Strengths

Bridgeport hospital is one of the five hospitals apart of the Yale New Haven Health System (YNHHS). Through collaborative efforts, this hospital takes pride in providing high quality patient-centered care with other networks who share the same goal (Bridgeport Hospital, 2019). The value/emphasis placed on teamwork is the first strength that supports the implementation of mandatory bedside reporting. Bedside reporting allows patient’s and family members to become more involved in healthcare planning and decision-making, instead of feelings of neglect during change of shift (Rush, 2012). Being considered as apart of the team can decrease anxiety, and often, they can confirm or deny information that is relayed from nurse to nurse, which prevents errors caused by miscommunication. Another strength of the organization that supports the implementation of bedside reporting is that employees share the same goal of increasing patient satisfaction and improving the patient experience. In 2013, Reinback and Fitzsimmons studied the effects of bedside report on “nursing communication. Over a six-month period nurses were required to perform bedside report at all shift changes. Upon completion of the study, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) scored were obtained; the results reflected an eight percent increase in  “nursing communication”, compared to those obtained prior to the implementation of bedside nursing. In another study by Freitag and Carroll (2011), bedside reporting resulted in a 4.4% increase in “client satisfaction” and 5.5% increase in “patient participation in care.” Lastly, bedside reporting can also reduce healthcare spending, which is an important aspect of providing cost efficient care at Bridgeport Hospital. Hospital spending is reduced as a result of less medication errors, patient falls, and duplicate treatments due to information lost during shift change. Reducing the opportunity for side-tracked conversations during report, can also improve nurse overtime rates, which could potentially save the hospital thousands per year (Tidwell et al., 2011).

Weaknesses

Staffing is a common organizational flaw that reduces healthcare quality. Lack of adequate staffing can put patients at increased risk for harm, nurse burnout, and high staff turnover rates. Implementing bedside reporting is not only beneficial to patient/family satisfaction but nurse satisfaction as well. It can help build trust among staff, foster teamwork, collaboration and respect (Vines et al., 2014). Another organizational weakness that supports implementing bedside report is poor communication in the transition of care. Poor communication can cause an interruption in the continuity of care (Harrison, 2016).  Bridgeport Hospital’s Emergency Department patient flow is very different from any other hospital and can be quite intimidating. Immediately after patients are evaluated in triage, they are put through a “split flow” process, which means they are constantly moving from room to room throughout the ED. This constant moving can make patients feel very uneasy because they are never really settled into one room. Once they are transferred to EDO, providers are reassigned (which is another change), and they are temporary placed in a room for which they will stay overnight. Bedside report would be especially beneficial to these patients because, it gives them their first sense of control over their care since they presented to ED; it is the first chance that they have witnessing continuity in their care. Off-shift nurses can introduce the on-coming nurse, which makes patients feel comfortable knowing that they are in good hands.

Opportunities

Bridgeport hospital is an affiliation of YNHH and its’ systems; an obtainable goal relevant to bedside nursing would be collaboration with other members of the healthcare delivery network. Yale’s main campus requires that every nurse participates in bedside nursing; through collaboration, leaders from both hospitals can discuss what worked for/against them in their hospital to promote adherence with bedside nursing, and what improvement may be needed at Bridgeport Hospital. Another obtainable goal that is relevant to promoting bedside nursing is upgrading the healthcare informatics system or installing computer stations in each patient’s room. In reviewing the literature, the most common complaints among nurses regarding change of shift, were that report or the availabilities of workstation on wheels (WOW’s) were too time consuming (Campbell, Dontje & Lansing, 2019). Hospitals can use this opportunity to educate staff that using a standardized tool to implement bedside nursing can save time during report. In fact, the Agency for Healthcare Research and Quality (AHRQ) (2019) recommends that report should be less than five minutes per patient. Installing a WOW in each patient’s room, can encourage use of electronic health records during report; which allows nurses to quickly review medication orders, lab results, pump settings, and pending tests, which could decrease preventable errors.

Threats

Internal factors that could negatively affect the implementation of this performance improvement plan is resistance from staff. Some nurses are set in their old habits and are not readily accepting of change. Others may have misinformed opinions of bedside report, viewing it as a violation to patient’s Health Insurance Portability and Accountability (HIPAA) rights. Regardless of the misconceptions staff may have, “continuous staff education, feedback, and audits can help adherence to bedside nursing” (Campbell et al., 2019). This means that leadership, as well, must stay consistent with their efforts to create this practice change. External threats that negatively affect the implementation of bedside reporting includes local competition from other hospitals in the area; without a patient population bedside report would not be needed.

