Connecting the Dots: The Impact of Bedside Shift Report on Nurse Communication and Patient Satisfaction

The nursing shift change report is an essential component of nursing practice that allows for the exchange of relevant patient information from one professional to another (Sherman et al., 2013). Report is the transfer of responsibility, accountability and authority for a patient and their care from one nurse to another (Sherman et al., 2013). Various methods of shift change report have been utilized in the nursing profession, with benefits and disadvantages to each. Bedside Shift Report (BSR) is an evidence-based method that actively involves three individuals: the off-going nurse, the oncoming nurse, and most importantly, the patient. This method of shift change report is used to increase patient involvement in their care and improve patient satisfaction (Vines et al., 2014). The BSR process includes nurses providing shift-to-shift report at the patient's bedside, with the patient present, allowing the patient to be more involved in their care (Anderson et al., 2006). Family members may also be present for bedside report, which is an extraordinary advantage for an ICU patient who is unresponsive and inherently unable to participate in their own care (Sherman et al., 2013). BSR should always include an opportunity for the patient, or family member, to ask questions and receive clarification regarding care (Sherman et al., 2013). Many benefits to BSR have been shown, including increased staff satisfaction, improved communication, reduced incidence of falls, lower medication error rates, and the facilitation of teamwork and accountability (Vines et al., 2014). Research has identified positive nursing perceptions towards report occurring at the bedside, including enhanced respect for peers, collaboration, and prioritization (Anderson et al., 2006). However, one of the most important benefits to BSR is the positive impact on patient satisfaction (Radtke, 2013). BSR allows for the promotion of relationship building between staff members and patients, allowing the patient to feel more informed, knowledgeable, and respected (Anderson et al., 2006). Patients desire updates on their health status, and progress towards their goals, and BSR provides for these opportunities on a more frequent basis throughout the hospitalization (Anderson et al., 2006). Often, patients can feel excluded from important information related to their health, and left out of decisions throughout their hospitalization (Radtke, 2013). In order to fill this gap, the BSR method incorporates patient-centered care, and typically leads to higher levels of patient satisfaction (Anderson et al., 2006) and enhanced communication among the healthcare team (Vines et al., 2014). Overall, BSR helps to connect the dots.

THE IMPACT OF BEDSIDE SHIFT REPORT Connecting the Dots: The Impact of Bedside Shift Report on Nurse Communication and Patient Satisfaction Cassidy Kotobalavu BSN, RN, OCN University of Utah May 4, 2021 In partial fulfillment of a Master of Science degree College of Nursing Major: Nursing Specialty: Nursing Education 1 THE IMPACT OF BEDSIDE SHIFT REPORT 2 Introduction The nursing shift change report is an essential component of nursing practice that allows for the exchange of relevant patient information from one professional to another (Sherman et al., 2013). Report is the transfer of responsibility, accountability and authority for a patient and their care from one nurse to another (Sherman et al., 2013). Various methods of shift change report have been utilized in the nursing profession, with benefits and disadvantages to each. Bedside Shift Report (BSR) is an evidence-based method that actively involves three individuals: the off-going nurse, the oncoming nurse, and most importantly, the patient. This method of shift change report is used to increase patient involvement in their care and improve patient satisfaction (Vines et al., 2014). The BSR process includes nurses providing shift-to-shift report at the patient’s bedside, with the patient present, allowing the patient to be more involved in their care (Anderson et al., 2006). Family members may also be present for bedside report, which is an extraordinary advantage for an ICU patient who is unresponsive and inherently unable to participate in their own care (Sherman et al., 2013). BSR should always include an opportunity for the patient, or family member, to ask questions and receive clarification regarding care (Sherman et al., 2013). Many benefits to BSR have been shown, including increased staff satisfaction, improved communication, reduced incidence of falls, lower medication error rates, and the facilitation of teamwork and accountability (Vines et al., 2014). Research has identified positive nursing perceptions towards report occurring at the bedside, including enhanced respect for peers, collaboration, and prioritization (Anderson et al., 2006). However, one of the most important benefits to BSR is the positive impact on patient satisfaction (Radtke, 2013). THE IMPACT OF BEDSIDE SHIFT REPORT 3 BSR allows for the promotion of relationship building between