End-of-Shift Report

Transforming care at the bedside to require that all information handoffs at change of shift be part of a standardized process across the healthcare community1 is almost a decade long Joint Commission national initiative which doesn’t appear to be fully implemented across the United States. The nationwide initiative was designed to improve hospital patient care and empower front-line nurses to implement innovative practices in their units and spend more time with patients. Adopting a standardized protocol to change-of-shift reporting that involves the patient in their care planning avoids communication errors and promotes patient safety. This has resulted in a new challenge for nursing staff to provide an efficient change-of-shift report that records essential information to promote patient safety, while including the patient in the care-planning process.2 Bedside handover allows patient to participate in communicating relevant and timely information for care planning.

Problem
The traditional change-of-shift process has repeatedly lacked structure and form. Insufficient hand-off reporting could result in the interruption of patient care and patient and family discontent. The traditional reporting tends towards treatment-focused data being communicated among caregivers instead of care plans that include psychological and social information regarding patient’s coping strategies. However understanding the patient perspective provides a foundation for caregivers to customize their bedside handovers to respect patients’ input and promote active participation in decision-making.3 Oral shift-to-shift handovers are often unreasonably lengthy, and frequently include extraneous and unrelated information that has no bearing on patient documentation. This could result in the increased cost of care and liability which could negatively impact patient safety, resource capacity and service efficiencies. The importance of bedside reporting cannot be underestimated since it helps build team cohesion, enhances shared values, and supports ritualistic functions. 4 Being well prepared at providing effective communication handoff at change of shift is critical.1-22

SEE ALSO: Call to Embrace Nursing Ethics

Purpose
The need for a standardized bedside change-of-shift reporting such as the SBAR (situation, background, assessment, recommendations) is a widely recognized research priority due to several high risks to quality and safety arising from the traditional shift-to-shift handover such as hospital to community transfer, inter-professional and inter-departmental risks, process risks and risks related to patient characteristics. Bedside change-of-shift reporting has been found to save money, improve patient and nurse satisfaction, and is a more comprehensive approach to change-of-shift reporting.5 It also gives the oncoming nurse the ability to incorporate early visual assessment of the patient and verify relevant change of shift details.

Outcome
The SBAR reporting model is a tool that hospitals can adopt to tailor a unit specific, standardized, change-of shift technique that would be beneficial to the nursing staff and ultimately their patients. 1-23 It encourages nurses to switch to bedside reporting, provides nurses with an opportunity to improve patient safety and increase patient collaboration in the plan of care, lowers nursing concerns related to inaccurate information since the report process includes actual patient visualization and increases accuracy and patient safety. Adoption of SBAR by hospitals will formalize the inputs and outcomes of the change-of-shift handover process. It has the advantage of creating trust within the healthcare team while improving accuracy and timeliness of handovers.

Implications
The implication of adopting the SBAR technique is that during bedside handover, patients can ask questions or contribute information to the discussion. This promotes patient involvement and improved satisfaction. It could be said that when patients have input into clinical communications, there is a reduced risk of miscommunication-related adverse events, fragmentation of care and a greater likelihood of continuity of care. Improved interactions among staff, patients, families and significant others as a result of the SBAR technique will encourage individualized care as well as promote patient’s active participation in the plan of care. This could result in improved transition during and post discharge. Bedside shift-to-shift reporting using SBAR can help foster the development of more accurate and concise communication modes among healthcare professionals which could result in highly cohesive and well-coordinated teams where everyone knows the plan of care.

Bedside handover provides an opportunity for patients to be involved as active participants in their care. They value having access to information on an ongoing basis, and although not all choose the same level of interaction, they see their role as important in maintaining accuracy, which promotes safe, high quality care.3-26 Significant improvement was observed in nurse perceptions of patient involvement in care based on comparisons nurses pre and post implementation of bedside nursing shift reporting.6

References
1 Capek J, Pascarella J, Tomlinson DW. Effective communication at change of shift: Standardize the process to increase report efficiency and patient safety. Nursing Critical Care. 2013:8(5):22-24.
2.Griffin T. Bringing change-of-shift report to the bedside: a patient- and family-centered approach. Journal of Perinatal and Neonatal Nursing. 2010;24(4):348-353.
3. McMurray A, Chaboyer W, Wallis M, Johnson J, Gehrke T. Patients’ perspectives of bedside
nursing handover. Collegian, 2011;18(1):19-26.
4. Nelson BA, Massey R. Implementing an electronic change-of shift report using transforming care at the bedside processes and methods. J Nurs Adm. 2010; 40(4):162-168.
5. Tidwell, JT, Edwards J, Snider E, et al. A nursing pilot study on bedside reporting to promote best practice and patient/family-centered care. Journal of Neuroscience Nursing. 2011:43(4):E1-E5.
6. Sherman J, Sand-Jecklin K, Johnson J. Investigating bedside report: a synthesis of theliterature. MedSurg Nursing. 2013;22:308-312.

Irene Obeng-Asiedu and Jeanne Percy-Rivera are currently studying for their Masters in Public Health at the University of Hartford.

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