Bedside shift reports can save lives

Bedside shift reports (BSR) are a fairly new concept for many nurses today, although they have been around for almost 40 years. Recently, hospitals have been putting their own take on BSRs in compliance with Joint Commission standards. BSRs have gone through a metamorphosis, moving from the nurse's station to the patient's bedside. This is designed to improve safety and give patients a better understanding of their condition and treatment plan.

By definition, a BSR is the change-of-shift report between the offgoing nurse and the oncoming nurse that takes place at the bedside. This makes patients a part of the process in the delivery of care.

Communication improves safety

Communication with the patient and family about all aspects of care, treatment, and services is an important characteristic of a culture of safety. The goal of the BSR strategy is to help ensure the safe handoff of care between nurses by involving the patient and family.

Traditionally, change-of-shift reports have been done at the nurses’ station, away from patients. While nurses are at the nurse's station filling out reports, research has shown that sentinel events are more likely to occur, according to “Bedside Shift Report: Implications for Patient Safety and Quality of Care,” an article in Nursing2015. BSRs eliminate that alone time and gives the patient a feeling of inclusion with the nurses as part of the healthcare team.

Because nurses are the first line of defense when it comes to patient safety, BSRs are an integral part of the care plan. The nurse is accountable for the communication that occurs during the change-of-shift report. This is the time that the nurse can verify the patient's health history, physical assessment findings, and plan of care, including prescribed medications.

During this time, the patient can ask questions and set short- and long-term goals with the nurse. This form of shift report improves staff communication while ensuring nurse accountability.

Implementing BSR

Several steps are involved in introducing and implementing BSR. The Agency for Healthcare Research & Quality (AHRQ) recommends implementing on a small scale by using a small unit as a pilot. This helps clinicians learn what works and what doesn't.

Once a hospital has identified target areas of improvement, the next step is to get the staff's buy-in, which is crucial to success.

Patients and family are informed about BSR during the previous shift and when their nurse is rounding. Nurses have to be trained in the critical elements of BSR using the same language with introductions, continuing the process using SBAR, and thanking the patient at the end. Presenting a consistent message builds trust with the patient and family.

According to AHRQ, the critical elements of a BSR are:

• Introduce the nursing staff, patient, and family to each another.
• Invite the patient and (with the patient's permission) family to participate. The patient determines who is family and who can participate in the BSR.
• Open the electronic health record at the bedside.
• Conduct a verbal report using words the patient and family can understand.
• Conduct a focused assessment of the patient and a room safety assessment.
• Review tasks to be done.
• Identify patient's and family's needs and concerns.

Nurses and patients reap rewards

The advantages for nurses begin with efficiency of reporting. BSRs also improve staff teamwork by giving nurses the opportunity to work together at the bedside, ensuring accountability. Using a standardized format reduces the risk of miscommunication. Better communication also helps the oncoming nurse prioritize assignments according to need. Nurses are always on the same page during the report because they're both looking at the same information at the same time.

Patients benefit from BSRs, too. By listening to the report, the patient learns about the care plan and goals. The BSR process acknowledges the patient as a partner and reassures the patient that the nurses work as a team. Knowing that nursing staff is getting the information needed to facilitate care decreases patient and family anxiety and improves patient satisfaction.

When you adopt a BSR plan, you will likely see patient satisfaction scores reflecting more positive experiences.

BSRs can reduce the risk of medication errors, in part because a two-verifier system lets the oncoming nurse verify with the offgoing nurse I.V. medications, pump settings, blood product compatibility, and possible drug adverse reactions. The nurse can also assess surgical wounds, check for pressure ulcers, and observe the patient's general appearance.

Challenges and concerns

Nurses have raised some concerns when it comes to BSR, including:

• lack of privacy in semiprivate rooms, leading to potential HIPAA violations
• unknown visitors or family in the room
• discovery of new diagnoses or lab results that haven't yet been discussed with the patient
• sleeping patient
• patient unable to participate due to cognitive or sensory limitations
• questions from patient that need lengthy clarification, increasing report time.

Patients must be made aware of the BSR during the admission process and asked about sharing information when friends and family are visiting. The patient has the final word on whether the family stays or leaves during report time. If the patient wants complete privacy, the nurse can courteously ask family and friends to leave. In addition, time should be set aside before or after BSR for the sharing of sensitive information that hasn't been told to the patient with the oncoming nurse.

Patients should also make the decision whether they would like to be awoken for the BSR. This is a consideration, since restful sleep is an important part of the healing process.

Once you overcome these challenges, BSRs can have a positive impact on patient care.