staff members and patients, allowing the patient to feel more informed, knowledgeable, and respected (Anderson et al., 2006). Patients desire updates on their health status, and progress towards their goals, and BSR provides for these opportunities on a more frequent basis throughout the hospitalization (Anderson et al., 2006). Often, patients can feel excluded from important information related to their health, and left out of decisions throughout their hospitalization (Radtke, 2013). In order to fill this gap, the BSR method incorporates patient-centered care, and typically leads to higher levels of patient satisfaction (Anderson et al., 2006) and enhanced communication among the healthcare team (Vines et al., 2014). Overall, BSR helps to connect the dots. The degree of communication between nursing staff and patients can be assessed through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey, which is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care (CMS, 2020). This patient satisfaction survey asks discharged patients 29 different questions about their recent hospital visit related to critical aspects of the hospital experience, such as communication with nursing and physician teams, discharge information, and communication about medication (CMS, 2020). The HCAHPS Survey has three main goals: produce data about patients’ perspectives of care that allow for objective and meaningful comparisons of hospitals on topics that are important to consumers, public reporting of results creating incentives for quality improvement, and enhanced accountability in healthcare by increasing transparency (CMS, 2020). HCAHPS survey results can indicate how well a nursing staff is communicating with their patient population. The BSR method of shift-to-shift report was first implemented in a large academic medical center located in the Western United States in 2016. The scope of BSR includes both THE IMPACT OF BEDSIDE SHIFT REPORT 4 Registered Nurses (RNs) and Health Care Assistants (HCAs). HCAHPS scores in this health system have historically been high, but recent survey results show there is room for improvement in the area of communication among the healthcare team, and a specific decrease in effective communication between nursing staff and patients. Recent trends also show that nursing staff members on a specific inpatient acute care unit are not consistently utilizing the BSR method. This unit has seen a downward trend in BSR compliance on patient-reported BSR frequency analysis reports since FY19, with overall compliance decreasing from 46% in Q1 FY2019 to 29% in Q3 FY2021. The nursing staff on this acute care unit will be surveyed to assess for barriers in implementing and practicing the BSR method. Based on survey results, new and improved education will be developed around the BSR method, specifically addressing these perceived barriers. HCAHPS scores will be assessed for patient satisfaction levels before and after a period of BSR implementation and observation. Modifications will be made to the BSR process, as survey results and other feedback deem necessary. The aim of this project is to assess for barriers to the BSR method of shift-to-shift report, develop a comprehensive education plan to standardize the practice of BSR and increase compliance among the nursing staff, and assess the corresponding impact on patient satisfaction, as measured by HCAHPS scores. Methods This project used the Plan-Do-Study-Act (PDSA) cycle model for developing a plan to test change, carry out the test, observe and learn from the test, and modify the process as necessary. The setting of this project is in a large academic medical center in the western United States, consisting of 585 beds total. The specific unit that this project focused on is a 25-bed inpatient acute care unit with an oncology patient population, staffed by a total of 101 nursing THE IMPACT OF BEDSIDE SHIFT REPORT 5 staff members, including 65 RNs and 36 HCAs. The unit is adequately staffed, with strong leadership presence, including a Clinical Nurse Coordinator (CNC), Nursing Professional Development Practitioner (NPDP), and Nurse Manager. The overall healthcare system provides robust support for quality improvement initiatives, and highly values the quality of care provided to patients. Plan Initially, a needs assessment was performed to assess for barriers to implementing the BSR method of shift-to-shift report. An 8-question survey was developed and disseminated to all nursing staff on the unit, to gather data on their perceptions and past experiences related to the BSR method (see Appendix A). The survey was designed in collaboration with, and sponsored by, the Nursing Quality department. Based on survey results, a comprehensive education plan was developed, which not only educated the nursing staff on the standardized BSR method, but also specifically addressed potential barriers, and provided ideas for overcoming those barriers. Survey results were analyzed in collaboration with the Nursing Informatics department, and the unit leadership team was provided results to help inform future unit initiatives related to the BSR method. HCAHPS