189). Further, it would important to support the educational sessions with policy. The nurses should understand the expected roles in bedside reporting to enhance accountability. Heightened awareness would enhance adherence to best practices in bedside reporting in line with the institutional goals of patient-centered care and safety (Sand-Jecklin & Sherman, 2013).

Capstone Challenges

Aspects that did not go well

In this project, not all staff nurses participated in the entire educational program as planned due to shifting overlaps with the training sessions. This aspect could affect staff capacity to implement bedside reports. Secondly, compliance with the new practice was low probably because Unit Managers were not always present at every shift handover. Therefore, they could not tell if bedside reporting was being implemented as planned. Thirdly, most patients/families were not aware of their roles in bedside reporting, an aspect that limited their involvement in the clinical process.

Impact on future projects

White and Dudley-Brown (2012) find a relationship between the nursing work environment and quality health care delivery. Further, clinical leadership is required to ensure full participation of nurses in QI projects through effective shift/time management. To address the unsuccessful aspects identified above in future projects, the Unit Managers could evaluate their unit’s level of engagement in the educational offering for an effective transition to bedside reporting. Full participation of nurses could be achieved through properly communicated educational hours for each nurse. Moreover, the Unit Managers could delegate the supervisory role to the Champions to monitor all shift handovers for compliance with bedside reporting best practices. Patients should receive educational brochures clarifying their expected role in bedside reporting at the point of admission. This approach would ensure effective patient involvement in the process as planned for improved patient and nursing outcomes.

Evidence and Current Practice

The articles reviewed focused on various aspects of bedside handoffs, including its efficacy, challenges, safety, and patient/nurse views about the practice. The educational component of the Capstone project focused on the benefits of bedside handoffs identified in the literature to create an impetus for change at the facility. There is compelling evidence that a transition from recorded reports to bedside reporting results in patient-centered care and improves the inpatient experience (Reinbeck & Fitzsimons, 2013). Studies further demonstrate that when patients participate in their care, their compliance with prescribed medications is higher (Cairns, Dudjak, Hoffmann, & Lorenz, 2013). Patient and nurse satisfaction has also been linked with bedside handovers (Vines, Dupler, Van Son, & Guido, 2014). The nurses were trained on the benefits of bedside reports over recorded reports, how to use bedside reports, and how to handle patient confidentiality issues.

Effective nursing handoffs have been shown to reduce medication errors, nosocomial infections (CAUTI rates), and LOS (Gregory, Tan, Tilrico, Edwardson, & Gamm, 2014; Sand-Jecklin & Sherman, 2014). Based on the article review, it became clear that implementing bedside shift reports requires a standardized approach in addition to nursing education. A structured bedside reporting protocol with templates could support effective communication of critical information at the change of shift. Therefore, a bedside reporting template was implemented in the SBAR tool placed in all units.

Post-implementation

Sustaining the practice change at the facility will require effective management of nurses’ attitudes, potential barriers, and restraining forces to enforce compliance. A proposal has been made to the DON to institute a bedside reporting policy at the facility. This administrative support structure will ensure that all nurses comply with bedside handovers. Further, the DON and Unit Managers agreed to make the educational sessions compulsory for all staff nurses. All nurses will now receive training on this subject and participate in mock bedside handovers to understand the process and its benefits. The facility will maintain and support unit-level quality committees comprising of the Unit Manager and trained champions who will educate new nurses on bedside reporting and supervise their compliance with bedside reporting. Also, the SBAR tool adapted for bedside reporting will be made available to all nurses via portable devices. To strengthen patient involvement, the DON made it a policy that new patients will receive brochures explaining their role in bedside reporting and the expected benefits.

Resources Required for Post-Implementation Support

The identified barrier to the adoption of bedside reporting at the hospital is the inadequate staff capacity or skills to drive a practice change. Therefore, for the continued use of bedside reporting at all units, the facility must adopt a sustained engagement process of the nurses through education. According to Sand-Jecklin and Sherman (2013), compliance with bedside shift reports requires strong unit-level leadership, staff education, and project evaluation. Additional resources would be required to support staff education through computer-based training for nurses. Adequate training for all unit nurses as the professionals involved in bedside shift reporting is an obligation of the hospital.

The facility must also support project evaluation through regular post-implementation surveys (nurse satisfaction) to monitor unit-level outcomes. Further, according to Kerr, Lu, and McKinlay (2013), effective communication of the change project, the expected outcomes, and its benefits to the nursing staff is important for the sustainability of the project. In this view, ongoing meetings between the clinical leadership, the champions, and staff nurses to identify deficiencies, review the protocol, and evaluate feedback would be needed for a successful implementation. As Radtke (2013) notes, a just-do-it approach may not evoke adequate support for a change; rather, an “upward voice” is important to cultivate a “culture of psychological safety” in the organization (p. 23). Therefore, ongoing meetings could provide nurses a platform to air their views and communicate problems to the leaders. Their views could indicate the deficiencies in the current educational curriculum and necessitate a review or re-education of the nurses for project sustainability.

