Stop errors with bedside reports at change of shift
Practice keeps nurses and patients informed
Dangerous mistakes made by ED nurses often occur during patient "handoffs" at change of shift — and accreditation surveyors will want to see that you have a system in place to address this potential problem. A Joint Commission on Accreditation of Healthcare Organizations' National Patient Safety Goal, which became effective Jan. 1, 2006, requires a standardized approach for handoffs with an opportunity for staff to ask and respond to questions.
Bedside reporting is the most effective way to communicate at change of shift because it involves the patient, says Staci Sutton, RN, BSN, TNS, emergency services manager at OSF St. Joseph Medical Center in Bloomington, IL. ED nurses use a handoff tool, which is laminated and put on the inside of every ED chart. "It's definitely a culture change," says Sutton.
When the ED began using topical anesthetics for all intravenous lines, a contest was successful in getting nurses used to that practice change — so the same strategy was used again, says Sutton. "Nurses had to sign up on the board at the end of their shift to report how many patients they had given bedside report to," she says. The two nurses with the highest number were given gift certificates to shopping malls or restaurants.
The new process has caught missed doses and procedures that nurses assumed were done but actually had not been, adds Sutton. "Several radiology procedures have been caught that were thought by the previous shift to be completed. During the handoff, nurses determined with patient involvement that the procedure had not been done or labs had not been drawn," she explains.
At Osceola Regional Medical Center in Kissimmee, FL, ED nurses were receiving complaints and incident reports because patients were being transferred to the floor without the proper orders carried out, such as a stat consultation not being called, says Michelle Tracy, RN, MA, CPN, CEN, clinical educator for emergency services. "In another case, a patient had a missing armband and was sent to the floor without it," says Tracy. "It was corrected after arrival to the floor but could have resulted in a negative outcome."
Bedside report at shift change was implemented to hold the previous shift accountable for their care and to help the nurse that is coming on shift to address any issues, concerns, and to get a better feel for the patient.
"The nurse brings the chart into the patient's room and gives report on the patient," says Tracy. "Of course anything sensitive would not be discussed in the room, and we would follow [Health Insurance Portability and Accountability Act] guidelines if they had visitors in the room."
At change of shift, both nurses check the following items:
- The patient's chart is complete.
- Drips are running at the correct rate.
- Cardiac monitor alarms are on with correct limits set and are communicating with the central station.
- The patient has armbands and allergy bands if appropriate.
- The patient's side rails are up, and the call light is within reach.
- Orders are carried out, signed off, and documented.
"This has really helped with the morale between the two shifts, because they are no longer blaming each other and are working together to guarantee patient safety," says Tracy. "It has also decreased potential patient safety issues that have arisen."
The "gurney side report" given by ED nurses at Mercy General Hospital in Sacramento, CA, serves two purposes: It informs the oncoming nurse, and it keeps the patient informed. "One of the things ED patients are most dissatisfied with is that they are not kept informed and they don't know what they are waiting for," says Becky Roberge, RN, the ED's clinical nurse educator. "This involves the patient in the plan of care."
The outgoing nurse introduces the patient to the new nurse, and the two nurses review the previous orders and treatments. The report includes the patient's name, age, chief complaint, significant medical history, allergies, any learning or social needs, and any abnormal assessment findings. "It's a double-check to make sure things have been done," says Roberge. "If the night shift nurse is tired, and a patient comes in at 6 a.m., the process prevents things from being missed, such as urine specimens not being sent."
It's also a way to make sure documentation is complete at the end of the shift, because you have two eyes looking at the chart instead of one, says Roberge. "If something wasn't charted, the new nurse asks if it was done," she says.
For more information on bedside reports at change of shift, contact:
- Becky Roberge, RN, Emergency Department, Mercy General Hospital, 4001 J St., Sacramento, CA 95819. Telephone: (916) 733-6250. E-mail: Becky.Roberge@chw.edu.
- Staci Sutton, RN, BSN, TNS, Emergency Services Manager, OSF St. Joseph Medical Center, Bloomington, IL. Telephone: (309) 662-3311, ext. 5114. E-mail: Staci.A.Sutton@osfhealthcare.org.
- Michelle Tracy, RN, MA, CPN, CEN, Clinical Educator, Emergency Services, Osceola Regional Medical Center, 700 W. Oak St., Kissimmee, FL 34741. Phone: (407) 518-3208. E-mail: michelle. firstname.lastname@example.org.