scores were also assessed, prior to BSR implementation, to identify baseline patient satisfaction levels. Do Clinical education was developed on the BSR method, and needs assessment survey results were incorporated, including barriers perceived and how to potentially overcome those barriers. The education was provided to staff in collaboration with the NPDP assigned to the unit. The education was designed as a PowerPoint presentation (with an additional virtual attendance option), and was sent out by email to staff who were not able to attend. Additional THE IMPACT OF BEDSIDE SHIFT REPORT 6 BSR Champions were identified on the unit, to provide supplemental support for night and weekend staff. The BSR Champion’s role was to advocate for the change, and ensure staff are understanding the purpose behind the new BSR process. Once education was provided, the BSR method of shift-to-shift report was implemented as a pilot on the unit with a set go-live date. Nursing leadership provided a strong presence on the unit during the initial go-live period, allowing for questions, concerns, and staff support. During each shift-to-shift report using the pilot BSR method, the oncoming nurse was to complete an audit form, which was designed in collaboration with the Nursing Quality team (see Appendix B). The audit form contained the 10 essential components of the BSR method, and asked the oncoming nurse to identify whether or not those components of BSR were covered during report by the off-going nurse. An additional open-ended question was included at the end, asking the oncoming nurse to identify any other concerns they might have about how the BSR method was utilized. An HCA-specific audit form would be implemented at a later date, with RN-specific audit results to inform the design. Study After the initial pilot period of BSR implementation, auditing, and observation, the change process was studied, using the following measures. BSR audit forms were analyzed by the unit nursing leadership team, and areas for improvement were identified, including a revised education plan that would address additional barriers acknowledged through the audit process. In order to obtain additional qualitative data, interviews were conducted with staff members to assess for perceived barriers and staff satisfaction. An overall measure of BSR compliance over the initial implementation period was reported to nursing leadership. Act THE IMPACT OF BEDSIDE SHIFT REPORT 7 Once the pilot intervention was studied, additional follow-up information was provided to all nursing staff through email, including lessons learned and tips for improvement. The preliminary BSR pilot intervention outcomes were reviewed with the unit leadership team, and potential modifications to the BSR process were discussed. Unit leaders made a commitment to see the BSR pilot through, and continue the project with a future official go-live date, once necessary modifications and adjustments were made in order to optimize the BSR process. Leaders also planned to compare pre- and post- pilot HCAHPS score, in order to evaluate patient satisfaction in response to the BSR method of shift change report. Once the official BSR go-live was implemented, nursing leadership would hold all staff accountable for completing BSR at each shift change opportunity, and would continually look at quarterly metrics provided by the Patient Experience team to ensure continued success. This project was quality improvement in nature, and not subject to IRB oversight. In addition, no conflicts of interest were identified. Results Description of Survey Respondents The needs assessment survey was sent out to staff through the Survey Monkey platform. Of the 101 total clinicians surveyed, 46 (46%) responded and were included in this analysis. A total of 55 clinicians surveyed did not respond. Survey respondents included 16 HCAs, 27 RNs, 1 CNC, 1 NPDP, and 1 Nurse Manager. For simplicity, the CNC, NPDP and Nurse Manager survey responses were included in the overall RN category, which gave 30 total RN responses. Description of Survey Results Needs assessment survey results were collected and analyzed, and key findings were summarized. First, quantitative data was measured and separated out between RN (n=30) and THE IMPACT OF BEDSIDE SHIFT REPORT 8 HCA (n=16) responses, to allow for more specific education to be given to each group (see Table 1). In total, only 20% (9/46) of total RN and HCA survey respondents reported performing BSR at the bedside “always.” In contrast, 70% (32/46) of total RN and HCA survey respondents believe all information during shift-to-shift report should be presented inside the patient room, versus outside the patient room. Only 35% (16/46) of total RN and HCA survey respondents agreed that BSR was being done effectively on the unit (by either responding “4- Agree” or “5Strongly Agree”). Next, qualitative data was evaluated and themed out by project participants. In regards to what was going well with the BSR process (survey question #2), staff mentioned increased staff accountability, more accurate patient assessments, finding errors or missing information, enhanced