Running head: PICOT & LITERATURE SEARCH 1 PICOT & Literature search: The effect of bedside shift report on patient care Saba Yifter Grand Canyon University: NRS-433V June 18, 2017 Running head: PICOT & LITERATURE SEARCH 2 Under normal circumstances, patient and their caregivers don’t take part in the development of change of shift report. In the past, shift reports got presented in conference rooms where nurses listened to the information and gave their recommendations. Things changed lately, where shift handoff gets performed in the patient room, using a computer. The bedside nursing offering the patient and the nurse the chance to share information, plan for personalized interventions and ask questions. A literature search performed through the PubMed, EBSCOhost, Cumulative Index of Nursing &Allied Health (CINAHL Plus), and other databases which focused on the given keywords aimed at defining information about bedside shift. Ix research articles were determined to have clinical and statistical significance in relation to this evidence-based report. The purpose of this evidence-based research project is to examine the effect of bedside report on patient outcome and nurse/patient satisfaction. The keywords during the searches included hand-off communication, bedside shift communication, and med-surge. The inclusion criteria followed involved articles not more than seven years old, adult med-surge patients and in patient’s hospitals. PICOT How does giving bedside shift report with patient involvement compare to giving handoff report outside patient's room affect patient's satisfaction during the length of their stay? Population: hospitalized patients and nurses Intervention: bedside shift report Comparison: handoff at nurses' station or outside the patient room Outcome: increased patient satisfaction Running head: PICOT & LITERATURE SEARCH 3 Time: length of hospital stay Reference #1 Abstract The first reference is a study entitled "A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation." The article's abstract reads: "The literature identifies several benefits of bedside nursing shift report. However, published studies have not adequately quantified outcomes related to this process change, having either small or unreported sample sizes or not testing for statistical significance. The aim of the study is to quantify quantitative outcomes of a practice change to a blended form of bedside nursing report. This will be done using quasi-experimental pre-and post-implementation design. Methods: Seven medical-surgical units in a large university hospital implemented a blend of recorded and bedside nursing report. Outcomes monitored included patient and nursing satisfaction, patient falls, nursing overtime and medication errors. Results: We found statistically significant improvements post-implementation in four patient survey items specifically impacted by the change to bedside report. Nursing perceptions of report were significantly improved in the areas of patient safety and involvement in care and nurse accountability post-implementation. However, there was a decline in nurse perception that report took a reasonable amount of time after bedside report implementation; contrary to these perceptions, there was no significant increase in nurse overtime. Patient falls at shift change decreased substantially after the implementation of bedside report. An intervening variable during the study period invalidated the comparison of medication errors pre- and post-intervention. There was some indication from both patients and nurses that bedside report was not always consistently implemented. Conclusions: Several positive outcomes were documented in relation to the implementation of a blended bedside shift report, with few drawbacks. Nurse attitudes about report at the final data Running head: PICOT & LITERATURE SEARCH 4 collection were more positive than at the initial post-implementation data collection. Relevance to clinical practice: If properly implemented, nursing bedside report can result in improved patient and nursing satisfaction and patient safety outcomes. However, managers should involve staff nurses in the implementation process and continue to monitor consistency in report format as well as satisfaction with the process" (Sand-Jecklin & Sherman, 2014). Reference #2 Abstract The second reference article is titled "Improving Patient Satisfaction with Nursing Communication Using Bedside Shift Report." The article's abstract reads: "Patient surveys taken after discharge from the hospital show that patients perceive nursing communication during their stay could be improved. Standardizing bedside reporting is one step toward improving communication between nurses, patients, and their families. The purpose of the study was to determine if standardizing shift report improves patient satisfaction with nursing communication. Method: A pilot bedside shift report process was developed on a medical/surgical intermediate care unit to improve patient satisfaction scores in the area of “nurse communicated well,” with the goal of reaching 90% satisfaction rates, which increased from 76% and 78%. Peplau’s interpersonal relations theory was used in the adoption of this practice. This theory is based on the idea that the nurse-patient relationship is therapeutic and that it is crucial for nurses to assess, plan, and put context behind the care delivered to their patients. Lewin’s Change Theory and the tenets of unfreezing, moving, and refreezing were crucial to the implementation of this practice change. Conclusion: Monitoring of patient satisfaction was continued for 3 months. There was a rise in patient satisfaction in nursing communication to 87.6%, an increase from 75% in the previous 6 months. This score did not meet the goal of 90%, but did show that this practice change did impact this particular area of Running head: PICOT & LITERATURE SEARCH 5 patient satisfaction. Implications: This process was instituted organization-wide. Reaching the goal of 90% satisfaction in the area of patient perceptions of nursing communication is the overall goal of this program" (Radtke, 2013). Reference # 3 Abstract The abstract to the third reference article entitled "Making the transition to nursing bedside shift reports" is as follows: "For hospitalized patients, shift handoffs between the off going and oncoming nurses, as represented in nurse shift reports, must include all critical information about a patient's plan of care, and that information must be well communicated. Few studies have provided the longitudinal results of the transition to bedside shift reports, and most of the data concern relatively short follow-up periods. A 20-bed inpatient nursing unit in a Midwestern academic