Bedside report : a patient-centered approach to inter-shift handoffs -

Abstract

In 2007 Joint Commission did a root cause analysis of sentinel events and showed that passing inaccurate information and incomplete information between nurses will lead to very serious sentinel events. Concerns were raised by nurses on a medical-surgical unit at American University of Beirut about the current problems with the inter-shift report such as: missing information, noise, a lot of interruptions and chaotic environment where report is given. The aim of this project is to propose a new handoff reporting method, one that standardizes procedures and provides patients and their families the opportunity to participate in the handoff process. Bedside Intershift report is a process that focuses on involving patients in their daily plan of care at the beginning of every shift. The transition plan is guided by Lewin’s Change Model: Unfreezing, Change and Refreezing. Four nurses participated in the piloting process in a medical-surgical unit at AUBMC. It took one minute for patient with acuity III, two minutes for patient with acuity IV and three minutes for patient with acuity V. Three main challenges faced during piloting phase were: violation patient confidentiality, functional care model at night and sleeping patients. To have a smoother change, it recommended to have a gradual implementation, extensive training, continuous monitoring and leaders’ support as means to sustain and integrate the change.