communication, improved patient safety, and more knowledge of the plan of care. In regards to what the current BSR process needed to improve in (survey question #3), staff mentioned less information being discussed at bedside, a more standardized process to follow, consistency, actively involving the patient in the discussion, and updating the patient whiteboard during BSR. Finally, barriers to BSR, as perceived by staff, were summarized (see Table 2). Barriers included the time requirement, staff compliance, lack of standardization, sensitive patient information, interruptions, and negative staff attitudes. Table 1 Quantitative results among survey respondents concerning Bedside Shift Report (BSR) Survey Question Question 4: How often do you perform BSR at the bedside? (slider scale) HCAs (n=16) RNs (n=30) 0% of the time (Never) – 0% (0//16) 25% of the time (Rarely) – 25% (4/16) 50% of the time (1/2 of the time) – 23% 0% of the time (Never) – 3% (1/27) 25% of the time (Rarely) – 23% (7/30) 50% of the time (1/2 of the time) – 20% 75% of the time (Usually) – 6% (1/16) 100% of the time (Always) – 19% (3/16) 75% of the time (Usually) – 33% (10/30) 100% of the time (Always) – 20% (6/30) (8/16) (6/30) THE IMPACT OF BEDSIDE SHIFT REPORT 9 Question 5: During the BSR process, should… (A) all information be presented inside the patient room? Or (B) should some information be presented outside the room? 81% (13/16) responded A 19% (3/16) responded B 63% (19/30) responded A 37% (11/30) responded B Question 7: Rate the following statement: “The way our unit is currently doing BSR is effective.” 6% (1/16) responded 1 38% (6/16) responded 2 19% (3/16) responded 3 25% (4/16) responded 4 13% (2/16) responded 5 7% (2/30) responded 1 20% (6/30) responded 2 40% (12/30) responded 3 23% (7/30) responded 4 10% (3/30) responded 5 Table 2 Qualitative themes that emerged in comments from clinicians in response to open-ended question concerning current BSR barriers (survey question #8) Theme 1 Description Sample feedback Theme 2 Description Sample feedback Theme 3 Description Sample feedback Theme 4 Time requirement The amount of time required to complete the BSR process • “The time commitment is so long. When doing BSR, the patient will request additional things, making the process last double the amount of time it should.” • “Often times during BSR, patients ask for or need things, which slow down the process.” • “BSR makes report take much longer, and it can be ridiculous.” • “The time required is too much when you just want to go home.” • “It tends to take longer, so if we’re in a hurry, we don’t do BSR.” Staff compliance Lack of compliance for the BSR process among nursing staff • “Staff participation is an issue. It is difficult to get the nurses to actually do report at the bedside.” • “Nurse willingness is my biggest barrier.” • “Nurses are too lazy to go into the rooms, and don’t want to comply.” • “Some nurses do not want to do BSR.” Lack of standardization No standard BSR process for all staff to follow during shift change report • “Inexperienced nurses can forget important information, and I wish we had a standard report sheet to follow.” • “Some staff want certain information passed along, but we don’t have a standard process in place, so they get frustrated.” • “Everyone does BSR differently, and that is hard. You never know what the other nurse wants.” Sensitive patient information THE IMPACT OF BEDSIDE SHIFT REPORT Description Sample feedback Theme 5 Description Sample feedback Theme 6 Description Sample feedback 10 Discussing sensitive patient information with the patient and/or family present can make the nursing staff uncomfortable. • “I don’t like talking about certain things during BSR, especially sensitive or private information.” • “I feel uncomfortable when I discuss certain things in front of the patient or their family, like prognosis or psych/social issues.” • “BSR can be tricky when you have certain things to tell the oncoming nurse, such as behavioral problems. I’d rather talk about those things outside the patient room.” Interruptions Interruptions from patients and/or family members during BSR • “When doing BSR, patients will interrupt and ask unrelated questions, or need to use the restroom. This gets me off track, and I forget what I was trying to say.” • “Distractions like call lights, codes, patient needs, nurses running late, too much small talk. These interruptions make it difficult.” • “Other staff come in to do vitals, doctors interrupt to round, or respiratory comes for breathing treatments. This interrupts BSR and makes it hard to finish on time.” Negative staff attitudes Staff feel negatively about BSR, and openly complain about the process • “There is a lot of resistance for BSR among staff.” • “I hear a lot of people openly complaining about having to do BSR. This rubs off on me, and others.” • “I think it’s a waste of time, and I wish we could do report outside the patient room like we used to for years.” Development and Dissemination of BSR Education A thorough education plan was developed, concerning the BSR process, by the project leaders and unit NPDP. A literature search was conducted to ensure the content was evidencebased. The education objectives included definitions of the BSR process, reasons for the change, staff benefits of BSR, patient benefits of BSR, perceived barriers to success, suggestions for overcoming barriers, measures of success, and clinical references. The BSR presentation was delivered to the nursing staff of the unit. Of the 101 nursing staff members, 32 attended in person, and 28 attended virtually through the online Zoom platform. 