Healthcare

A healthcare initiative that exists in Bridgeport Hospital that is relevant to implementing mandatory bedside reporting is their culture of being a high reliability organization (HRO). This means, there is an expectation of 200% accountability among employees, which includes demonstrating “CHAMP behaviors- communication, effective hand-off, attention to detail, mentorship, and practicing a questioning attitude” (Bridgeport Hospital, 2015). The “National Patient Safety Goal” is an external healthcare initiative that could be brought into the hospital to address bedside nursing. This healthcare initiative, developed by the Joint Commission, requires and emphasizes the importance of hand-off information between the off-shift/on-coming nurse, patient and caregiver (2017). It serves as a guide for reporting health information that should be communicated during the transition of care.

Summarize

The current evidence-based literature that exists stresses the importance of bedside nursing. Overall, bedside nursing can improve patient/family/staff satisfaction, patient safety, quality of care provided, and is financially beneficial. Among staff, bedside nursing facilitates teamwork, collaboration, and allows everyone to assume more accountability over their patients. Patients and family member feel included in healthcare decision making and more in control of their care. During this time of report, nurses can visualize their patient’s and intervene early if a problem is observed. As a result, less sentinel events can help save hospitals money.

Strategies

Education was the most common strategy that was presented in each peer-reviewed literature that addressed bedside nursing. One study used video recordings and PowerPoints, while another study used in-services and simulation. Staff involvement in developing a bedside report narrative was also an effective strategy that was used. If employees feel that their opinions are incorporated into changes, they are more likely to be accepting of new policies. Lastly, daily audits and supervision by managers during shift change and other members of leadership was another method that was used to implement bedside nursing. Leaders have to be fully invested in implementing change, if they expect their staff members to do the same, if not, staff may regress back to what was comfortable for them.

Discuss

The “Guide to Patient and Family Engagement in Hospital Quality and Safety” is an initiative that help hospitals develop relationships between patient and family members, in efforts to provide higher quality of care and patient safety (AHQR, 2019). This document serves as a guide; explaining the importance of bedside report, how it should be performed and strategies of how it can be implemented. Another healthcare initiative that is relevant to bedside reporting is the “High Five Project” developed by the World Health Organization (WHO) in 2006. This international initiative targets the top five patient safety events worldwide; with miscommunication during handoff being number four (WHO, 2013). Gaps in communication, can cause harm to patient safety and, potentially, be the deciding factor between a life and death situation. Nurses play a critical role in maintaining patient safety and preventing harm, especially during high-alert times, such as change of shift.  Bedside shift report is an important mandatory practice that should be second nature to every nurse’s routine.

References

• Agency for Healthcare Research and Quality. 2019. Nurse bedside shift report: Implementation handbook. retrieved from https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy3/Strat3_Implement_Hndbook_508.pdf
• Bridgeport Hospital. (2015). HRO training video focuses on using CHAMP behaviors in practice. Retrieved from
  
  https://www.bridgeporthospital.org/publications/medical-staff-news/january-2015/hro.aspx
  
• Bridgeport Hospital. (2019). Vision, mission, and values. Retrieved from
  
  https://www.bridgeporthospital.org/about/hospital-overview/mission-vision-and-values.aspx
  
• Campbell, D., & Dontje, K. (2019). Implementing Bedside Handoff in the Emergency Department: A Practice Improvement Project. Journal of Emergency Nursing, (2). https://doi-org.ezproxy.snhu.edu/10.1016/j.jen.2018.09.007
• Freitag, M., & Carroll, V. (2011). Handoff communication: Using failure modes and effects analysis to improve the transition in care process. Quality Management in Health Care, 20(2), 103
• Harrison, J. P. (2016). Essentials of Strategic Planning in Healthcare (Vol. Second edition). Chicago, Illinois: Health Administration Press. Retrieved from https://search-ebscohost-com.ezproxy.snhu.edu/login.aspx?direct=true&db=nlebk&AN=1843079&site=eds-live&scope=site
• Reinbeck, D., & Fitzsimons, V. (2013). Improving the client experience through bedside shift report. Nursing Management, 44 (2), 16

• Tidwell, T., Edwards, J., Snider, E., Lindsey, C., Reed, A., Scroggins, I., … Brigance, J. (2011). A nursing pilot study on bedside reporting to promote best practice and patient/family-centered care. Journal of Neuroscience Nursing, 43(4), E1–E5. https://doi-org.ezproxy.snhu.edu/10.1097/JNN.0b013e3182212a1d
• Vines, M. M. , Dupler, A. E. , Van Son, C. R. & Guido, G. W. (2014). Improving Client and Nurse Satisfaction Through the Utilization of Bedside Report. Journal for Nurses in Professional Development, 30(4), 166–173. doi: 10.1097/NND.0000000000000057.
• World Health Organization. 2013. The high 5’s project interim report. https://www.who.int/patientsafety/implementation/solutions/high5s/ps_high5s_project_overview_fs_2010_en.pdf