health center made the transition to conducting nursing shift reports at the patient's bedside. Methods: Preparatory work for designing the bedside shift report process, which began in February 2009, included examining baseline patient satisfaction scores, reviewing the existing shift report processes, and identifying potential barriers and facilitators in moving to bedside shift reports. Unit wide implementation of the new bedside shift report process began in June 2009. In the redesigned process, off-going nurses were required to ask patients to write down any questions they would like to ask during the shift report. Results: For the first six months following implementation of bedside shift reports, there were significant increases in six nursespecific patient satisfaction scores (scores increased at least 8.7 points, and percentile rankings increased from the 20th to > the 90th percentile when compared with similar nursing units in peer institutions). Longer-term results reflected subsequent declines and substantial month-tomonth variation. Conclusion: Although the transition to bedside shift reports met with some Running head: PICOT & LITERATURE SEARCH 6 resistance, the transition was made smoother by extensive planning, training, and gradual implementation. Based on this pilot study, the decision was made to adopt bedside shift reports in all inpatient nursing units in each of the system's five hospitals (Wakefield et al, 2012). Reference # 4 Abstract The fourth research article is called "Incorporating bedside shift reporting into the change-of-shift report. The abstract reads: "Conventionally patients and their family/caregivers were not involved in the process of change of shift report. In the past, shift report has been held in each unit’s conference room with all the nurses listening to report on every patient in the unit. Now days, change of shift handoff is done in the patient room, usually at the computer in front of the EMR. Bedside nursing report allows the patient and nurse the opportunity to share information, ask questions, and plan individualized interventions. Methods: implementation of moving changes od shift report to the bedside. Implementing the change of report started with a pre-implementation survey to all the nurses. Nurses were provided with survey question, consisted 6 statement, and they were asked to circle all the statement they found to be true. The questions were: (1) Bedside report can improve patient safety. (2) bedside report provides an opportunity for patient to discuss their plan of care (3) Bedside report violate patient’s confidentiality (4) Bedside report holds off going staff more accountable than taped report (5) Bedside report takes longer than taped report (6) Bedside report reassure patient that staff work as a team. After bedside report was initiated the result showed that most of the nurses felt that bedside report had improved patient safety and satisfaction (70%) and gives patient opportunity to discuss their plan (78%). In addition, it showed less issues with inaccurate or missing information, because it includes actual patient visualization. Recommendation: the patient satisfaction was improved once reporting was done Running head: PICOT & LITERATURE SEARCH 7 with the patient in the room. Moving the report to the bedside allows accurate information to be exchanged. It was found that bedside reporting works best at the start of the day and evening shift" (Laws & Amato, 2010). Reference # 5 Abstract The fifth reference study is entitled, "Bedside Nurse-to-Nurse Handoff Promotes Patient Safety." The abstract reads as follows: Nurse-to-nurse beside handoff allows the oncoming nurse to visualize the patient and ask questions of the previous nurse. Bedside nurse report allows the patients to be involved actively in their care and allows standardized communication between nursing shifts. “Patient handoff between nurses at shift change has been an important process in clinical nursing practice, allowing nurses to exchange necessary patient information to ensure continuity of care and patient safety. Bedside handoff allows the patient the ability to contribute to his or her plan of care. It also allows the oncoming nurse an opportunity to visualize the patient and ask questions. This is critical in meeting the Joint Commission's 2009 National Patient Safety Goals. It encourages patients to be involved actively in their care and it implements standardized handoff communication between nursing shifts. Bedside handoff promotes patient safety and allows an opportunity for patients to correct misconceptions. METHODS: A convenience sample of 60 patients was enrolled, 30 before the practice change and 30 after the change. All nursing staff were invited to participate. Both patients and staff were given self-designed surveys before and after the practice change. RESULTS: Fifteen nurses with a mean of 2 years in the profession completed the pre- and post-survey. Most staff were not satisfied with the current shift change report, but statistical improvement was achieved after the practice change. Also, statistical improvement was achieved with patients' satisfaction with involvement in their plan of care. Running head: PICOT & LITERATURE SEARCH 8 Conclusion: Use of bedside nursing handoff promotes staff accountability, two-person IV medication reconciliation, and patient satisfaction” (Maxson et al, 2012). Reference # 6 Abstract The sixth reference study is entitled, "Bedside shift report associated with improved patient outcome". The abstract reads as follows: “Experts identify bedside shift report as an effective means of improving patient safety, nurse accountability and patient perception of involvement in their care. Several studies have examined both nurse and patient perception of the practice supports these perspectives. Methods: A quasiexperimental design was used to retrospectively evaluate the impact of implementing bedside nursing shift report on specific patient outcomes in 15 adult inpatient units at a large academic medical center. Existing sources were mined for data on RN education and certification, patient volumes and worked hours to determine if there were significant changes overtime. Total fall data and medication error occurrence reports were extracted and incident rates constructed to allow comparison across units. Responses to patient satisfaction questions specific to nurse communication were also extracted. Statically control chart and comparison of means were used to analyze the data. Results: while there was not a statistically significant change in the rate of patient falls, the medication administration error rate decreased by almost half (p
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