41 total clinicians did not attend. Based on class evaluation feedback gathered THE IMPACT OF BEDSIDE SHIFT REPORT 11 immediately after, initial feedback from staff was overwhelmingly positive. Staff members felt supported in this upcoming process change, appreciated the updated education regarding the importance and potential value of BSR, and were able to ask questions to leadership regarding the actual shift-to-shift process at the bedside. Overall, evaluations demonstrated strong support for the upcoming shift-to-shift expectations of BSR. Implementation of BSR Pilot and RN Audit Results The BSR method was implemented as a pilot on the unit, with a specific “go-live” date communicated to staff. An initial audit review was done on the first 7-days of implementation. Nursing leadership was able to be present for 71% (10/14) of the RN shift-to-shift timeframe opportunities during the initial 7-days of implementation. Overall, nursing staff stated they felt strong support for the BSR process change from the leadership team during the first week of the pilot phase. During the pilot, the integrated audit process allowed for an inside view into what was occurring during BSR, and the potential impact it had on patient care, communication levels, and satisfaction. Of the 14 designated RN BSR times during the initial 7-days of pilot implementation, (2 BSR opportunities/24-hour day), 12 RN BSR audits were completed by oncoming/off-going nursing staff (86%). BSR audit results were collected, analyzed and summarized (see Table 3). One patient room was analyzed per BSR audit form, totaling 12 BSR occurrences. A notable finding in this data was that incomplete tasks, near misses, or errors were identified in 58% of shift change opportunities, nodding to BSR’s potential positive impact on patient safety. Qualitative data for this audit question was further analyzed and themed (see Table 4). Key themes included medication administration, pump rate, and intravenous set-up. THE IMPACT OF BEDSIDE SHIFT REPORT 12 Based on overall audit results, areas for improvement include reviewing the correct components of BSR with the oncoming nurse, including nursing orders, the MAR, LDAs, I&Os, and the white board. Also, the 24-hour chart check was not always completed and reviewed during BSR, which should be done with the oncoming nurse. The unit leadership team discussed whether or not this should be a component of BSR moving forward, given the low number of staff members who reviewed it during the preliminary audit review. Table 3 Quantitative RN audit results concerning Bedside Shift Report (BSR) Audit Question RN responses (n=12) Was BSR completed in the room? 100% Yes (12/12) 0% No (0/12) Were nursing orders reviewed? 92% Yes (11/12) 8% No (1/12) Was the MAR reviewed? 100% Yes (12/12) 0% No (0/12) Were overdue tasks completed? 75% Yes (9/12) 25% No (3/12) 92% Yes (11/12) 8% No (1/12) Were LDAs reviewed? Were lab results reviewed? 100% Yes (12/12) 0% No (0/12) Were I&O’s reviewed? 83% Yes (10/12) 17% No (2/12) Were vital signs reviewed? 100% Yes (12/12) 0% No (0/12) Was the white board reviewed? 83% Yes (10/12) 17% No (2/12) Was a 24-hour chart check/treatment plan completed? 25% Yes (3/12) 75% No (9/12) Was anything identified during BSR that was not completed, a near miss, or an error? 58% Yes (7/12) 42% No (5/12) THE IMPACT OF BEDSIDE SHIFT REPORT 13 Table 4 Qualitative audit themes that emerged in comments from clinicians in response to open-ended question concerning BSR items identified as not completed, a near miss, or an error Theme 1 Description Sample feedback Theme 2 Description Sample feedback Theme 3 Description Sample feedback Medication administration Medications not given or overdue • “We found two medications that were overdue on the MAR, and were able to give them during BSR.” • “Looking back on the MAR, we saw a medication that was not given by the prior shift. I notified the provider and an additional dose was ordered.” • “There were a few PRN medications that had been given, but were not documented on, so we completed that during BSR.” Pump rate Alaris pumps running at the incorrect rate • “We realized the maintenance IV fluid had been running at the wrong rate, so we fixed that.” • “The PCA was double checked during BSR, and we realized the basal rate was incorrect, so that was adjusted.” • “The chemo flush bag was running too slow, so we increased the rate in order to finish the flush on time.” Intravenous set-up Intravenous pump tubing and/or fluid bags set-up incorrectly • “The Tacrolimus was set up without low-sorb tubing, so that was fixed. Otherwise, the Tacro levels would have been artificially high. Good