Bedside Shift Reporting in an Acute Hospital Setting

CAPSTONE PROJECT: BEDSIDE SHIFT REPORTING IN AN ACUTE HOSPITAL SETTING
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Capstone Project: Bedside Shift Reporting in an Acute Hospital Setting
Background
In the healthcare industry, the patients are the center of the practice. It can be said that the main and only goal of hospitals and healthcare organizations is to promote the overall well-being of a person. However, it can still be well-noted that even in organizations as critical as healthcare centers, mistakes can still be made because there are still human components to the industry. While technology has advanced well enough to make significant changes in nursing and medical processes, the main figures who take action are human nurses, practitioners, and other healthcare professionals. Needless to say, they are still capable of making mistakes for a myriad of reasons, no matter how people believe there is no room for mistakes when it comes to people's lives.
Shift reporting is an important process in nursing, especially during handoffs. In handoffs, off-going nurses turn over specific information and duties to nurses who will be starting their shifts. There are various traditional ways to do shift reporting, including written notes, recorded notes, and face-to-face with other nurses. This made for a good process until the technology became advanced and workloads have been increased. Now, there are multiple tools that nurses can make use of to store pertinent information, but there are still risks involved with any type of handoff. Bedside shift reporting is an alternative process where the handoff can be done bedside, with the presence of the patient and possibly their carers or their families. In this type of shift reporting, the information being passed on is not confined to the knowledge of the off-going and incoming nurses alone but also involves the patient. While bedside shift reporting is fairly new and has not yet been implemented in many hospitals for the time being, research has shown that the process was proposed as early as 1978 (Ofori-Atta et al., 2015).
Clinical Problem Statement
Bedside shift reporting is being gradually implemented in multiple healthcare institutions in the United States and globally. However, because of the differences in how different hospitals and units handle cases, there are different needs that need to be addressed for a successful transition to bedside shift reports. Furthermore, there are also disparities in terms of the standards of nursing care, especially when considering the global context (McAllen et al., 2018). Implementing bedside shift reports with standardized protocols assures that procedures are being followed religiously and that all pertinent information is transferred during handoffs. Successful implementation of bedside shift reports can improve patient safety and lower risks of complications and mistakes, as well as improve nurse performance and satisfaction. Because each patient and case are unique, the lack of standardized implementation practices contributes to an inconsistent and ineffectual bedside shift report. Hence, it is vital to ensure that there is consistency in the processes involved.
Purpose of the Change Proposal
The main purpose of the change proposal is to ensure that institutions implement bedside shift reports as a standard protocol during nursing handoffs. The higher rates of mistakes or medical errors made from miscommunications between caregivers and patients can be resolved by bedside shift reports because of the involvement of multiple parties that can validate the information being passed on (Mitchell et al., 2017). The general trend of outcomes from the implementation of the change proposal seems to be leaning toward favorable outcomes for patients and nurses, but there is still evidence of reluctance among those involved prior to implementation. With the help of nursing education and training and in utilizing the checklist selected for the implementation plan, the change proposal can be carried out or at least tested and retested prior to full implementation. The desired outcome is a better outcome for patients through increased engagement, transparency, and accountability.
PICOT Question
For adult patients in an acute care setting (P), does the implementation of bedside report during the patient transfer of care (I) for ten weeks (T) improve patient communication and patient safety (O) as compared to handoff report performed away from the bedside (C)?
Literature Search Strategy and Literature Evaluation
The literature search strategy employed involved finding reliable sources, including timely peer-reviewed journal articles related to the topic. The search made use of keywords such as “bedside shift reporting,” “bedside shift report acute hospital settings,” “bedside handoff,” and “AHRQ bedside shift report checklist.” From the results, appropriate and timely evidence-based research was selected based on the goal of the change proposal.
The articles chosen for the capstone project were carefully selected to support the proposed implementation plan and the rationale behind it. The author chose eight articles that pertain to practices made for the implementation of bedside shift reports in various types of hospitals, including acute care hospitals. The variations between the studies conducted in the literature acquired show the different perspectives one can take to understand the importance of the change proposal and how it can be conducted.
Of the eight articles, four provided evidence-based information on the benefits of implementing bedside shift reports on patient communication, safety, and nurse satisfaction (Mitchell et al., 2017; Bigani & Correia, 2018; Dorvil, 2018; McAllen et al., 2018). Two of the eight articles tackled gaps in the implementation of beside shift reports, as well as possible improvements for better outcomes (Grimshaw et al., 2020; Schrim et al., 2018). Finally, three articles covered the experiential aspect of bedside shift reports from both patient/family and nurse perspectives (Bressan et al., 2019; Schirm et al., 2018; Bigani & Correia, 2018). Most of the articles tackled first-hand evidence gathered by researchers on specific institutions, primarily in acute care units or hospitals mainly for acute care (Elgin & Poston, 2019; McAllen et al., 2018; Schirm et al., 2018; Bigani & Correia, 2018; Grimshaw et al., 2020).
Change/Nursing Theory
This capstone project entailed a concept of planned change. With this, the author utilized Rogers’ Five Phases of Planned Change (Rogers’ Change Theory). According to Rogers’ theory, the five phases are Awareness, Interest, Evaluation, Trial, and Adoption (Rogers, 2003, as cited in Mitchell, 2013). In this capstone project, the Awareness phase is exemplified by being aware of the weaknesses of current shift report practices, such as the increasing impracticality of manual, time-consuming methods, as well as the potential for bedside shift reports in improving processes and patient care quality. The Interest phase is selecting the proper course for the implementation and conceptualizing a plan. The Evaluation phase entailed the research and literature evaluation efforts to build a case for justifying and developing the implementation plan. The Trial phase is the implementation that will be conducted, and the Adoption phase is what will happen when there is a successful primary implementation that will gradually change to full implementation until the “change” becomes the “norm” in the long run.
Proposed Implementation Plan and Outcome Measures
The proposed implementation plan is to implement bedside shift reporting in acute care hospitals. Specifically, the proposed plan is to make use of a standardized guideline or standard operation protocols across all relevant departments for a period of ten days to ensure that the transition to bedside shift reporting can be done well and the potential benefits can be maximized. Bedside shift reporting procedures vary across institutions depending on the needs of the hospital or the unit/s. However, there are organizations that provide resources for any institutions that want to improve hospital quality and patient outcomes through patient engagement. The Agency for Healthcare Research and Quality (AHRQ) proposed four main strategies to facilitate this goal, and the nurse bedside shift report is the third strategy in the guide. Within the strategy,...