The importance of bedside shift reports and how they can affect your work along with patient outcomes
During my clinical rotation, I remember sitting in a conference room of a skilled nursing facility to receive shift report – the oncoming nurses listened to the nurses who had just worked, providing updates on the residents. Upon shifting to a clinical rotation at a hospital, shift report was held in a similar fashion – we sat in a break room and pertinent information was passed on while we hurriedly scribbled down information.
When I took my first nursing job, we received and provided shift report using a tape player – yes, a tape player. Because our assignments were often large or split up from the previous shift, taping report ensured that the nurse leaving didn’t stay overtime.
But eventually our director informed us that we would need to provide bedside shift report. Did we like it? Well, not at first! However, eventually it became the norm. And as it turns out, our patients enjoyed partaking in report.
Most importantly, research indicates that bedside shift report, or BSR, can improve patient outcomes.
What is Bedside Shift Report?
BSR is defined as “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.” Although BSR is a relatively new concept, there have been facilities who have performed BSR for almost 40 years.
BSR is becoming more and more prevalent because a successful patient “hand-off” is Joint Commission standard; there are varying ways in which hand-off may occur, and many facilities have gone the way of BSR as it allows nurses to include the patient and family members, as well as include a multidisciplinary approach if necessary. BSR also allows for the nurse to relay critical communication, which is required at every hand-off; this information includes –
- Contact information
- Illness assessment, including severity
- Patient summary
- To-do action list
- Contingency plans
- Allergy list
- Code status
- Medication list
- Dated laboratory tests
- Dated vital signs
Bedside Shift Report – the Rewards and Evidence
Though many nurses have concerns when BSR is initiated, most nurses find that BSR is a great way to interact with their coworkers and with their patients as it promotes teamwork and increases patient satisfaction. This is often because of communication – during traditional nursing report, information may be left out or forgotten. BSR allows for this communication to occur and for questions to be asked.
According to Lippincott Solutions, “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.”
Evidence indicates that BSR is effective; in a study conducted by Kimberly Radtke, it was found that patients like meeting their caregivers and to be involved in their plan of care. In the study, Radtke reported that BSR, “decreases the perception the healthcare team members are ‘hiding something’” and “patients feel like they are in ‘safe hands’”.
While we want our patients to be satisfied, we also want our staff to be satisfied. Research indicates that most nurses find benefit to BSR. According to the Journal of Healthcare Communications, “…nurses felt more prepared immediately after the change-of-shift handoff to discuss patient care issues with physicians and other health care providers.”
Yet another study found that overtime hours actually decreased as a result of BSR; in this study, BSR took less time; it also led to improved teamwork between nurses, increased efficiency of report, and improved accountability.
BSR Concerns
Despite its benefits, many nurses have concerns with BSR. For example, BSR can be difficult when the patient is sleeping. The question arises whether to wake the sleeping patient or allow them to continue to rest. This can be amended by discussing BSR with the patient immediately upon admission and asking them their preference.
Another concern is a lack of privacy in semiprivate rooms. Many nurses have concerns that this is a HIPPA violation. Along the same vein is family members or visitors that may be present for BSR. Although it can be difficult to be discreet in a semiprivate room, visitors can be asked to step out of the room during BSR.
Chatty patients or patients who ask for lengthy explanations is another concern as this lengthens BSR; setting the expectation with the patient is important prior to beginning.
How to Perform BSR
Each facility will need to implement a BSR that works best for their staff. In order to do this, it is recommended to begin with one unit as a pilot. Starting BSR on a smaller scale allows for staff to determine what works – and what doesn’t.
Once BSR can begin, the Agency for Healthcare Research and Quality recommend that the following elements occur in each BSR –
- An introduction of the nursing staff, patient, and any family members that are present.
- Invite the patient to participate in BSR. If family members or other visitors are present, the patient may invite them, but if otherwise they should be excused from the room.
- The electronic health record should be opened at the bedside so that both the oncoming and offgoing nurse may review medications, vital signs, and labs.
- Verbal report should be conducted in a way that the patient can understand.
- A focused assessment of the patient should be completed, as well as a safety assessment of the room.
- A review of any tasks that need to be completed should be performed.
- There should be an opportunity to identify patient and family concerns.
The Bottom Line…
Bedside shift report is a means of handing off information, nurse-to-nurse, that is effective, promotes nurse and patient satisfaction, and improves patient outcomes.
Resources
Bedside shift report can save lives. (2017, November 17). Lippincott Solutions. http://lippincottsolutions.lww.com/blog.entry.html/2017/11/17/bedside_shift_report-dMev.html
Inadequate hand-off communication. (2017, September 12). Joint Commission. https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/sea_58_hand_off_comms_9_6_17_final_(1).pdf?db=web&hash=5642D63C1A5017BD214701514DA00139
Mitchell, A., Gudeczauskas, K., Therrian, A., & Zauher, A. (2017). Bedside reporting is a key to communication. Journal of Healthcare Communications, 3(1:13), 1–3. https://doi.org/10.4172/2472-1654.100124