catch!” • “The secondary infusion antibiotic was not hung higher than the primary bag, so it didn’t empty all the way. We were able to adjust the timing on the MAR, and infuse the antibiotic during BSR.” • “The NS was not y-sited into the chemotherapy line correctly. Line was moved, and NS restarted.” • “Curos caps were not found on each port for the primary line. Added them to each port during BSR.” Discussion Major Findings Key findings from the survey and audit results point to the concept of BSR positively impacting patient satisfaction and communication among the healthcare team (Vines et al., THE IMPACT OF BEDSIDE SHIFT REPORT 14 2014). While survey and audit tools focused on communication and satisfaction outcomes, preliminary data also endorsed the potential positive impact on patient safety, which is consistent with literature findings (Vines et al., 2014). HCAHPS survey trends and compliance data were confirmed, and it was found that a large number of staff on this unit were not performing BSR correctly by including all essential components in the shift change process at the bedside. Therefore, survey results were somewhat expected, but did reiterate the need for a robust BSR process during shift change, in order to connect the dots for patients, and allow them to feel more actively involved in their care. The education plan on BSR was successful, and gave a comprehensive overview of the process, benefits, potential barriers, and how to overcome those barriers. Initial feedback from staff was overwhelmingly positive, and evaluations demonstrated strong support for the BSR process change. Study Limitations A limitation of the study was the length of time needed for approval on survey distribution. The needs assessment survey was required to pass through the hospital Nursing Executive team, including the Chief Nursing Officer (CNO), for official approval before dissemination. Due to various system delays in this process, the survey took an unexpected long period of time to receive approval, which pushed the project timeline out much further than anticipated, and led to additional time limitations in other project components. In turn, these delays impacted the amount of time available to interpret survey and audit results, which were needed for further BSR implementation and stakeholder buy-in. Therefore, the project is still ongoing. THE IMPACT OF BEDSIDE SHIFT REPORT 15 An additional study limitation was the survey response rate of 46%. While this response rate was higher than expected, considering the delays that occurred with survey distribution and the short amount of time given for response, project leaders hope to see higher response rates with future surveys so the data is truly representative and accurate. Lessons Learned & Recommended Next Steps Next steps for this project include ongoing audits during the remainder of the pilot phase, to continually assess and study the process change. Time constraints for this project led to only a preliminary audit review, and a thorough assessment of the remainder of the pilot phase will be necessary in order to evaluate for effectiveness. However, the initial review showed promising preliminary results. A sufficient amount of information was revealed and learned during early analysis to conclude that the BSR process is worth investing in for a future process change. Feedback will continually be given to clinicians on the unit, based on pilot evaluations. Official pilot results will inform the finalized BSR process that is implemented on the unit, and any needed modifications. The Patient Experience team plans to analyze and compare pre- and post- pilot HCAHPS survey results in order to evaluate patient satisfaction and response to the BSR method of shiftto-shift report. These results will be transparently shared with nursing leadership to help inform future decisions related to the BSR process. Quarterly metrics, such as the HCAHPS scores, will continue to be measured by the Patient Experience team. Once the pilot completes, a newly revised education plan will be disseminated to staff that specifically addresses how the pilot intervention went, barriers that were seen upon evaluation, and how the BSR process will be modified to meet the needs of staff and patients. Through survey results and mini-interviews, it was learned that some staff will require positive THE IMPACT OF BEDSIDE SHIFT REPORT 16 reinforcement and empowerment, in order to combat the negative emotional contagion surrounding BSR on the unit. An official go-live date for BSR will be set, and adjustments to the BSR method will be implemented, as deemed necessary by pilot outcomes. As of the go-live date, nursing leadership will hold staff accountable for practicing the BSR method of shift-toshift report, moving forward, and perform routine audits on the process and documentation to assess for effectiveness. Conclusion Patients inherently want to be involved in their care, and feel valued when they are part of the conversation. This patient-centered style of care, known as Bedside Shift Report (BSR), allows for the patient to play an equal role in the shift change discussion, where