Reflection

Integration of MSN Program Outcomes

Through the fieldwork experience component of the WGU MSN program, I was able to apply research evidence in advanced nursing practice. I was able to integrate three WGU MSN program outcomes into my Capstone project on bedside shift reporting.

Patient-care technologies and information management strategies

I was able to integrate information management practices learned from the MSN program into my Capstone project. Designing, organizing, and allocating resources were employed to manage the educational sessions and determine tasks or action steps to effect the change. Also, the bedside reporting project was based on research evidence obtained through the appraisal of relevant studies as learned from the MSN program. The evidence-based project aims to promote patient care through changes in shift-to-shift reporting. Bedside shift reporting is associated with a low medical error risk and improved patient satisfaction and outcomes (Rush, 2012).

Scientific findings and continual improvement of nursing care

The shift to bedside reporting was a quality improvement project aimed at enhancing nursing efficiency and clinical outcomes. I was able to incorporate scholarly evidence assembled from relevant studies into bedside reporting best practices. Nursing research articles with different levels of evidence/hierarchy were appraised and their findings incorporated into practice change. The MSN program guidelines on article search and evidence appraisal were applied to support the need for bedside shift reporting at the facility. Also, supportive literature and theories of organizational change, e.g., Lewin’s change model, were utilized in the project to ensure a successful implementation process.

Interprofessional teams and clinical communication/collaboration

The Capstone project was premised on improving patient safety through effective shift-to-shift communication. The implementation of this project brought together nurses, physicians, clinical leaders, patients, and ancillary staff, among others. The interprofessional relationships were vital in supporting care coordination and collaboration to realize the objectives of bedside reporting. Further, a standardized bedside reporting protocol was deployed in all units to ensure clear shift-to-shift communications. I was able to apply organizational skills learned from the MSN program to create an interprofessional implementation team headed by unit-level committees and nurse champions. The committees facilitated shared decision-making to overcome restraining forces that impede practice change. The project also enhanced patient involvement in clinical decisions to improve the inpatient experience, minimize sentinel events, and promote healthcare quality.

References

Cairns, L. L., Dudjak, L. A., Hoffmann, R. L., & Lorenz, H. L. (2013). Utilizing bedside shift report to improve the effectiveness of shift handoff. Journal of Nursing Administration, 43(3), 160-165. Web.

Clarke, C. M., & Persaud, D. D. (2011). Leading clinical handover improvement: A change strategy to implement best practices in the acute care setting. Journal of Patient Safety, 7(1), 11-18. Web.

Gregory, S. Tan, D. Tilrico, M. Edwardson, N., & Gamm, L. (2014). Bedside shift reports: What does the evidence say? The Journal of nursing administration, 44(10), 541-545. Web.

Kerr, D., Lu, S., & McKinlay, L. (2013). Bedside handover enhances completion of nursing care and documentation. Journal of Nursing Care Quality, 28(3), 217-225. Web.

Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia Socio-Medica, 26(1), 65-67. Web.

Poh, C. L., Parasuram, R., & Kannusamy, P. (2013). Nursing inter-shift handover process in mental health settings: A best practice implementation project. International Journal of Evidence-Based Healthcare, 11(1), 26-32. Web.

Radtke, K. (2013). Improving client satisfaction with nursing communication using bedside shift report. Journal for Advanced Nursing Practice, 27(1), 19-25. Web.

Reinbeck, D., & Fitzsimons, V. (2013). Improving the client experience through bedside shift report. Nursing Management, 44(2), 16-17. Web.

Rush, S. K. (2012). Bedside reporting: Dynamic dialogue. Nursing Management, 43(1), 40-44. Web.

Sand-Jecklin, K., & Sherman, J. (2013). Incorporating bedside report into nursing handoff: Evaluation of change in practice. Journal of Nursing Care Quality, 28(2), 186-194. Web.

Sand-Jecklin, K., & Sherman, J. (2014). A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation. Journal of Clinical Nursing, 23(19), 2854-2863. Web.

Tidwell, T., Edwards, J., Snider, E., Lindsey, C., Reed, A., Scroggins, I.,…Brigance, J. (2011). A nursing pilot study on bedside reporting to promote best practice and patient/family-centered care. Journal of Neuroscience Nursing, 43(4), 1-5. Web.

Vines, M. M., Dupler, A. E., Van Son, C. R., & Guido, G. W. (2014). Improving client and nurse satisfaction through the utilization of bedside report. Journal for Nurses in Professional Development, 30(4), 166-173. Web.

Wakefield, D. S., Ragan, R., Brandt, J., & Tregnago, M. (2012). Making the transition to nursing bedside shift reports. Joint Commission Journal on Quality & Patient Safety, 38(6), 243-253. Web.

White, K. M., & Dudley-Brown, S. (2012). Translation of evidence into nursing and health care practice. New York, NY: Springer.

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