important decisions are made, and updates are given. BSR leads to higher patient satisfaction, and overall, more efficient communication between the patient and their care providers (Anderson et al., 2006). The focus of this project was to evaluate for staff-perceived barriers to BSR, educate on how to potentially overcome them, and assess the impact of a BSR pilot on patient satisfaction and communication among the healthcare team. Limitations delayed the project timeline, but the project continues and further data will be collected and analyzed. In conclusion, it was learned through an initial review that the BSR process was an effective method of communicating with patients and connecting the dots for them. Staff felt that BSR was an efficient way to exchange patient-related information, while actively including the patient in the conversation and plan of care. Audit findings point to the positive impact of BSR on patient safety. Implications of this study could be translated beyond the setting of this project, and to any other patient care environment, where shift change report occurs. THE IMPACT OF BEDSIDE SHIFT REPORT 17 References Anderson, C. D. & Mangino, R. R. (2006). Nurse shift report: Who says you can’t talk in front of the patient? Nursing Administration Quarterly, 30(2), 112-122. Centers for Medicare & Medicaid Services (CMS). (2020). HCAHPS: Patients’ Perspectives of Care Survey. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/HospitalQualityInits/HospitalHCAHPS Radtke, K. (2013). Improving patient satisfaction with nursing communication using bedside shift report. Clinical Nurse Specialist, 27(1), 19-25. Sherman, J., Sand-Jecklin, K. & Johnson, J. (2013). Investigating bedside nursing report: A synthesis of the literature. Medsurg Nursing, 22(5), 308-318. Vines, M., Dupler, A., Van Son, C., & Guido, G. (2014). Improving client and nurse satisfaction through the utilization of bedside report. Journal for Nurses in Professional Development, 30(4), 166-173. THE IMPACT OF BEDSIDE SHIFT REPORT 18 Appendix A U Health Bedside Shift Report Feedback Survey In order to improve and optimize communication with our patients, we are gathering feedback from frontline staff on the Bedside Shift Report process. We appreciate your input! 1. What is your job title? (optional) RN HCA Clinical Nurse Coordinator (CNC) Nursing Professional Development Practitioner (NPDP) Nurse Manager 2. In regards to Bedside Shift Report, what is going well in your clinical area? ______________________________________________________________________________ 3. In regards to Bedside Shift Report, what do you think is missing? ______________________________________________________________________________ 4. How often do you perform bedside shift report at the bedside? (slider scale) 0% of the time ------------------------------ 50% of the time ------------------------------100% of the time 5. During the Bedside Shift Report process, should all information be presented inside the patient room? Or should some information be presented outside the patient room? A. All information should be presented inside the patient room B. Some information should be presented inside the patient room, and some information should be presented outside the patient room 6. If you answered “B” to the previous question, please describe which topics of information you think should be covered inside the room vs. outside the room. ______________________________________________________________________________________ 7. Rate the following statement: “The way our unit is currently doing Bedside Shift Report is effective.” 1 – Strongly Disagree 2 – Disagree 3 – Neutral 4 – Agree 5 – Strongly Agree 8. What are the barriers to consistently conducting Bedside Shift Report? ______________________________________________________________________________________ Thank you for your feedback on Bedside Shift Report! We appreciate your input. THE IMPACT OF BEDSIDE SHIFT REPORT 19 Appendix B RN Bedside Shift Report (BSR) Audit Form Off-going RN: _______________________________________________ Date: ____________________ Oncoming RN: _______________________________________________ Shift: D-12 / N-12 Patient Room # Patient Room # Patient Room # Patient Room # Patient Room # BSR completed in the patient room? Y□ N□ Y□ N□ Y□ N□ Y□ N□ Y□ N□ Nursing Orders reviewed? Y□ N□ Y□ N□ Y□ N□ Y□ N□ Y□ N□ MAR reviewed? (Including Due/Overdue medications) Y□ N□ Y□ N□ Y□ N□ Y□ N□ Y□ N□ Overdue Tasks completed? Y□ N□ Y□ N□ Y□ N□ Y□ N□ Y□ N□ LDAs reviewed? Y□ N□ Y□ N□ Y□ N□ Y□ N□ Y□ N□ Lab Results reviewed? Y□ N□ Y□ N□ Y□ N□ Y□ N□ Y□ N□ I & O’s reviewed? Y□ N□ Y□ N□ Y□ N□ Y□ N□ Y□ N□ Vital Signs reviewed? Y□ N□ Y□ N□ Y□ N□ Y□ N□ Y□ N□ White Board reviewed? Y□ N□ Y□ N□ Y□ N□ Y□ N□ Y□ N□ 24-hour Chart Check/Treatment Plan Y□ N□ Y□ N□ Y□ N□ Y□ N□ Y□ N□ (including worklist) (lines traced & MRN programed in pump) (Update: healthcare providers, upcoming plans, symptom management and goals) completed? Was anything identified during BSR that was not completed, a near miss or an error? Y □ N □ If yes, please explain: _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________